title: Combined acanthamoeba and Stenotrophomonas maltophilia keratitis treated with a conjunctival flap followed by penetrating keratoplasty.
abstract: OBJECTIVE
  To describe whether a technique of treatment of a combined acanthamoeba-stenotrophomonas keratitis with a conjunctival flap followed by a penetrating keratoplasty is successful.
  
  
  METHODS
  A case of chronic ring-shaped keratitis in which Stenotrophomonas maltophilia was isolated with corneal scrapings, and acanthamoeba cysts were found with a corneal biopsy. The infection was resistant to conventional medical treatment. It was treated with a conjunctival flap combined with corneal cryo treatment, followed by a penetrating keratoplasty 6 months later.
  
  
  RESULTS
  The patient achieved immediate pain relief after the conjunctival flap. All medications were tapered off over 3 months. A penetrating keratoplasty was performed after 6 months. The cornea remained clear and the best-corrected visual acuity is 20/25 2 years after surgery.
  
  
  CONCLUSIONS
  A combined acanthamoeba-stenotrophomonas keratitis, which is resistant to medical therapy, can be treated successfully with a conjunctival flap followed by a penetrating keratoplasty.
authors.affiliation: Department of Ophthalmology, The Ohio State University, Columbus, Ohio 43210, USA. Mauger.2@osu.edu
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Mauger
authors.forename: Elson
authors.initials: E
authors.lastname: Craig
mesh_terms: D000048:Acanthamoeba / Q000302:isolation & purification; D015823:Acanthamoeba Keratitis / Q000150:complications / Q000601:surgery*; D000818:Animals; D003228:Conjunctiva / Q000601:surgery*; D015818:Eye Infections, Bacterial / Q000150:complications / Q000601:surgery*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000601:surgery*; D006801:Humans; D015948:Keratoplasty, Penetrating; D008875:Middle Aged; D020615:Stenotrophomonas maltophilia / Q000302:isolation & purification*; D013524:Surgical Flaps