Bilateral acanthamoeba keratitis following photorefractive keratectomy: a rare, severe complication

This is a rare case report of bilateral Acanthamoeba keratitis following photorefractive keratectomy (PRK), as confirmed by histopathology and confocal microscopy. Preoperative counseling and early suspicion can prevent disastrous outcomes.

PRK with mitomycin C was performed in both eyes. After the procedure, the patient was treated with moxifloxacin-dexamethasone eye drops, lubricating eye drops, and therapeutic contact lenses. Follow-up care was provided as necessary. The patient presented with persistent pain and signs of infection postoperatively. This work has been reported in line with the SCARE criteria.

A corneal scraping culture revealed Acanthamoeba in both eyes. Cysts were found at confocal microscopy. Topical drugs improved the pain after 4 months of treatment. Twelve months post-surgery, the patient is pain-free. Visual acuity was 0.2 in the right eye and 1.0 in the left eye.

Cold water from the tap had been splashed directly into the patient's eyes in the first days following the procedure, which may have caused the infection. Preoperative counseling regarding contact with water is crucial in preventing this serious complication.