Visual outcome and rehabilitation in a case of bilateral acanthamoeba sclerokeratitis

To report a rare and complicated case of bilateral Acanthamoeba sclerokeratitis (ASK).

Case report of a 42-year-old patient who was referred to the Massachusetts Eye and Ear Infirmary 7 months after a history of culture-confirmed bilateral Acanthamoeba polyphaga sclerokeratitis. At the time of referral to the MEEI, he was noted to have iris neovascularization and chronic mydriasis in both eyes. The anterior chambers were shallow, and there were mature cortical cataracts that obscured the posterior pole in both eyes. His visual acuity in both eyes was limited to hand motions.

The patient underwent sequential cataract extraction, penetrating keratoplasty (PK), and yttrium-argon-garnet laser capsulotomy of the right eye over a span of 3 months. This treatment substantially improved the vision in his right eye to 20/400. Cataract extraction surgery and a PK have been scheduled for this patient's left eye in the near future.

Some patients with ASK and apparently poor visual prognosis can achieve substantial visual improvement after anterior-segment surgery. This report describes the management and outcome of only the second reported case of bilateral ASK in the world.