EEBA Program (PDF/3MB) - EEBA - Annual Meeting

SURGICAL TREATMENT OF ACANTHAMOEBA KERATITIS – CASE REPORTI. Romac, I. Mravičić, I. Dekaris, N. GabrićSpecial Eye Hospital Svjetlost, Department of Ophthalmology, School of Medicine in Rijeka, University of Rijeka, CroatiaIntroduction: Acanthamoeba keratitis (AK) is a serious, debilitating, and intensely painful infectionof the cornea caused by parasites of the genus Acanthamoeba. If it is not diagnosed early andtreated aggressively, extensive ocular damage can occur. At present, diagnosis of the disease isnot straightforward, and treatment of AK is very demanding. Despite the aggressive treatment,occasionally, the disease fails to respond. AK, originally associated with trauma with vegetative matterand exposure to contaminated water, in recent literature has been most closely linked to soft contactlens use, although it can occure even in the absence of contact lenses. The incidence of contact lensrelatedAK is still unclear, but it has been estimated that one in 300-1500 contact lens wearers maydevelop some form of AK over a 30-year period of contact lens wearing.Methods: Case report.Results: A 52-year-old woman, soft contact lens wearer was referred to our Clinic with cloudy vision,photophobia and a red, painful right eye. Swab corneal sample was taken and Acanthamoeba wasproved. The patient was treated with chlorhexidine,brolene, atropine, ciprofloxacin and vigamoxtopically. 1 month after starting with therapy, the patient developed persistent epithelial cornealdefect and secondary glaucoma. Visual acuity of the right eye was light perception. Combinationof timolol and dorzolamid drops was included in therapy and amniotic membrane transplantationwas performed. As no improvement occur, therapeutic penetrating keratoplasty was recommended.Triple procedure (phacoemulsification with posterior chamber intraocular lens implantation andpenetrating keratoplasty) and anterior chamber lavage with voriconazol was the treatment of choice.Postoperative, the patient was treated with tobramycin, dexamethasone, voriconazole, chlorhexidine,combination of timolol and dorzolamid, brimonidin topically and voriconazole orally. The eyepressure was high despite the treatment with topical antiglaucoma drugs so the implantation of miniglaucoma shunt was necessary. Finally, after one year, the eye pressure was stabilized to normal leveland corneal graft remained clear.Conclusions: AK is a potentially blinding corneal infection which is often misdiagnosed. Earlydefinitive diagnosis of AK and the prompt initiation of appropriate therapy are essential for a favorableclinical prognosis. Therapeutic penetrating keratoplasty is a method of choice when medicaltreatment fails.82