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Recrudescence of an uncommon corneal infection

Poster Details

First Author: D.Gallagher IRELAND

Co Author(s):    E. McElnea   G. Fahy                 

Abstract Details

Purpose:

Free-living amoebae of the genus Acanthamoeba produce a progressive infection of the cornea termed Acanthamoeba keratitis. Recrudescent disease is rare but has been described as late as five years after initial treatment of the condition. Here we report a case of recrudescent Acanathamoeba keratitis, discuss useful diagnostic techniques and currently available treatments.

Setting:

Department of Ophthalmology, University College Hospital Galway, Galway, Ireland

Methods:

A forty-four year old female contact lens wearer was treated for Acanthamoeba keratitis affecting her right eye with propamidine isothionate or Brolene 0.01% and polyhexamethylbiguanide or PHMB 0.02% for six months. Fifteen months later she re-presented with recurrence of right eye pain and redness. Limbal injection, peripheral stromal haze and radial keratoneuritis were apparent. Resolution of these symptoms and signs occurred after re-treatment with PHMB 0.02%. The patient maintained a visual acuity of 6/7.5.

Results:

One other case of delayed recurrence of Acanthamoeba keratitis in a patient with no obvious risk factors has been described. Despite apparent clinical resolution of an initial infection, viable Acanthamoeba cysts may persist, dormant, in the cornea. Their reactivation causes recurrence. Confocal microscopy detects Acanthamoeba with 90% sensitivity and specificity. Options for the treatment of Acanthamoeba keratitis have expanded.

Conclusions:

Recrudescent Acanthamoeba keratitis is rare. Nonetheless, patients should be advised that after initial, apparent, resolution of the condition, recurrence is possible. Suspicion and early detection of recrudescent disease is important if a favourable visual outcome is to be achieved. Confocal corneal microscopy may be helpful in this regard.

Financial Disclosure:

NONE

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