title: Scleral and intraocular amoebic dissemination in Acanthamoeba keratitis.
abstract: OBJECTIVE
  To review an Acanthamoeba keratitis case series for the documented extracorneal spread of the amoeba.
  
  
  METHODS
  A retrospective review of an observational case series from a single institution.
  
  
  RESULTS
  Three patients with 4 instances of microbiologically confirmed extracorneal amoebic spread were identified. Patient 1 had nodular scleritis after undergoing penetrating keratoplasty and was treated successfully with double freeze-thaw cryotherapy; patient 2 had intraocular dissemination of the amoeba detected in a retrocorneal membrane; and patient 3 had, after undergoing tectonic keratoplasty, intraocular dissemination of the amoeba that was treated successfully with intraocular and systemic voriconazole and, afterwards, a nodular scleritis treated with double freeze-thaw cryotherapy and a large-diameter corneal graft to treat corneal recurrence.
  
  
  CONCLUSIONS
  Acanthamoeba can migrate to the sclera or to the intraocular tissues in some instances, such as in long-standing disease or in penetrating keratoplasty. A prompt biopsy for microbiological analysis and early treatment are required, if this is suspected. Voriconazole can be effective for intraocular invasion when used orally and intraocularly. Scleral involvement might require a surgical approach with double freeze-thaw cryotherapy to treat the localized disease.
authors: *Cornea Unit, Ophthalmology Department, Ramón y Cajal Hospital, Madrid, Spain; and †Department of Parasitology, Ecology and Genetics (Area of Parasitology), University Institute of Tropical Diseases of the Canary Islands, University of La Laguna, Tenerife, Spain.
authors: Francisco
authors: F
authors: Arnalich-Montiel
authors: Laia
authors: L
authors: Jaumandreu
authors: Marina
authors: M
authors: Leal
authors: Basilio
authors: B
authors: Valladares
authors: Jacob
authors: J
authors: Lorenzo-Morales
mesh_terms: D015823:Acanthamoeba Keratitis / Q000150:complications* / Q000628:therapy; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D017679:Cryotherapy; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000627:therapeutic use; D012189:Retrospective Studies; D015423:Scleritis / Q000469:parasitology* / Q000628:therapy; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole