Acanthamoeba Revenge

Acanthamoeba keratitis (AK) is a corneal infection characterized by an indolent course and challenging management. Known risk factors include contact lens (CL) wear, freshwater exposure, and trauma. Dr. Jaime Martinez and Pietro Carletti describe the case of a 55-year-old woman with a history of CL use who presented with a nonresolving corneal ulcer. Three weeks after onset, cultures demonstrated no growth, and AK was diagnosed with a corneal biopsy. Her condition improved initially with long-term maximal topical therapy, but then recurred and was refractory to aggressive treatment, including oral miltefosine and Rose Bengal photodynamic antimicrobial therapy. She progressed to develop scleral involvement, elevated intraocular pressures, and severe pain, and thus underwent therapeutic corneoscleral transplantation and open-sky cataract extraction. At 2 months after surgery, there were no signs of infection recurrence.

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