Perspectives on the Incidence of Acanthamoeba Keratitis: A Systematic Review and Meta-Analysis

Francesco Aiello; Gabriele Gallo Afflitto; Francesca Ceccarelli; Maria Vittoria Turco; Yuyi Han; Guillermo Amescua; John K Dart; Carlo Nucci

doi:10.1016/j.ophtha.2024.08.003

Perspectives on the Incidence of Acanthamoeba Keratitis: A Systematic Review and Meta-Analysis

Ophthalmology. 2024 Aug 9:S0161-6420(24)00462-7. doi: 10.1016/j.ophtha.2024.08.003. Online ahead of print.

Authors

Francesco Aiello¹, Gabriele Gallo Afflitto², Francesca Ceccarelli¹, Maria Vittoria Turco¹, Yuyi Han³, Guillermo Amescua⁴, John K Dart⁵, Carlo Nucci¹

Affiliations

¹ Ophthalmology Unit, Department of Experimental Medicine, Università di Roma "Tor Vergata," Rome, Italy.
² Ophthalmology Unit, Department of Experimental Medicine, Università di Roma "Tor Vergata," Rome, Italy; Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. Electronic address: gabrielegalloafflitto@gmail.com.
³ Department of Ophthalmology, Affiliated Hospital of Jiangnan University, Wuxi, China.
⁴ Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
⁵ Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research (NIHR) Moorfields Biomedical Research Centre, London, United Kingdom.

PMID: 39127408
DOI: 10.1016/j.ophtha.2024.08.003

Abstract

Topic: To provide an overview on the incidence of Acanthamoeba keratitis (AK).

Clinical relevance: Although being a sight-threatening cause of infectious keratitis, a comprehensive assessment of the incidence of AK is lacking.

Methods: Incidence of AK was computed as the number of eyes with AK per health care center, per year (annualized center incidence [ACI]). Two meta-analytical ratios also were calculated: (1) the ratio of eyes with AK to the count of eyes with nonviral microbial keratitis (MK) and (2) the ratio of eyes with AK to the overall population (i.e., the total number of people in a nation or region, as indicated by the authors in each study). Center was defined as the health care facility where the study took place. Actual and projected estimates of the number of eyes with AK in years were calculated multiplying the ratio of eyes with AK to the total population and the corresponding population estimates, sourced from the United Nations Population Prospects.

Results: Overall, 105 articles were included, published between 1987 and 2022. The total number of eyes identified was 91 951, with 5660 eyes affected by AK and 86 291 eyes affected by nonviral MK. The median ACI was 1.9 eyes with AK per health care center per year (95% confidence interval [CI], 1.5-2.6 eyes), with no statistically significant differences among continents. The ratio of eyes with AK to the total number of eyes with MK was 1.52% (95% CI, 1.03%-2.22%), whereas the ratio of eyes with AK in relationship to the entire population was estimated at 2.34 eyes per 1 000 000 people (95% CI, 0.98-5.55 per 1 000 000 people). The projected increase in the numbers of eyes with AK indicated an increase of 18.5% (n = 15 355 eyes with AK) in 2053 and 25.5% (n = 16 253 eyes with AK) in 2073, compared with the baseline of 2023 (n = 12 953 eyes with AK).

Discussion: Acanthamoeba keratitis emerged as a relatively low-incident disorder, and no significant differences in terms of its incidence were found among different continents.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Acanthamoeba; Acanthamoeba keratitis; Keratitis; Meta-analysis; Parasitic eye infections.

Publication types

Review