Scleral and intraocular amoebic dissemination in Acanthamoeba keratitis.

Abstract

PURPOSE:

To review an Acanthamoeba keratitis case series for the documented extracorneal spread of the amoeba.

METHODS:

A retrospective review of an observational case series from a single institution.

RESULTS:

Three patients with 4 instances of microbiologically confirmed extracorneal amoebic spread were identified. Patient 1 had nodular scleritis after undergoing penetrating keratoplasty and was treated successfully with double freeze-thaw cryotherapy; patient 2 had intraocular dissemination of the amoeba detected in a retrocorneal membrane; and patient 3 had, after undergoing tectonic keratoplasty, intraocular dissemination of the amoeba that was treated successfully with intraocular and systemic voriconazole and, afterwards, a nodular scleritis treated with double freeze-thaw cryotherapy and a large-diameter corneal graft to treat corneal recurrence.

CONCLUSIONS:

Acanthamoeba can migrate to the sclera or to the intraocular tissues in some instances, such as in long-standing disease or in penetrating keratoplasty. A prompt biopsy for microbiological analysis and early treatment are required, if this is suspected. Voriconazole can be effective for intraocular invasion when used orally and intraocularly. Scleral involvement might require a surgical approach with double freeze-thaw cryotherapy to treat the localized disease.

• Authors: Francisco Arnalich-Montiel, Laia Jaumandreu, Marina Leal, Basilio Valladares, Jacob Lorenzo-Morales
• Journal: Cornea (Cornea) Vol. 32 Issue 12 Pg. 1625-7 (Dec 2013) ISSN: 1536-4798 [Electronic] United States
• PMID: 23974886 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antifungal Agents
• Pyrimidines
• Triazoles
• Voriconazole

Topics

• Acanthamoeba Keratitis (complications, therapy)
• Adult
• Antifungal Agents (therapeutic use)
• Cryotherapy
• Female
• Humans
• Keratoplasty, Penetrating (adverse effects)
• Male
• Middle Aged
• Pyrimidines (therapeutic use)
• Retrospective Studies
• Scleritis (parasitology, therapy)
• Treatment Outcome
• Triazoles (therapeutic use)
• Voriconazole