Good visual outcome after prompt treatment of acanthamoeba keratitis associated with overnight orthokeratology lens wear.
OBJECTIVE
To describe a patient with a good visual outcome after prompt treatment of Acanthamoeba keratitis as a complication of overnight orthokeratology lens wear.


METHODS
Interventional case report.


RESULTS
A 9-year-old boy experienced pain, photophobia, and redness in his right eye 3 days after visiting a swimming pool. He had been wearing overnight orthokeratology lenses for 5 months for the correction of moderate myopia in both eyes. On examination, best-corrected visual acuity in the right eye was 20/40. A diagnosis of Acanthamoeba keratitis with the presence of the classic feature of perineural infiltrates was made. The patient responded well to treatment with polyhexamethylene biguanide and propamidine isethionate (Brolene). Culture of corneal scrapings and contact lens solution showed heavy growth of Acanthamoeba. Treatment was tapered gradually during the next 4 months, and the final best-corrected visual acuity was 20/25.


CONCLUSIONS
Acanthamoeba keratitis may be a vision-threatening complication associated with overnight orthokeratology lens wear. It is essential for eye care professionals to fully explain and warn parents of the potential downsides that may be associated with orthokeratology. Ophthalmologists should have a high level of suspicion of this complication because prompt diagnosis and treatment can result in good visual outcome.
Wong
Victoria W Y
VW
Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, People's Republic of China. drvwong@hotmail.com
Chi
Stanley C C
SC
Lam
Dennis S C
DS
D015823:Acanthamoeba Keratitis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D001550:Benzamidines / Q000627:therapeutic use; D001645:Biguanides / Q000627:therapeutic use; D002648:Child; D002940:Circadian Rhythm; D018639:Contact Lens Solutions; D003261:Contact Lenses / Q000009:adverse effects*; D003315:Cornea / Q000382:microbiology; D004340:Drug Contamination; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D054158:Orthokeratologic Procedures / Q000009:adverse effects*; D014792:Visual Acuity
D001550:Benzamidines; D001645:Biguanides; D018639:Contact Lens Solutions; C053597:dibrompropamidine; C031233:polihexanide