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
RIGID GAS-PERMEABLE CONTACT LENS CORRECTION OF INFANT APHAKIA FOLLOWINGCONGENITAL CATARACT SURGERYA. K. Grünert, M. Klüppel, J. Hausser, T. Reinhard, R. Sundmacher, T. Fuchsluger*, G.Geerling*Düsseldorf University Hospital, Germany*equal contributionPurpose: To evaluate the functional outcome and safety of rigid gas-permeable contact lens wear fortreating aphakia in congenital cataract infants following cataract surgery.Methods: Outcomes of 75 infants treated with rigid gas-permeable contact lenses (CL) followingcataract removal between 1987 and 2011 were evaluated. The infants were stratified into differentgroups: bilateral aphakia (Group I), monolateral aphakia with early (Group II) or late (Group III)surgery, aphakia with additional pathology (Group IV). Main parameters of analysis were visual acuity,keratometric power and keratometric astigmatism.Results: As first analyses show, rigid contact lenses were tolerated very well by (small) infants.Handling was unproblematic following training of the parents. Visual acuity was dependent on thegroup: Whereas bilateral cases (Group I) obtained visual acuities up to 1.0, the results decreased withincreasing time before cataract removal (Group II > III). Group IV showed the least postoperativevalues. Refractive CL power to compensate lens removal decreases along time necessitating frequentprescriptions of adapted CL.Conclusions: To our knowledge, this is the largest patient collective yet analysed. Rigid gas-permeablecontact lenses are a safe tool to avoid amblyopia in children with congenital cataract. Provided goodcollaboration with the parents, these rigid lenses are a favourable alternative to soft lens therapy orintraocular lens implantation.XXV ANNUAL MEETING OF THE EUROPEAN EYE BANK ASSOCIATION Zagreb, Croatia 18/19 January 2013 83
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