Ángeles Arance-Gil1, Ángel Ramón Gutiérrez-Ortega1, César Villa-Collar2, Amelia Nieto-Bona3, Daniela Lopes-Ferreira4, José Manuel González-Méijome5. 1. Clínica Oftalmológica Novovision, Paseo de la Castellana, Madrid, Spain. 2. Universidad Europea de Madrid, Spain. 3. Universidad Complutense de Madrid, Spain. 4. Clinical & Experimental Optometry Research Lab (CEORLab), Center of Physics, University of Minho, Braga, Portugal. 5. Clinical & Experimental Optometry Research Lab (CEORLab), Center of Physics, University of Minho, Braga, Portugal. Electronic address: jgmeijome@fisica.uminho.pt.
Abstract
PURPOSE: To report a case of Acanthamoeba keratitis diagnosed using confocal microscopy in a patient corrected by orthokeratology and treated with corneal crosslinking (CXL) after failure to respond to medical treatment. METHODS: After diagnosis, the patient was treated with several medications until CXL was applied during one 30-min session using ultraviolet A radiation and application of riboflavin. The clinical signs of the disease observed using slit-lamp biomicroscopy and confocal microscopy were evaluated and the visual acuity was measured during the course of the infection and treatment over a period of 30 months including 12 months of medical treatment, 9 months after cross-linking and amniotic membrane transplant and 9 months after penetrating keratoplasty and cataract extraction. RESULTS: In this case, confocal microscopy facilitated early diagnosis of an Acanthamoeba infection even if other signs and symptoms might be confounding. CXL was more effective than aggressive medication against the microorganism. After CXL, the symptoms and the corneal appearance improved significantly but the ulcer did not heal completely. After amniotic membrane transplantation, the patient underwent penetrating keratoplasty (PK) with no rejection, and the visual function substantially improved over 9 months of follow-up. CONCLUSIONS: Swimming in contaminated water might represent a risk for orthokeratology patients. CXL was effective for treating Acanthamoeba keratitis in an orthokeratology patient to eliminate active and cystic forms of the microorganism. Confocal microscopy was useful to confirm the diagnosis in the presence of confounding clinical signs observed during a conventional slit-lamp examination. Both CXL and confocal microscopy are essential to the outcome of PK.
PURPOSE: To report a case of Acanthamoeba keratitis diagnosed using confocal microscopy in a patient corrected by orthokeratology and treated with corneal crosslinking (CXL) after failure to respond to medical treatment. METHODS: After diagnosis, the patient was treated with several medications until CXL was applied during one 30-min session using ultraviolet A radiation and application of riboflavin. The clinical signs of the disease observed using slit-lamp biomicroscopy and confocal microscopy were evaluated and the visual acuity was measured during the course of the infection and treatment over a period of 30 months including 12 months of medical treatment, 9 months after cross-linking and amniotic membrane transplant and 9 months after penetrating keratoplasty and cataract extraction. RESULTS: In this case, confocal microscopy facilitated early diagnosis of an Acanthamoeba infection even if other signs and symptoms might be confounding. CXL was more effective than aggressive medication against the microorganism. After CXL, the symptoms and the corneal appearance improved significantly but the ulcer did not heal completely. After amniotic membrane transplantation, the patient underwent penetrating keratoplasty (PK) with no rejection, and the visual function substantially improved over 9 months of follow-up. CONCLUSIONS: Swimming in contaminated water might represent a risk for orthokeratology patients. CXL was effective for treating Acanthamoeba keratitis in an orthokeratology patient to eliminate active and cystic forms of the microorganism. Confocal microscopy was useful to confirm the diagnosis in the presence of confounding clinical signs observed during a conventional slit-lamp examination. Both CXL and confocal microscopy are essential to the outcome of PK.
Authors: Aaron B Zimmerman; Kathryn Richdale; Gladys Lynn Mitchell; Beth T Kinoshita; Dawn Y Lam; Heidi Wagner; Luigina Sorbara; Robin L Chalmers; Sarah A Collier; Jennifer R Cope; Maya M Rao; Michael J Beach; Jonathan S Yoder Journal: Cornea Date: 2017-08 Impact factor: 2.651