Posters

Case-report of dramatic anterior and posterior-segment complications related to an Acanthamoeba keratitis (or to its therapy)

Poster Details

First Author: L.Terracciano ITALY

Co Author(s):    D. Mucciolo   G. Albani                 

Abstract Details

Purpose:

To describe a case of Acanthamoeba keratitis complicated by the abrupt onset of corneal thinning, cataract, iris atrophy and severe pan-retinal ischemic vasculitis.

Setting:

Eye Clinic, AOU Careggi, Florence. Retrospective case report.

Methods:

We evaluated a case of a 19 year-old boy contact-lens wearer who came to our Eye Clinic complaining of severe ocular pain and visual blurring: diagnostic suspicion of Acanthamoeba Keratitis was confirmed by confocal findings and PCR analysis on corneal material. During the first 2 months of therapy an acute onset of maximal mydriasis and visual drop to light perception occurred, with hard-white cataract progression that led to a full-thickness corneal transplantation with lens removal. Fundus-evaluation revealed signs of dramatic pan-retinal ischemic vasculitis involving the whole retina, while the PCR analysis of vitreous material excluded the presence of endobulbar infection.

Results:

After the first months of topical intensive care (PHMB + Diamidine) the development of severe intraocular complications led to a dramatic reduction in visual acuity. Despite this, the stability of the corneal involvement and the negativity for DNA in the vitreous material suggests that different, non-infectious mechanisms may be involved in the genesis of these complications. Interestingly, the patient benefited from a cycle of acupuncture which helped solving the severe periocular pain and headache related to the corneal involvement. After 2-years of follow-up, no signs of recurrence or visual improvement were noted.

Conclusions:

This case describes the whole spectrum of pan-ocular complications that can be related to Acanthamoeba corneal infection and its topical therapy; the absence of Acanthamoeba DNA in the vitreous material suggests that immune mechanisms could be responsible for the retinal vasculitis and should lead us to consider the introduction of systemic immunosuppressive therapy at the outset of intraocular inflammatory signs.

Financial Disclosure:

None