Demographic Characteristics, Contributing Risk Factors, and Prognosis of Acanthamoeba Keratitis in Eastern China: An in vivo Confocal Microscopy-Based Fifteen-Year Study

Chuwei Lu,1,* Jiajia Wang,1,* Jiaxu Hong,1– 4 Jianjiang Xu,1,2 Xujiao Zhou,1– 3 Lijia Tian,1 Qihua Le1,2 1Department of Ophthalmology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People’s Republic of China; 2NHC Key Laboratory of Myopia and Related Eye Diseases, Shanghai, People’s Republic of China; 3Shanghai Key Laboratory of Rare Disease Gene Editing and Cell Therapy; Shanghai Engineering Research Center of Synthetic Immunology, Shanghai, People’s Republic of China; 4Department of Ophthalmology, Children’s Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qihua Le, Department of Ophthalmology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People’s Republic of China, Fax +86 21-64377134 ext 2672, Email [email protected] Lijia Tian, Department of Ophthalmology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People’s Republic of China, Fax +86 21-64377134 ext 2378, Email [email protected]: To investigate the demographic characteristics, contributing risk factors, and prognostic outcomes of Acanthamoeba keratitis (AK) in Eastern China in the recent 15 years using in vivo confocal microscopy (IVCM).Patients and Methods: This single-center, retrospective study included 145 patients (147 eyes) diagnosed with AK based on IVCM findings at the Eye & ENT Hospital of Fudan University from April 2009 to September 2024. Demographic information, clinical features at presentation, contributing risk factors (if identified), treatment strategies, and final visual outcomes were retrieved in the medical records and analyzed using descriptive statistics.Results: The median age of patients was 51 years old, with 98.6% of infections being unilateral. Corneal trauma (62.1%) was the leading risk factor overall, whereas contact lens wear was the independent risk factor among children and adolescents. The most common clinical features at presentation were stromal infiltrate (60.6%) and deep stromal ulcers (36.5%). Anti-AK therapy was mainly composed of polyhexamethylene biguanide (PHMB), chlorhexidine, propamidine isethionate (Brolene) and metronidazole. Surgical interventions were required in 24 eyes, with evisceration/enucleation identified as an independent predictor of poor visual prognosis.Conclusion: This study provides valuable epidemiological insights into AK in Eastern China, underscoring the need for improved prevention, early diagnosis, and evidence-based treatment protocols to guide clinical management.Keywords: Acanthamoeba keratitis, in vivo confocal microscopy, demographic characteristics, contributing risk factors, prognosis