A Case Of Successful Surgical Treatment Of Severe Acanthamoebа Keratitis In A Contact Lens Wearer Patient

to present a clinical case of successful surgical treatment of severe acanthamoeba keratitis in a contact lens wearer patient

State Institution «The Filatov Institute of eye diseases and tissue therapy NAMS of Ukraine», Odessa, Ukraine

Patient, complained of decreased visual acuity, photophobia, lacrimation, pain in OD. The patient is a user of contact lenses due to high myopia. A month ago, at night, while on the road, he replaced the contact lens with dirty hands and lubricated the lenses with his own saliva for easy implantation. The next day, he noticed discomfort and pain in the right eye, after which he removed the contact lens. Two days later the patient was diagnosed of Herpetic keratitis and antiviral therapy was prescribed. Upon admission: BCVA OD 0,005, BCVA OS 0,85. Diffuse corneal stroma infiltrations with uneven borders, surrounded by satellite foci, stromal edema, were observed. Patient was diagnosed with Keratitis of mixed etiology (acanthamoeba?).

Patient was prescribed chlorhexidine,voriconazole,brolen. Photodynamic therapy with methylene blue was conducted. Confocal microscopy revealed subepithelial cysts of Acanthamoeba. Just after 20 days active resorption of the corneal  infiltration was admitted, but persistent epithelial defect remained. Patient underwent amniotic membrane transplantation. Removed epithelium was sent for microbiological examination which found Acanthamoeba cysts, trophozoites  and Citrobacter koseri. 10 days after surgery patient was discharged from the hospital. Amniotic graft was well adapted by interrupted sutures. BCVA OD 0.02. After 2 months amniotic graft was well adapted and safe. No recurrences of acanthamoebic keratitis were observed during 6 months.

Treatment of acanthamoeba keratitis is a challenging problem for ophthalmologists around the world. The diagnosis is difficult and is usually made late due to the low specificity of symptoms and clinical signs.  Due to specific amebocidal and anti-inflammatory therapy with simultaneous photodynamic therapy with methylene blue, positive dynamics was noted in the patient. Thanks to the transplantation of the amniotic membrane, the reduction of inflammation and epithelialization of the corneal surface was achieved.The patient continued instillations of chlorhexidine and brolene for 6 months.