Resolution of <i>Acanthamoeba</i> Keratitis with Adjunctive Use of Oral Miltefosine

Abstract

<i>Purpose</i>: To report a series of cases demonstrating the resolution of <i>Acanthamoeb</i>a keratitis (AK) with adjunctive use of oral miltefosine.<i>Methods</i>: Retrospective case series.<i>Results</i>: The first case was a 27-year-old female who presented with severe pain and photophobia. The diagnosis of AK was made with confocal microscopy, which revealed a significant burden of stromal cysts. After approximately 2 weeks of adjunctive oral miltefosine therapy, there was a severe inflammatory response within the cornea followed by quick resolution of the AK. The second case was a 31-year-old male in whom the diagnosis of AK was confirmed by culture and polymerase chain reaction. Adjunctive oral miltefosine was started 3 months after presentation, leading to a quick resolution.<i>Conclusions</i>: Oral miltefosine may have cysticidal properties and should be considered as adjunctive therapy for the treatment of AK, particularly in cases with a significant burden of cysts or in cases recalcitrant to other treatments.