A CASE OF END-STAGE OF ACANTHAMOEBA KERATITIS IN WHICH ACANTHAMOEBA CYST WERE DETERMINED IN NEARLY ALL LAYERS OF THE EYE

To report a rare case of contact lens related Acanthamoeba keratitis which finally necessitated enucleation of the bulbus. Histologic examination showed Acanthamoeba cysts in the retina, sclera and ciliary body.

University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands

A 64-year old female soft contact lens wearer presented at our outpatient clinic with pain, redness and diminution of vision of the right eye since nearly a month. She had no known systemic illnesses. Slit lamp bio-microscopy showed conjunctival hyperemia, small disseminated stromal infiltrates without a corneal ulcer, a relatively mild keratitis. Topical treatment aimed at treating bacterial and Acanthamoeba causative agents was started, by using ofloxacine, propriamide and chlorhexidine. Because the clinical situation deteriorated and repeated corneal scrapings yielded no results, a corneal biopsy was taken, which confirmed the presence of Acanthamoeba cysts. Since the severity of the infection did not abate after intensifying treatment two subsequent perforating keratoplasties were performed. Ten months after presentation, the eye showed signs of severe anterior and posterior uveitis and retinitis, that necessitated enucleation. Histologic examination showed chronic inflammation of the sclera, iris, ciliary body, choroid and retina. Acanthamoeba cysts were found in the iris, ciliary body, and retina.

We conclude that Acanthamoeba keratitis in rare cases can be very difficult to treat and subsequently may spread to almost all layers of the eye necessitating enucleation.