Surgical therapies for Acanthamoeba keratitis by phototherapeutic keratectomy and deep lamellar keratoplasty.
OBJECTIVE
To report the efficacy of phototherapeutic keratectomy (PTK) and deep lamellar keratoplasty (DLKP) in the treatment of Acanthamoeba keratitis.


METHODS
Two patients with delayed diagnosis of Acanthamoeba keratitis failed to respond to multiple systemic and topic antiamoebic agents supplemented by twice-weekly corneal scraping. Three weeks into such therapy, one developed a ring-shaped subepithelial infiltration and PTK was performed. The other was treated with DLKP for progressive keratitis that had invaded the midstromal layer after 50 days of medical therapy.


RESULTS
Improvements were observed immediately after the operations and medical therapy was gradually discontinued. Best-corrected visual acuity improved to 20/20 for both patients.


CONCLUSIONS
PTK and DLKP were found to be effective surgical procedures, especially for advanced Acanthamoeba keratitis that fails to respond to medical therapy and corneal debridement.
Department of Ophthalmology, Kinki University School of Medicine, Osaka-Sayama City, Japan. taenaka@ganka.med.kindai.ac.jp
Naoko
N
Taenaka
Masahiko
M
Fukuda
Tsuyoshi
T
Hibino
Yoko
Y
Kato
Eiko
E
Arimura
Yasuo
Y
Ishii
Yoshikazu
Y
Shimomura
D000048:Acanthamoeba / Q000648:ultrastructure; D015823:Acanthamoeba Keratitis / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D003315:Cornea / Q000601:surgery / Q000648:ultrastructure; D016039:Corneal Transplantation; D005260:Female; D006801:Humans; D054018:Lasers, Excimer; D008875:Middle Aged; D018903:Photorefractive Keratectomy; D017211:Treatment Failure; D014792:Visual Acuity
D000981:Antiprotozoal Agents