Flap amputation for the diagnosis and treatment of acanthamoeba keratitis: A case report

Aims/Purpose: To report a laser assisted in situ keratomileusis (LASIK) flap amputation as both diagnostic and therapeutic tool in a case of Acanthamoeba keratitis, in a scleral contact lens patient. Methods: Case report and literature review. Results: Acanthamoeba keratitis is a serious sight‐threa...

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Bibliographic Details
Published in:Acta ophthalmologica (Oxford, England) England), 2024-01, Vol.102 (S279), p.n/a
Main Authors: Usuga, Juan Cadavid, Velez, Mauricio, Usuga, Maria Ortiz, Perdomo, Camilo Restrepo, Izquierdo, Luis
Format: Article
Language:English
Subjects:
Acanthamoeba
Acuity
Amputation
Case reports
Chlorhexidine
Contact lenses
Cornea
Cysts
Diagnosis
Keratitis
Literature reviews
Sensation
Voriconazole
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Summary:Aims/Purpose: To report a laser assisted in situ keratomileusis (LASIK) flap amputation as both diagnostic and therapeutic tool in a case of Acanthamoeba keratitis, in a scleral contact lens patient. Methods: Case report and literature review. Results: Acanthamoeba keratitis is a serious sight‐threatening infection, which imposes a considerable diagnostic and therapeutic challenge to the ophthalmologist. We report a case of a 38 years old male with post‐LASIK ectasia who was using scleral fitted contact lenses; as he developed keratitis, who had unspecific symptoms such as tearing, photophobia, burning sensation, foreign body sensation and decreased vision. His LASIK flap was surgically amputated as both diagnostic and therapeutic procedure. Histopathology analysis revealed abundant acanthamoeba cysts (Figure 1: Intact intrastromal Acanthamoeba cysts (arrow). Right (R): HE x 400 and left (L): Gomori Methenamine‐Silver Stain ×400). After diagnosis, treatment initiated with 0.2% Chlorhexidine, Propamidine Isothionate and systemic Voriconazole, observing resolution of the infiltrate and complete epithelization within 1 week. At 1 month postoperative, the patient developed symptoms secondary to medications without changes in his visual acuity; Fluorometholone drops were added to the anti‐amoebic treatment, which was continued for six more months. Conclusions: Corneal Flap amputation is a reasonable option as a diagnostic and therapeutic aid in the management of Acanthamoeba keratitis in patients with past history of LASIK. Figure 1
ISSN:1755-375X
1755-3768
DOI:10.1111/aos.16036