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Acanthamoeba keratitis –diagnostics difficulties

Poster Details

First Author: S.Wagner POLAND

Co Author(s):    M. Sarnat   E. Mrukwa- Kominek   S. Sapeta        

Abstract Details

Purpose:

The aim of this article is to present a case of patient with chronic inflammation of the cornea with the implementation of the targeted treatment after confocal microscopy.

Setting:

Department of Ophthalmology, University Center of Ophthalmology and Oncology, Medical University of Silesia, Katowice, Poland

Methods:

A 20-year-old woman, highly myopic, soft contact lens user, admitted to the emergency department with a 7 months history of increasing pain, photophobia and progressively diminution of vision in her left eye. She was being treated for a possible microbial/viral keratitis and after removal of the amniotic membrane on the cornea in another hospital 2 months earlier. The best-corrected visual acuity (BCVA) in the left eye of patient was 0.006. The ophthalmological examination showed mixed-conjunctival injection, central corneal ulcer- discoid keratitis with accompanying grayish-white, ring-shaped stromal infiltrate. Right eye was normal. The patient was examined using an in vivo confocal microscopy (IVCM). High-contrast round bodies resembling the Acanthamoeba cysts were found near the edges of corneal scarring. The topical therapy was started with propamidine 0, 1% eye drops and neomycin eye ointment. Acyclovir, fluconazole, co-trimoxazole were used in the systemic therapy. Symptomatic improvement was observed within 7 days. After 1 month BCVA in the left eye was 0.04, the pain subsided, during examination the edges of the ulcer much shallower and reduced infiltration. The topical treatment was continued for 10 months. At present, visible central corneal subepithelial and stromal haze, BCVA is 0.08.

Results:

Acanthamoeba should be considered in the differential diagnosis of any unexplained keratitis, even those of long duration. Clinical confocal microscopy has the unique ability to provide non-invasive evaluation of corneal injury and disease at the cellular level. The prognosis of Acanthamoeba keratitis depends on rapid diagnosis and treatment at the early stage of the disease.

Conclusions:

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Financial Disclosure:

NONE

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