Therapeutic Penetrating Keratoplasty In Acanthamoeba Keratitis: A Case Report
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR204 | Type: Poster | DOI: 10.82333/1wma-mr75
Authors: Dr Hibat Allah Eddaoui* 1 , Dr Youness Bouhafra 1 , Dr Boutaina Bousellam 1 , Dr Nour Alsaket 1 , A/Prof. Nabiha Benchekroun 1 , A/Prof. mohammed belmekki 1
1ophtalmology,Cheikh zaid international hospital,rabat,Morocco
Purpose
Acanthamoeba keratitis is commonly associated with contact lens wear or corneal trauma followed by water exposure. It is a severe ocular infection requiring prompt and appropriate medical treatment. In resistant cases, therapeutic keratoplasty may be necessary to control the infection and preserve ocular integrity.
We report the case of a 20-year-old patient with a history of three previous hospitalizations for right corneal abscess related to contact lens wear, who presented with persistent painful red eye.
Setting
Best-corrected visual acuity was limited to counting fingers at close range in the affected eye.
Ophthalmic examination revealed a central corneal opacity with epithelial and perineural infiltrates. Anterior segment optical coherence tomography (AS-OCT) showed multiple rounded and oval hyperreflective images measuring less than 30 µm, distributed throughout the corneal endothelium.
Methods
espite systemic antifungal therapy, clinical worsening was observed, leading to the decision to perform therapeutic penetrating keratoplasty. Microbiological analysis of the excised corneal button confirmed the presence of Acanthamoeba (Acanthamoeba polyphaga). Postoperative OCT demonstrated persistence of rounded hyperreflective structures corresponding to trophozoites, associated with a highly adherent fibrinous membrane.
High-dose antifungal therapy was continued postoperatively. No recurrence was observed one month after surgery, and follow-up OCT showed a marked reduction in the number of trophozoites.
Results
The prognosis of Acanthamoeba keratitis is often poor, particularly in cases of delayed diagnosis and resistance to medical therapy. In our case, despite several unfavorable prognostic factors, therapeutic keratoplasty allowed infection control and preservation of ocular integrity. Some authors report better postoperative outcomes with penetrating keratoplasty compared to lamellar grafting in advanced infectious cases.
Conclusions
Urgent therapeutic penetrating keratoplasty remains a last-resort treatment when ocular integrity is threatened and infection progresses despite maximal medical therapy.