Dysregulated Intraocular Pressure in Acanthamoeba Keratitis: Clinical Associations, Therapy, and Prognosis

This retrospective multicenter cohort study investigated the incidence, treatment, and prognostic impact of dysregulated intraocular pressure (DIOP; >24 mmHg requiring therapy) in patients with acanthamoeba keratitis (AK). Eighty-one eyes from 81 patients with confirmed AK were included; co-infections were excluded. DIOP and best corrected visual acuity (BCVA) were assessed at baseline, follow-up, and after penetrating keratoplasty (PKP). Overall, 28% of eyes were managed conservatively, 46% required one PKP, and 26% required two. DIOP occurred in 4% before AK, 11% after AK onset, and 10% after the first PKP. Eyes with DIOP prior to PKP had significantly worse final BCVA compared to those without DIOP (0.5 ± 0.7 vs. 1.8 ± 1.1 logMAR, p < 0.001) and required PKP more frequently (100% vs. 67%, p = 0.01). Time to correct diagnosis was significantly longer in the AK-associated DIOP group (64 ± 50 vs. 50 ± 68 days, p = 0.03). DIOP was also associated with higher rates of prior cortisone use and complications, including fixed dilated pupil, cataract, anterior synechiae, and anterior chamber irritation. Overall, DIOP represents a major complication in AK and is linked to poorer visual outcomes. Earlier therapy may help reduce DIOP and hence improve prognosis.