Clinical Course Of Acanthamoeba Radial Perineuritis In Contact Lens Wearer: Case Report

To report the clinical course and long-term visual outcome of a young contact lens wearer diagnosed with Acanthamoeba keratitis (AK), highlighting complete resolution of ring infiltrate and radial keratoneuritis without visual compromise. Additionally, to describe the safety and outcome of subsequent refractive surgical interventions, including INTACS implantation, after confirmed eradication of infection.

Emergency department and cornea specialty services at a tertiary ophthalmology center managing infectious keratitis, including microbiological diagnosis and long-term follow-up with refractive surgical evaluation.

A 25-year-old medically free female contact lens wearer presented with severe right ocular pain for 10 days, unresponsive to broad-spectrum topical antibiotics. She reported cleaning lenses with tap water and showering while wearing them. Uncorrected visual acuity was 20/80 OU. The right eye showed ciliary injection, epithelial irregularities, subepithelial opacities, and radial keratoneuritis. Corneal scraping confirmed Acanthamoeba infection on day 4.

She was treated initially with fortified cefazoline and ceftazidime hourly, then switched to topical chlorhexidine and voriconazole hourly, with gradual tapering over several months. Topical prednisolone acetate 1% was introduced after 6 months with close monitoring; no reactivation occurred.

Within one year, the ring infiltrate and corneal scarring resolved completely, and best corrected visual acuity improved to 20/20 OU. During refractive evaluation, tomography suggested forme fruste keratoconus. The patient underwent Implantable Collamer Lens insertion in the left eye and INTACS implantation in the right eye. At 1-year postoperative follow-up, vision remained 20/20 OU with no recurrence of infection.

Early microbiological confirmation and aggressive anti-amoebic therapy can result in complete structural and visual recovery in Acanthamoeba keratitis. Prompt diagnosis within three weeks likely contributed to the excellent outcome. This case also suggests that, after confirmed eradication and long-term stability, selected patients may safely undergo corneal refractive procedures such as INTACS without reactivation.