Contact Lens-Related Acanthamoeba Keratitis

Abstract

Acanthamoeba keratitis is a rare but severe disease, with more than 95% of cases occurring in contact lens wearers. With a worldwide resurgence of contact lens-related disease, this report illustrates the clinical characteristics and treatment challenges representative of this disease. This report describes Acanthamoeba keratitis in a 47-year-old female using extended wear silicone hydrogel contact lenses, with a history of swimming in a home pool and failure to subsequently disinfect the contact lenses. The diagnosis was based on clinical signs, disease course, and confocal microscopy results despite a negative result for corneal smear and culture. The corneal signs included an epithelial defect, epithelial irregularities, anterior stromal infiltrates, perineural infiltrates, an anterior stromal ring infiltrate, and hypopyon. The case was diagnosed as an infective keratitis and treated promptly using intensive topical administration of fortified gentamicin and cephalothin. The high likelihood Acanthamoeba prompted immediate use of polyhexamethylbiguanide and chlorhexidine, with propamide and adjunct treatment using atropine and oral diclofenac. Steroids were added on day 3, and the frequency of administration of antibacterial treatment was gradually reduced and ceased by day 10. The analgesia was stopped at 3 months. The frequency of administration of antiamoeba therapy and steroid treatment was slowly reduced and all treatment was ceased after 18 months. Despite considerable morbidity in terms of the treatment duration, hospitalization, outpatient appointments, and associated disease costs, the final visual outcome (6/6) was excellent.

Postmarket Surveillance of Menicon Z Rigid Gas-Permeable Contact Lenses for up to 30 Days Continuous Wear in the United States

“…26 Many investigations about CL-related microbial keratitis have been reported. [27][28][29] However, based on the lack of microbial keratitis in this postmarket surveillance study and the low rate of other complications, we conclude that the CW of the Menicon Z hyper-Dk/t RGP lens provides a safe, full-time vision correction alternative for patients who can adapt to RGP lens wear.…”

Pharmacological treatment for infectious corneal ulcers

“…The incidence and/or prevalence of corneal ulceration with Acanthamoeba vary depending on geographic region and risk factors. In the more industrialized countries, contact lens wear (80 --90%) is the greatest risk factor with a rate of < 1/10,000 in the USA to 0.33/10,000 in Europe and parts of Asia [44][45][46]49,50]. The incidence in the UK is 15 times that in the USA.…”

Patient attitudes and level of compliance to soft contact lens care in Turkey

“…However, despite the progression in CL materials and designs, fitting success has been jeopardized by the occurrence of complications. These complications range from mild discomfort to severe microbial keratitis including acanthamoeba keratitis (1,2). Although CL related complications are rare, and most can be managed without any serious side-effects, vision loss does occur (3).…”