Crosslinking and Fulguration in the Treatment of Acanthamoebic Keratitis

Purpose: to study the combined Photo-Activated Chromophore for Keratitis — Corneal Cross-Linking (PACK-CXL) in combination with fulguration of the infiltration zone in the treatment of medically refractive acanthamoebic keratitis.Patients and methods. The study included 9 patients (10 eyes) with medically refractive acanthamoebic keratitis. The diagnosis was confirmed by confocal microscopy data from a microbiological study of scraping of corneal tissue from the lesion site with Romanovsky-Giemsa stain. All patients underwent combined surgical treatment of PACK-CXL with pre-fulguration. Optical coherence tomography (OCT) of the anterior segment of the eye was also performed using an RTVue-100 apparatus (Optovue USA), determination of visual acuity, photographing before and after surgery.Results. In 6 cases (60 %), a positive effect was noted, relief of the symptoms of the disease and the formation of turbidity within a month after the procedure, as well as an increase in the maximum corrected visual acuity. According in vivo confocal microscopy, 6 months after the intervention, no signs of infection were detected. In 4 cases, the therapeutic effect was absent. Subsequently, 3 patients (3 eyes) underwent therapeutic keratoplasty. In one eye, the infectious process was stopped medically for 6 months.Conclusion. The combined PACK-CXL method together with fulguration can be effective and safe in the treatment of medically refractive acanthamoebic keratitis, allowing keratoplasty to be performed with an optical goal if necessary, after stopping the infection process in a distant period.

Current Trends in Treating Acanthamoeba Keratitis: A Brief Narrative Review

The Author, after examining the historical evolution of scientific knowledge and treatment of severe Acanthamoebic keratitis, presents this brief review on the treatment of this serious eye disease, relatively frequent in patients with corneal contact lenses. Therapy of Acanthamoeba keratitis is always very long and demanding. Its management requires adequate experience because it is not always easy to evaluate the response to treatment and complications can be very serious and difficult to manage. Resistance to therapy can also occur during treatment and must be distinguished from drug-induced toxicity. In cases where no improvement is obtained with maximum medical therapy, it is advisable to repeat the corneal sampling and proceed to new laboratory tests for Acanthamoeba, bacteria and fungi. Prevention, which always remains of fundamental importance, is practically based on avoiding contact of the corneal lens with contaminated water, since this Acanthamoeba has a ubiquitous diffusion. It is therefore recommended to always avoid the use of corneal contact lenses in the pool or in the shower, not to wash them under running tap water and to frequently replace the relative container of these lenses. Key Words: Acanthamoeba Keratitis, Corneal ulcer, Contact lenses.