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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

doi: 10.1097/ICO.0b013e31829ded51
Case Report

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.

*Cornea Unit, Ophthalmology Department, Ramón y Cajal Hospital, Madrid, Spain; and

Department of Parasitology, Ecology and Genetics (Area of Parasitology), University Institute of Tropical Diseases of the Canary Islands, University of La Laguna, Tenerife, Spain.

Reprints: Francisco Arnalich-Montiel, Servicio de Oftalmología, Hospital Ramón y Cajal de Madrid. Carretera de Colmenar Viejo km. 9.100, 28034 Madrid, Spain (e-mail:

Supported by the Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo (PI021056) and Fundación Mutua Madrileña, Madrid, Spain.

F. Arnalich-Montiel contributed to the conception, design, analysis, and interpretation; drafting of the article, and to the final approval of the version. L. Jaumandreu and M. Leal contributed to the acquisition of data, revision of the article, and to the final approval of the version. B. Valladares contributed to analysis and interpretation of data, revision of the article, and to the final approval of the version. J. Lorenzo-Morales, contributed to the analysis and interpretation, drafting of the article, and the final approval of the version

The authors have no conflicts of interest to disclose.

Received May 01, 2013

Accepted May 28, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.