Posters

Acanthamoeba stromal keratitis: how early diagnosis and systemic treatment with voriconazole increases final visual prognosis

Poster Details

First Author: C.Colliga SPAIN

Co Author(s):    A. Baeza Autillo   N. Saenz Madrazo                 

Abstract Details

Purpose:

To study how early diagnosis and systemic treatment of amebic keratitis caused by Acanthamoeba may condition final visual prognosis. Acanthamoeba keratitis is considered to be a rare, vision threatening, parasitic infection, usually related to contact lenses use.  Late diagnosis and delay of treatment remain the main causes of Acanthamoeba stromal keratitis development, which lead to serious complications in quite a few cases.

Setting:

Unit of Cornea, Ophthalmology Department, Hospital Gregorio Marañon, Madrid (Spain)

Methods:

We present one case of Acanthamoeba stromal keratitis in a 29 year old male with these clinical findings: redness, exorbitant pain and blurred vision in left eye. He was previously treated with topical tobramycin-dexamethasone with progressive worsening and then, referred to our Department. Biomicroscopy revealed the presence of a pseudodendritic corneal ulcer. Cultures were taken, growing Acanthamoeba as well as Acanthamoeba cysts were also observed in confocal microscopy.

Results:

We started treatment with oral voriconazole 200 mg twice daily and topical chlorhexidine 0.02% and propamidine 0.1 % each 2 hours. Liver function tests were performed at the time of starting and weekly during the first month of voriconazole therapy and monthly thereafter. Fluorometholone 0.1% was added after 6 weeks of antiparasitic agents to control inflammatory response (radial keratoneuritis). After 6 months of systemic and topical treatment, best corrected visual acuity was 20/20 despite the presence of diffuse, presumptively inactive, corneal infiltrates, located out of the visual axis.  There was not any sign of intraocular involvement. No surgical procedure was performed.

Conclusions:

Acanthamoeba is a recognised cause of potentially severe infectious keratitis, important to take into account, specially in the setting of contact lenses wearers. Microbiological culture and direct techniques such as confocal microscopy must be performed for an early diagnosis, which is critical for a better clinical outcome. Systemic treatment with voriconazole, active in vitro against Acanthamoeba might be useful as initial treatment for amebic keratitis. FINANCIAL DISCLOSURES We do not report any financial disclosure

Financial Disclosure:

None