Сase of severe acanthamoeba keratitis.

Abstract

Purpose to present a case of severe acanthamoeba keratitis Setting State Institution «The Filatov Institute of eye diseases and tissue therapy NAMS of Ukraine», Odessa, Ukraine Report of case Patient, 62y.o., complained of decreased vision, photophobia, lacrimation, pain in the left eye. One month ago, after washing with water from a well, his left eye became inflamed. Upon admission to the hospital: BCVA of the right eye - 1,0, BCVA of the left eye - correct light perception. The conjunctiva was hyperemic, corneal abscess, corneal melt to the limbus, no anterior chamber, intumescent cataract. The patient was diagnosed with Acanthamoeba keratitis based on a PCR study of the tear and underwent penetrating keratoplasty d = 9.0/9.5 mm with extracapsular cataract extraction. Chlorhexidine and chloramphenicol were prescribed as well. In 3 weeks the corneal graft was well adapted, the surface was epithelialized. BCVA of the left eye was 0,12. Due to the pandemic, the patient came for an examination after 6 months. The conjunctiva was hyperemic, ulcer and edema of corneal graft, partial failure of interrupted sutures with local ectasia of the border ring. BCVA - correct light perception. Additional interrupted sutures were placed on the graft. At the discharge corneal graft was well adapted with small torpid corneal erosion. In 10 days - graft ulcer recurrence with stromal infiltration and edema, partial ectasia of the border ring, elevated IOP. Photodynamic therapy using methylene blue was conducted. Corneal perforation occurred and the patient underwent tectonic keratoplasty d = 12 mm with simultaneous subscleral sinustrabeculectomy with basal iridectomy and sclerinkleisis and partial blepharorrhaphy. At the discharge - flat filter pad, corneal graft well adapted with interrupted sutures, no fluorescein staining, normal IOP. In 1 month patient returned with no complaints. The conjunctiva was hyperemic, corneal graft melt, perforation, stromal infiltration. The anterior chamber was small, irregular, hypotension. Due to incorrect light perception, repeated corneal perforation, retinal detachment, secondary uncompensated glaucoma, it was decided to perform evisceration of the left eyeball. Conclusion/Take home message Treatment of acanthamoeba keratitis is a real challenge for ophthalmologists all over the world. Due to the untimely started antiamebic therapy and despite the complex etiopathogenetic conservative and surgical treatment, the eye could not be saved.