A Case Of Histopathologically Confirmed Acanthamoeba Keratitis In A Pediatric Patient With Orthokeratology Contact Lens Wear-Related Keratitis

We report a case of Acanthamoeba keratitis (AK) in a pediatric patient who was diagnosed after wearing orthokeratology contact lenses (OKL) and underwent penetrating keratoplasty (PKP) due to extensive corneal opacity that persisted despite appropriate treatment.

Case report. This study case wase taken by Department of Ophthalmology, Yeungnam University College of Medicine, South Korea.

A 13-year-old girl presented with right ocular pain for 5 weeks. The patient had been wearing OKL daily for 4 years and stopped after the onset of symptoms. She was diagnosed with herpetic keratitis at the hospital she first visited 5 weeks ago and was treated with topical moxifloxacin, ganciclovir gel, and fluorometholone for 1 month. Fluorometholone was discontinued 1 week before visiting our hospital, and the corneal lesion rapidly worsened, so she was referred to our hospital. At her first visit to our hospital, BCVA was hand motion. Slit-lamp examination showed large extensive ring-shaped stromal infiltration in the central cornea, 7x6 mm of epithelial defect, extensive conjunctival/scleral injection, with 2+ anterior chamber cells. We clinically diagnosed as advanced stage of AK, the patient was treated with topical 0.04% PHMB, 0.04% chlorhexidine, moxifloxacin and 5% ceftazidime simultaneously at 1-hour intervals. Corneal scraping culture revealed E. cloacae and P. aeruginosa, but Acanthamoeba was not identified. After treatment, pain was reduced and conjunctival/scleral injection gradually improved. At 4 months of treatment, amniotic membrane transplantation was performed due to persistent epithelial defect. Postoperatively, the epithelial defect healed, but central corneal opacity remained significant. Therefore, PKP was performed at 6 months. Corneal button biopsy revealed acanthamoeba cyst. Six months after PKP, the grafted cornea showed clear, and BCVA was 0.8.

Adequate awareness, caution, and clinical suspicion are required for Acanthamoeba keratitis, a rare and serious complication that may occur due to the use of orthokeratology contact lenses particularly in pediatric age.