Abstract

P 246

Unusual case of keratitis associated with contact lens wear, in which Acanthamoeba could be demonstrated through culture

Huchzermeyer C.¹, Schörner C.², Cursiefen C.^1
1Department of Ophthalmology and Eye Clinic, ²Department of Clinical Microbiology, Immunology and Hygiene, University Erlangen-Nürnberg  

Objective: Description of a case of Acanthamoeba keratitis, which was diagnosed through culture. The histological examination of a corneal scraping was negative earlier during the course of the disease.
Methods: Description of a case of a 44-year-old patient with redness and pain of the left eye for 2 weeks before presentation, as well as a discrete subepithelial infiltrate, superificial punctate keratitis and cells in the anterior chamber. There was no considerable amelioration under treatment with fortified cefazolin and tobramycin eyedrops, local steroids and local as well as systemic antiviral therapy. Acanthamoeba keratitis was suspected, despite the absence of pain, keratoneuritis and a typical ring-shaped infiltrate. Corneal scrapings were negative for Acanthamoeba. Intensive antibacterial and antiviral therapy was continued. During the course of the treatment a discrete hypopyon developed. Due to the persistent epithelial defect an amniotic membrane patch transplantation was performed and a therapeutic contact lense was applied. Intraoperatively, another corneal scraping was performed. Culture on agar with E. coli overlay demonstrated Acathamoeba trophozoites.
Results: The patient was admitted to the hospital once more 2 weeks after amniotic membrane transplantion. After removal of the therapeutic contact lens and the remainder of the amniotic membrane a local regimen with propamidine, chlorhexidine, polyhexamethyl biguanide and neomycin eyedrops accompanied by local and systemic steroids was was administered. The hypopyon resolved, and the stromal infiltrate improved considerably.
Conclusions: Histologic examination is the gold standard for the diagnosis of Acanthamoeba keratitis. The diagnosis could only ber confirmed using culture on agar with E. coli overlay.

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