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Acanthamoeba scleral abscess reoccurring after penetrating keratoplasty
  1. Brad Barnett1 and
  2. Kyle McCloskey2
  1. 1Ophthalmology, Duke Medicine, Durham, North Carolina, USA
  2. 2University Health Systems of Eastern Carolina, Greenville, North Carolina, USA
  1. Correspondence to Dr Brad Barnett; bradpbarnett{at}gmail.com

Abstract

Two months following penetrating keratoplasty for Acanthamoeba keratitis, a 76-year-old man was referred due to inability to wean high-dose topical steroids. Despite a very healthy graft and minimal pain, a scleral abscess involving three clock hours of the superior conjunctiva was present. The patient underwent conjunctival and scleral excision of the area of apparent infection with adjuvant mitomycin C and double freeze–thaw cryotherapy treatment followed by amniotic membrane graft. Recurrence was confirmed with PCR. Following a multimonth regimen of oral voriconazole and topical polyhexamethylene biguanide, chlorhexidine and moxifloxacin, the patient was weaned from all anti-infectious agents. After cataract surgery and scleral lens fitting, the patient is now 20/20 in the affected eye. This case highlights the need for judicious use of immunosuppressive agents as well as the necessary vigilance to monitor for recurrence with Acanthamoeba infection. It also represents the first reported use of adjuvant mitomycin C and double freeze–thaw cryotherapy for treatment of Acanthamoeba scleral abscess.

  • anterior chamber
  • ophthalmology
  • surgery
  • pharmacology and therapeutics
  • infectious diseases

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Footnotes

  • Twitter @DrBradBarnett

  • Contributors BB was involved in (1) conception and design, acquisition of data or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; (3) conception and design, acquisition of data or analysis and interpretation of data; (4) final approval of the submitted manuscript; (5) agrees to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved. KM was involved in (1) conception and design, acquisition of data or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; (3) conception and design, acquisition of data or analysis and interpretation of data; (4) final approval of the submitted manuscript; (5) agrees to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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