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ophthalmology. Acanthamoeba infections are increasing in Italy, more than one a day

The pathogen is responsible for very serious and frequent keratitis in contact lens wearers, who risk serious damage to the cornea while bathing in the sea or swimming pool. Up to 50% of cases of acanthamoeba keratitis do not heal with medical treatments and do not respond to antitoxins. Warning from Sisu

June 30

When swimming in the sea or in the pool, it is best to remove contact lenses before diving.

This is what ophthalmologists recommend during the 20th congress International Society of Cornea, Stem Cell and Eye Sciences (Sicsso .)), stressing that the water of swimming pools, sea, rivers, lakes and even shower water can be contaminated with pathogens capable of causing even serious infections. The most feared is Acanthamoeba, a parasite that spreads widely especially in water.

In Italy, it is estimated to be responsible for more than 400 keratitis annually, and it is constantly increasing due to the greater aggressiveness of pathogens and the increasing use of contact lenses. Unfortunately, 12 to 50% of cases of spina bifida do not respond to medical treatments and involve the need for a corneal transplant, which is not always conclusive and fails in more than half of cases, especially because the operation is delayed.

However, hope comes from anterior lamellar keratoplasty, or DALK, in which a full-thickness cornea is not transplanted: the results of this technique applied to Acanthamoeba keratitis, presented at the conference and obtained in our country, are satisfactory and guarantee success in 90 % of patients if the intervention is performed early in cases of more severe infection. However, prevention remains the best weapon, following the rules of hygiene in the use of contact lenses and remembering to remove them every time you shower.

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“There are 4 million Italians who wear contact lenses and in more than half of the cases they are very young or very young people under the age of 30. Moreover, the use of contact lenses is increasing in the summer, to experience the summer with more freedom – he explains Vincenzo Sarnicola, head sexo And a member of the board of directors Italian Society of Ophthalmology (Siso), which provided the latest data on Acanthamoeba keratitis in our country – contact lenses are a formidable tool for correcting vision defects, but if some basic precautions are not followed, there is a risk of serious complications. ”

Unfortunately, lenses, especially softer and more porous ones, warns the expert, favor the adhesion of microorganisms that are not always eliminated by preservation fluids, since there are no such strong antiseptics. “The probability of dangerous germs remaining on the lenses is even higher, if they are stored in a simple saline solution – he said – added to this the bad habit of bathing in the sea or in the pool or even showering with contact lens material: pathogens may be present in the water which It then causes, on contact with the eye, infectious keratitis.One of the most dangerous is Acanthamoeba, a parasite that is spread almost everywhere and is very dangerous if it reaches the cornea: every summer we witness a gradual increase in access to emergency rooms for keratitis caused by this parasite, Especially at sea or in a pool due to its greater aggressiveness and the increasingly widespread use of contact lenses.”

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In critical conditions for its survival, the chokempa cuts itself off and is thus able to resist everything, even antiseptics; If the parasite infects the cornea, symptoms are initially mild, such as slight discomfort in the light, slightly blurred vision, foreign body sensation and development is slow compared to bacterial keratitis. This often leads to a delay in diagnosis and specific treatment, so the parasite has the potential to infect the cornea deeply with corneal nerves involved, causing severe injuries and pain.

“In Italy, it is estimated that there is more than one case per day: there are more than 400 patients a year and they are on the increase – Sarnicola continues – Unfortunately, specific medical treatments cannot always eliminate infections that do not respond to anti-inflammatories, they are also difficult to find in Italian pharmacies.So the unextracted microorganism has time to penetrate and damage the cornea to such an extent that it requires a transplant in 12-50% of cases, which is also not always decisive.Classic full-thickness corneal transplantation fails in more than half of cases and in 40% of patients, Glaucoma, an ocular disease associated with increased intraocular pressure and later onset of blindness, develops; rejection is frequent and in some cases, unfortunately, it is even necessary to surround the eye. But only the middle class. The results presented show that early intervention in severely affected patients leads to transplant success in 90% of cases compared to 44% of later interventions, more than 5 and a half months after infection.”

However, the best treatment is prevention, Sarnicola recommends: “Unfortunately, contact lens wearers are rarely told to remove the devices when showering, but rather a simple rule of thumb that can really make a difference, avoiding keratitis that can have serious consequences.” “.

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Tips for using contact lenses and avoiding infections

remove contact lenses before swimming in the sea or pool;

Wash your hands before touching them and dry them carefully;

Prefer disposable contact lenses that reduce the risk of Acanthamoeba infection;

Clean containers before putting them away and replace them regularly: they can be both a container and a vehicle for transferring germs;

Do not use running water to rinse and store lenses.

30 June 2022
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