Posters

Acanthamoeba and fungal keratitis in a man with a history of therapeutic contact lens wear

Poster Details

First Author: Y.Aydin Akova TURKEY

Co Author(s):    O. Donmez                    

Abstract Details

Purpose:

To report a culture positive-PCR positive Aspergillus Flavus and PCR positive Acanthamoeba keratitis with a history of therapeutic contact lens wear.

Setting:

Bayindir Hospital, Department of Ophthalmology, Ankara, Turkey

Methods:

We present a contact lens related unilateral Aspergillus Flavus and Acanthamoeba keratitis who developed corneal ulcer and corneal perforation. He was managed with topical and systemic medical treatment, intracameral, intrastromal, subconjunctival antifungal and subconjuncitval antibiotic injections, amniotic membrane transplantation, cross-linking and penetrating keratoplasty.

Results:

A 54 year-old-man was referred to our clinic with resistant large central corneal ulcer with  a grayish-white, paracentral, ring-shaped stromal infiltrate and hypopyon. Confocal scan microscopy showed filamentous fungal keratitis.Topical fortified antibiotics, antifungal drops,systemic meropenem, vancomycin and voriconazole were started with mixed infectious keratitis diagnosis. Collagen cross-linking was performed.Intracameral,intrastromal,subconjunctival antifungal and antibiotic injections,amniotic membrane transplantation were performed biweekly.The culture and PCR results from corneal samples were positive for Aspergillus flavus.Confocal microscopy showed Acanthamoeba cysts in the first month and confirmed with PCR.Cationic antiseptics and diamidines were started.In third month,penetrating keratoplasty was performed due to corneal perforation.He was stable postoperatively.

Conclusions:

Microbiologial work ups, confocal microscopy, PCR tests from corneal samples should be performed and repated in patients with severe keratitis resistant to medical treatment. Ophthalmologists should consider uncommon presentations of Acanthamoeba and Aspergillus keratitis in the differential diagnosis.

Financial Disclosure:

None