Chang Mok Lee, Jae Yong Kim and Hungwon Tchah*
Department of Ophthalmology, University of Ulsan College of Medicine, South KoreaFulltext PDF
Diagnosis of Acanthamoeba keratitis is challenging, and the available treatments are lengthy and not fully effective against all strains. It takes a lot of time to make a correct diagnosis and after a successful medical treatment, significant corneal opacity which reduces vision are remained. A 19-year-old female orthokeratology lens wearer presented with a persistent bilateral corneal ulcer. There was a total corneal infiltration with circumferential neovascularization. The patient was started on intensive anti-acanthamoeba therapy with topical polyhexanide methylene biguanide (0.02%) and chlorhexidine (0.02%) eye drops after confirmation of acanthamoeba growth on the non-nutrient agar. Despite this combination therapy, her condition failed to improve, oral voriconazole (200 mg twice daily) and topical bevacizumab (8 mg/ml thrice daily) were started after admission. After 4 months of treatment, her cornea was healed with neovascularization and bilateral Deep Anterior Lamellar Keratoplasty (DALK) was performed one year after the onset of symptoms. Clinicians should be mindful of Acanthamoeba keratitis in all contact lens wearers. Patients with Acanthamoeba keratitis with visually significant stromal opacification can achieve excellent visual outcomes and realize a significant improvement in corneal transparency by undergoing DALK.
Deep anterior lamellar keratoplasty; Acanthamoeba keratitis; Orthokeratology
Lee CM, Kim JY, Tchah H. Deep Anterior Lamellar Keratoplasty (DALK) after Bilateral Acanthamoeba Keratitis in an Orthokeratology Lens Wearer: A Case Report. Ann Clin Case Rep. 2019; 4: 1627.