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Triple penetrating keratoplasty (PK) for recurrent Acanthamoeba keratitis

Poster Details

First Author: M.Garriga Beguiristain SPAIN

Co Author(s):    S. Martin   M. Calatayud   J. Puig   A. Segura   D. Mora   S. Bover     

Abstract Details


To describe the case of an Achantamoeba keratitis with torpid evolution that required three consecutive keratoplasties.


Cornea and ocular surface unit, Vall d'Hebron Hospital, Barcelona, Spain.


An 18 year-old male patient, contact lens wearer, was referred to our hospital with a severe corneal thinning and descemetocele on his left eye, after months of suffering undiagnosed infectious keratitis with negative corneal cultures.


Hot PK was performed with broad-spectrum antibiotics and antiamoebic drugs postoperatively added. The AP exam of the patient cornea was unconclusive and the corneal graft was transparent over the first two months. Then a stromal infiltrate appeared, and another revision of the extracted button was applied, which finally revealed the presence of isolated Achantamoeba cysts. Consecuently antiamoebic treatment was intensified. Nevertheless keratitis worsened, with an acute perforation that required a second keratoplasty and an Urrets-Zavalia syndrome occurred. A third PK was performed after a rejection episode and nowadays this last corneal graft remains transparent, treated with oral immunosupresors and topical clorhexidine


Early etiologic diagnosis in Acanthamoeba keratitis is necessary since a delay in it can induce a greater difficulty in eradicating the parasite and a higher probability of complications. We need to consider the possibility of subsequent rejection when repeated keratoplasties are performed and the higher risk of failure despite we perform an intensive antiamoebic treatment.

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