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Session Title: Inflammation
Session Date/Time: Tuesday 08/10/2013 | 16:30-18:00
Paper Time: 17:46
Venue: Auditorium (First Floor)
First Author: : D.Maychuk RUSSIA
Co Author(s): : Y. Kishkin A. Slonimskiy
To develop an algorithm of diagnostic and treatment care in cases of acanthamoeba keratitis in early stages of the disease
5 stages of acanthamoeba eye infection disorder were evaluated: I Superficial epithelial keratitis. II Superficial infiltrative punctate keratitis. III Stromal ring infiltrates. IV Ulcerative keratitis. V Keratoscleritis.
6 patients with non specific superficial keratitis (6 eyes) were suspected to have acanthamoeba etiology of the disease. 5 of them were previously treated for bacterial infection. For diagnostic reasons scraping of the cornea and confocal microscopy were performed in all cases. After acanthamoeba positive laboratory diagnostics all patients received traditional topical treatment with chlorhexidine and polyhexamethylene biguanide. After the recurrence of the disease in all cases, patients underwent excimer laser phototherapeutic keratectomy (PTK). The topical treatment with chlorhexidine and polyhexamethylene biguanide was again administered after PTK. Special care was taken to delay the full epithelization of the cornea up to 3 days. Immediately after the recurrence of the clinical symptoms in 1 case the penetrative keratoplasty was performed.
Acanthamoeba was cultured in 3 out of 6 cases. PCR analysis proved acanthamoeba etiology in 4 cases. By confocal microscopy acanthamoeba was found in all 6 corneas. After topical treatment full epithelization was achieved in all cases, but in 1 month period recurrence of keratitis developed. Treatment with PTK was considered successful in 5 cases. Penetrative keratoplasty was effective in 1 case. Follow up period from 1 to 3 years did not show any signs of corneal abnormalities.
Confocal microscopy was found to be the most effective diagnostic tool in cases of keratitis with suspected acanthamoeba etiology. Diagnostic scraping of the cornea may not only miss the microorganisms and cists, but cause intensive penetration of acanthamoeba into deeper stroma. Topical treatment with antimicrobial agents is questionably successful due to their low abilities of corneal penetration, but PTK is proven to be effective in early (I, II) stages of acanthamoeba keratitis. The ex?imer laser ablation not only mechanically erases microorganisms, but opens a pass way for drugs to reach the cysts and trophozoites in non ablated area.
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