Multimodal Management Of Refractory Acanthamoeba Keratitis In A Contact Lens Wearer

To present a case of refractory Acanthamoeba keratitis (AK) in a contact lens wearer managed with a staged multimodal approach.

This case report was conducted at the Department of Cornea, Beijing  Aier-Intech Eye Hospital, China.

An 18-year-old female contact lens wearer presented with a 3-month history of pain and blurred vision, initially misdiagnosed as bacterial keratitis. Diagnosis was confirmed by in vivo confocal microscopy and corneal scraping. Intensive topical anti-amoebic therapy plus corneal debridement with collagen cross-linking (CXL) controlled infection but left dense central scarring with BCVA reduced to hand motion. She underwent two lamellar keratoplasties, then PKP, and later cataract extraction with trifocal IOL implantation; recurrent graft rejection ultimately necessitated Descemet-membrane endothelial keratoplasty (DMEK), which was successfully performed. At 58 months, the graft remained clear with best-corrected visual acuity (BCVA) of 0.9. No recurrence was observed.

This long journey underscores that refractory AK demands prolonged, step-wise and multidisciplinary care—ranging from intensive anti-amoebic therapy and CXL to repeated corneal and lens surgeries—to convert potential blindness into useful vision; no single intervention suffices, and meticulous long-term management is mandatory.