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Acanthamoeba keratitis: report of three cases
Abstract:
During the last year we diagnosed three patients to have Acanthamoeba keratitis. In one patient, who wore soft contact lenses, keratitis had developed after swimming in a contaminated heated swimming pool. Neither a history of trauma was present in two other patients nor did they wear contact lenses. Diagnosis of Acanthamoeba was established by Calcofluor White (cellufluor) staining of the scraped corneal material. Patients were treated with Flagyl (metronidazole) 0.5% eyedrops, Brolene (propamidine isethionate) 0.1% eyedrops, Neomycin eyedrops, topical corticosteroids (including sustain-release corticosteroid subconjunctival injections) and mydriatics. Keratitis in one patient healed within one month with full visual recovery, whereas the disease nearly ameliorated in the second patient. Corneal inflammation subsided markedly in the third patient with medical therapy, but a keratoplasty had to be performed because of a central opaque and ectatic cornea. This patient had already developed severe keratitis with necrosis of the cornea at the time of diagnosis.
Insights
Acanthamoeba keratitis can affect contact lens wearers and non-wearers, sometimes linked to swimming. Early diagnosis and varied treatments are crucial for visual recovery, though some cases may require corneal transplantation.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Acanthamoeba keratitis (AK) is a severe microbial infection of the cornea.
- Risk factors include contact lens wear and exposure to contaminated water.
- This study reports on three cases of AK with varied presentations and outcomes.
Observation:
- One patient developed AK after swimming in a contaminated pool while wearing soft contact lenses.
- Two patients had no history of trauma or contact lens wear.
- Diagnosis was confirmed using Calcofluor White staining of corneal scrapings.
Findings:
- Treatment involved a combination of antimicrobial eyedrops (metronidazole, propamidine isethionate, neomycin), topical corticosteroids, and mydriatics.
- One patient achieved full visual recovery within a month.
- Another patient showed near-complete amelioration, while the third, presenting with severe necrotic keratitis, required keratoplasty due to central opacity and ectasia.
Implications:
- Acanthamoeba keratitis presents diverse clinical scenarios, impacting both contact lens users and non-users.
- Prompt diagnosis via specific staining methods is vital for effective management.
- While medical therapy can be successful, advanced cases may necessitate surgical intervention like corneal transplantation for visual rehabilitation.