Acanthamoeba keratitis is a rare but serious complication of contact lens wear that may cause severe visual loss. The clinical picture is usually characterised by severe pain, sometimes disproportionate to the signs, with an early superficial keratitis that is often misdiagnosed as herpes simplex virus (HSV) keratitis. Advanced stages of the infection are usually characterised by central corneal epithelial loss and marked stromal opacification with subsequent loss of vision. In this paper, six cases of contact lens-related Acanthamoeba keratitis that occurred in Australia and New Zealand over a three-year period are described. Three of the patients were disposable soft lens wearers, two were hybrid lens wearers and one was a rigid gas permeable lens wearer. For all six cases, the risk factors for Acanthamoeba keratitis were contact lens wear with inappropriate or ineffective lens maintenance and exposure of the contact lenses to tap or other sources of water. All six patients responded well to medical therapy that involved topical use of appropriate therapeutic agents, most commonly polyhexamethylene biguanide and propamidine isethionate, although two of the patients also subsequently underwent deep lamellar keratoplasty due to residual corneal surface irregularity and stromal scarring. Despite the significant advances that have been made in the medical therapy of Acanthamoeba keratitis over the past 10 years, prevention remains the best treatment and patients who wear contact lenses must be thoroughly educated about the proper use and care of the lenses. In particular, exposure of the contact lenses to tap water or other sources of water should be avoided.

Background: To investigate the ocular microbiome in meibomian gland dysfunction in Auckland, New Zealand.

This study confirms that keratoconus may continue to progress beyond age 30. Older subjects with keratoconus should be monitored for progression, particularly with respect to possible corneal collagen cross-linking or astigmatic correction in cataract surgery.

Reports indicate the presence of up to three independent cone shapes in keratoconus (round/oval/global) but the preponderance of one cone over another is unclear. This work evaluates keratoconic corneal topography and corneal thickness using videokeratoscopy and ultrasound pachometry, respectively. An EyeSys videokeratoscope (VKS) (EyeSys Laboratories, Houston, TX, USA) was used to assess the topography of 54 keratoconic eyes (27 subjects) and 27 age-matched normals. In addition, ultrasonic pachometry measurements were made over 14 known areas in normal and keratoconic eyes. Corneal thinning was significant for all keratoconic areas measured except for the far temporal cornea. A correlation between corneal radius and thickness was evident. Analysis of cone shape revealed a potential fourth variety: the asymmetric bow-tie cone. Further topographic evaluation of this cone entity using the VKS revealed its dependence on gaze direction which may account for apparent differences in progression patterns between round and bow-tie cones.

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