Successful management of recurrent Acanthamoeba keratitis using topical and systemic miltefosine

Purpose Acanthamoebae are ubiquitous free‐living amoebae. As facultative pathogens, they are the causative agents of Acanthamoeba keratitis (AK), a sight‐threatening ocular surface infection. AK can have a favorable prognosis when diagnosed and treated early in the disease course but available treatment options can remain ineffective even when started early. Methods Case presentation Results AK can have a favorable prognosis when diagnosed and treated early in the disease course but available treatment options can remain ineffective even when started early. We present a case of AK that was successfully treated with topical and systemic miltefosine after showing sight‐threatening recurrences under recommended therapy including a combination of propamidine 0.1%, miconazole nitrate 1%, neomycin, diamide and cationic antiseptics over a 12 months period. Conclusion In previous studies, miltefosine (hexadecylphosphocholine), an alkylphosphocholine, approved for the oral and topical treatment of leishmaniasis, proved to be highly active against Acanthamoeba in vitro [Walochnik et al. 2002]. This has been confirmed by several other studies [e.g. Schuster et al. 2006, McBride et al. 2007, Walochnik et al. 2009, Polat et al.2012].