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[Bilateral acanthamoeba keratitis]

F G Holz1, R O Burk, H E Völcker

  • 1Universitäts-Augenklinik Heidelberg.

Klinische Monatsblatter Fur Augenheilkunde
|December 1, 1993
PubMed
Summary

Acanthamoeba keratitis is a challenging infection, often missed by initial diagnostic tests. Even with prompt treatment, medical therapy may fail, necessitating corneal transplants for vision preservation.

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Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Microbiology

Background:

  • Acanthamoeba keratitis presents diagnostic and treatment challenges due to its increasing incidence and protracted course.
  • This case highlights the difficulties in diagnosing and managing severe Acanthamoeba keratitis, particularly in contact lens wearers.

Observation:

  • A contact lens wearer developed bilateral keratouveitis with corneal ring ulcers, initially showing negative Acanthamoeba cultures from corneal scrapings.
  • Despite extensive medical and surgical interventions, including penetrating keratoplasty, the infection progressed in one eye.

Findings:

  • Histopathology of corneal buttons confirmed Acanthamoeba cysts, revealing diagnostic limitations of initial cultures.
  • Bacterial co-infection with Klebsiella oxytoca and Serratia marcescens was identified in the contact lens container.
  • While one corneal graft remained clear, the other eye experienced recurrence, secondary glaucoma, and optic atrophy.

Implications:

  • This case underscores the importance of considering Acanthamoeba keratitis even with negative initial cultures and disproportionate symptoms.
  • Diagnostic procedures, including corneal scrapings, may fail to detect Acanthamoeba, necessitating histopathological examination of corneal buttons.
  • Treatment failure can occur despite early antiparasitic therapy, emphasizing the need for vigilant monitoring and potential surgical intervention.

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