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However, a significant proportion of patients still require surgical treatment. The purpose of this study was to identify clinical predictors for the need of therapeutic keratoplasty (TK) in patients with AK.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a single-center, retrospective longitudinal study including 51 eyes from 46 patients with AK diagnosed by real-time polymerase chain reaction between March 2010 and October 2022. The primary outcome was the need for TK. Eyes were divided into two groups (TK\n                      <jats:italic>versus<\/jats:italic>\n                      non-TK) and compared regarding demographic features, initial clinical presentation, and anti-\n                      <jats:italic>Acanthamoeba<\/jats:italic>\n                      treatment. Univariable and multivariable analyses were performed using generalized estimating equations (GEE) logistic regression to account for within-patient correlation (two eyes from the same subject).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty-one eyes of 46 patients (71.7% female; mean age 35.3\u2009\u00b1\u200913.9 years) were included, with a mean follow-up of 39\u2009\u00b1\u200930.2 months. All cases were associated with contact lens wear. The median time from symptom onset to diagnosis was 22 days. Fifteen eyes (29.4%) required TK. In univariable GEE analysis, older age at diagnosis (OR 1.09; 95% CI 1.03\u20131.16;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005) and longer symptom duration (OR 1.03; 95% CI 1.01\u20131.05;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011) were associated with TK. Presenting BCVA was significantly worse in eyes requiring TK than in non-TK eyes in the full cohort, but could not be reliably estimated in GEE regression because of quasi-complete separation. In the multivariable GEE model, older age at diagnosis (OR 1.09; 95% CI 1.02\u20131.17;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015) and longer symptom duration (OR 1.03; 95% CI 1.003\u20131.05;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028) remained independent predictors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this cohort of PCR-confirmed AK, nearly one-third of eyes required TK. Older age at diagnosis and longer symptom duration were independently associated with TK, while worse presenting BCVA likely remained a clinically relevant marker of disease severity. These findings highlight the importance of early diagnosis, prompt treatment, and close monitoring of high-risk patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00417-026-07321-1","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T03:37:27Z","timestamp":1781581047000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prognostic factors for therapeutic keratoplasty in Acanthamoeba keratitis: a retrospective study"],"prefix":"10.1007","author":[{"given":"Pedro","family":"Marques-Couto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Margarida","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Gama e Castro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra Campos","family":"da Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"Cunha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Neves","family":"Cardoso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiago","family":"Monteiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u00eds","family":"Torr\u00e3o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Am\u00e2ndio","family":"Rocha-Sousa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Pinheiro-Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"Vilares-Morgado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"7321_CR1","doi-asserted-by":"publisher","first-page":"473","DOI":"10.4103\/ijo.Ijo_2627_23","volume":"72","author":"A Raghavan","year":"2024","unstructured":"Raghavan A, Rammohan R (2024) Acanthamoeba keratitis - A review. 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