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Cornea:
doi: 10.1097/ICO.0b013e31829ded51
Case Report

Scleral and Intraocular Amoebic Dissemination in Acanthamoeba Keratitis

Arnalich-Montiel, Francisco MD, PhD*; Jaumandreu, Laia MD*; Leal, Marina MD*; Valladares, Basilio PhD; Lorenzo-Morales, Jacob PhD

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Abstract

Purpose:

To review an Acanthamoeba keratitis case series for the documented extracorneal spread of the amoeba.

Methods:

A retrospective review of an observational case series from a single institution.

Results:

Three patients with 4 instances of microbiologically confirmed extracorneal amoebic spread were identified. Patient 1 had nodular scleritis after undergoing penetrating keratoplasty and was treated successfully with double freeze–thaw cryotherapy; patient 2 had intraocular dissemination of the amoeba detected in a retrocorneal membrane; and patient 3 had, after undergoing tectonic keratoplasty, intraocular dissemination of the amoeba that was treated successfully with intraocular and systemic voriconazole and, afterwards, a nodular scleritis treated with double freeze–thaw cryotherapy and a large-diameter corneal graft to treat corneal recurrence.

Conclusions:

Acanthamoeba can migrate to the sclera or to the intraocular tissues in some instances, such as in long-standing disease or in penetrating keratoplasty. A prompt biopsy for microbiological analysis and early treatment are required, if this is suspected. Voriconazole can be effective for intraocular invasion when used orally and intraocularly. Scleral involvement might require a surgical approach with double freeze–thaw cryotherapy to treat the localized disease.

Copyright © 2013 by Lippincott Williams & Wilkins

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