Acanthamoeba keratitis: a challenge in diagnosis and the role of amniotic membrane transplant as an alternative therapy
AbstractAcanthamoeba keratitis (AK) is a very rare, sight-threatening corneal disease caused by the infection of a free-living amoeba. The aim of this report was to demonstrate the challenges in the diagnosis of AK with an atypical presentation. Amniotic membrane transplantation (AMT) was done in this case to accelerate wound healing. A woman who frequently used contact lens came with redness and a whitish spot in her left eye 2 weeks before admission. There was a history of rinsing contact lens in tap water. The patient had already been on a topical steroid for 2 weeks. Visual acuity of the left eye was light perception with wrong projection. Examination of the left cornea showed a semi-circular central ulcer with a 5.8-mm area and 1/3 stromal depth. It is surrounded by a feathery-edge infiltrate with positive satellite lesions but without hypopyon. It was diagnosed as corneal ulcers due to mixed infection (bacteria and fungi). After 2 weeks of bacterial and fungal therapy, the size of the ulcer decreased, but the corneal infiltrate remained; therefore, an Acanthamoeba culture was done to determine the possibility of Acanthamoeba infection. Two weeks after the Acanthamoeba topical therapy, the visual acuity improved. AMT was performed to accelerate wound healing. Two months post-AMT, visual acuity improved to 1/60 with no conjunctival or ciliary vasodilation, and the ulcer was resolved. The patient was planned to undergo keratoplasty. The diagnosis of AK with an atypical presentation is challenging. AMT can be used as an alternative therapy to accelerate wound healing.
Page MA, Mathers WD. Acanthamoeba keratitis: a 12-year experience covering a wide spectrum of presentations, diagnoses, and outcomes. J Ophthalmol. 2013;2013:670242. http://doi.org/10.1155/2013/670242
Clarke B, Sinha A, Parmar DN, Sykakis E. Advances in the diagnosis and treatment of acanthamoeba keratitis. J Ophthalmol. 2012;2012:484892. https://doi.org/10.1155/2012/484892
Rahimi F, Hashemian SM, Tafti MF, Mehjerdi MZ, Safizadeh MS, Pour EK, et al. Chlorhexidine monotherapy with adjunctive topical corticosteroids for Acanthamoeba keratitis. J Ophthalmic Vis Res. 2015;10(2):106–11. https://doi.org/10.4103/2008-322X.163782
Dini LA, Cockinos C, Frean JA, Niszl IA, Markus MB. Unusual case of Acanthamoeba polyphaga and Pseudomonas aeruginosa keratitis in a contact lens wearer from Gauteng, South Africa. J Clin Microbiol. 2000;38(2):826–9.
American Academy of Ophthalmology. Infectious diseases of the external eye: microbial and parasitic infections In: American Academy of Ophthalmology, ed. External disease and cornea. San Fransisco: American Academy of Ophthalmology; 2011:167–4.
Dart JK, Saw VP, Kilvington S. Acanthamoeba keratitis: diagnosis and treatment update 2009. Am J Ophthalmol. 2009;148(4):487–99. https://doi.org/10.1016/j.ajo.2009.06.009
Sharma S, Garg P, Rao GN. Patient characteristics, diagnosis, and treatment of non- contact lens related Acanthamoeba keratitis. Br J Ophthalmol. 2000;84(10):1103–8. https://doi.org/10.1136/bjo.84.10.1103
Jiang C, Sun X, Wang Z, Zhang Y. Acanthamoeba keratitis: clinical characteristics and management. Ocul Surf. 2015;13(2):164–8. https://doi.org/10.1016/j.jtos.2015.01.002
Desrina, Susiyanti M. Profil Demografis, Karakteristik Klinis dan Evaluasi Hasil Terapi Ulkus Kornea Akibat Lensa Kontak di Divisi Infeksi Imunologi RSCM Kirana Periode Januari 2013–Desember 2014. Penelitian Deskriptif. Jakarta: Universitas Indonesia; 2015.
Ariesta P, Sitompul R, Susiyanti M, Setiawati A, Mun'im A. Keamanan rebusan daun sirih (Piper Betle Linn) 5%, 10% dan 20% terhadap jaringan anterior mata normal pada kelinci percobaan [tesis]. Jakarta: Universitas Indonesia; 2007. Indonesian.
Graffi S, Peretz A, Jabaly H, Naftali M. Acanthamoeba keratitis. Isr Med Assoc J. 2013;15(4):182–5.
Wilson ME Jr, Trivedi RH, Buckley EG, Granet DB, Lambert SR, Plager DA, et al. ASCRS white paper. Hydrophobic acrylic intraocular lenses in children. J Cataract Refract Surg. 2007;33(11):1966–73. https://doi.org/10.1016/j.jcrs.2007.06.047
Vemuganti GK, Pasricha G, Sharma S, Garg P. Granulomatous inflammation in Acanthamoeba keratitis: an immunohistochemical study of five cases and review of literature. Indian J Med Microbiol. 2005;23(4):231â8.
Motlagh BF. Recurrence of Acanthamoeba keratitis after deep anterior lamellar keratoplasty. Iran J Ophthalmol. 2014;26(1):53–7.
Kim JS, Kim JC, Hahn TW, Park WC. Amniotic membrane transplantation in infectious corneal ulcer. Cornea. 2001;20(7):720–6. https://doi.org/10.1097/00003226-200110000-00010
Casalita V, Sitompul R. Hasil Tata Laksana Transplantasi Membran Amnion pada Ulkus KorneaInfeksi di Departemen Ilmu Kesehatan Mata FKUI-RSCM Periode 2015–2017. Penelitian Deskriptif. Jakarta. Universitas Indonesia; 2017. Indonesian.
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