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10 - 14 Sept. 2016, Bella Center, Copenhagen, Denmark

This Meeting has been awarded 27 CME credits

 

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Rapid response of Acanthamoeba keratitis but torpid evolution due to superinfection

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Session Details

Session Title: Presented Poster Session: Endophthalmitis/Ocular Infections

Session Date/Time: Monday 12/09/2016 | 15:00-16:30

Paper Time: 16:20

Venue: Poster Village: Pod 3

First Author: : P.Puy SPAIN

Co Author(s): :    J. San Roman   M. Gabarron   E. Corredera        

Abstract Details

Purpose:

To describe the rapid response to topical treatment with chlorhexidine 0,04% eye drops combined with propamidine 0.1% and oral Voriconazol in a patient with severe Acanthamoeba keratitis, and the torpid evolution due to a neurotrophic superinfected ulcer.

Setting:

Acanthamoeba keratitis is a sight threatening infection of the cornea which should be early diagnosed and treated to obtain a good anatomical and visual outcome. Close monitorization is necessary to treat frequent complications as neurotrophic ulcers and superinfection.

Methods:

We show the case of a contact lens user, who after ten days of treatment with artificial tears and three with fluorometholone eye drops is clinically diagnosed of Acanthamoeba keratitis. The pathognomonic clinical picture of corneal peripheral nerve infiltrates associated with intense photophobia and pain, discrete epiteliopathy with scarce fluorescein staining is shown with photographs. Empirical treatment is started, after doing corneal scrapings and smears. 48h later a severe anterior uveitis develops with severe stromal edema but a significant improvement of the corneal infiltrates is appreciated. We show the evolution with serial photographs.

Results:

After one week of treatment with chlorhexidine 0.04%, propamidine 0.1 and oral Voriconazol, we started Dexametaxone eyedrops because of the intense anterior chamber reaction. Two days later the cornea clears almost completely remaining only PRKs and a very mild anterior inflammation. Three days later a neurotrophic ulcer appears and then 20% autologous serum treatment is added. One week later a superinfection occurs, that slowly responds to fortified antibiotic eye drops. Two months after the first symptom the patient remains asymptomatic with treatment with chlorhexidine 0.02% and Voriconazol orally. Photographs show the resolution of the initial corneal infiltrates with a residual leukoma secondary to the neurotrophic superinfected ulcer.

Conclusions:

Acanthamoeba keratitis is a severe infection that even responding promptly to specific medical treatment can have a torpid evolution because of complications that frequently appear as in this case are described. Careful following is recommended, trying to avoid iatrogenic ulcers and if this happens antibiotics should cover the high risk of superinfection.

Financial Disclosure:

NONE

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