Bilateral Acanthamoeba keratitis with late recurrence of the infection in a corneal graft: a case report.
OBJECTIVE
To report a case of bilateral Acanthamoeba keratitis with late, atypical recurrence after penetrating keratoplasty a chaud.


METHODS
A 23-year-old contact lens wearer was treated for bilateral Acanthamoeba keratitis and underwent penetrating keratoplasty in the right eye for descemetocele with impending risk of perforation. The postoperative course was uneventful and topical steroids were combined with neomycin and propamidine. Two months after the operation in the right eye the patient presented with active infection in the left eye. One month later recurrence appeared in the right eye, as a central corneal infiltrate in the graft.


RESULTS
Recurrences in both eyes were successfully treated with a combination of hexamidine and neomycin, and with polyhexamethylene biguanide respectively. The right eye was regrafted three months after the recurrence and penetrating keratoplasty was done two years later in the left eye. Both grafts were successful and remained clear. There has been no further recurrence in the long-term follow-up.


CONCLUSIONS
Recurrence of Acanthamoeba keratitis after penetrating keratoplasty a chaud may occur even several months after the operation and the manifestation may be atypical. Current antiamoebal therapy was effective and regrafting in the quiet eye was successful.
Department of Ophthalmology and Visual Sciences, San Raffaele Hospital, Milano, Italy.
P
P
Rama
S
S
Matuska
M
M
Viganò
A
A
Spinelli
G
G
Paganoni
R
R
Brancato
D000048:Acanthamoeba / Q000302:isolation & purification; D015823:Acanthamoeba Keratitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001550:Benzamidines / Q000627:therapeutic use; D001645:Biguanides / Q000627:therapeutic use; D003263:Contact Lenses, Hydrophilic / Q000009:adverse effects*; D003315:Cornea / Q000469:parasitology* / Q000473:pathology; D004202:Disinfectants / Q000627:therapeutic use; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D009355:Neomycin / Q000627:therapeutic use; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity
D000900:Anti-Bacterial Agents; D001550:Benzamidines; D001645:Biguanides; D004202:Disinfectants; C031233:polihexanide; C018961:hexamidine; D009355:Neomycin