**2.1.3 Clinical findings and diagnosis**

Significant visual decrease (0.15-0.01) was seen in almost all cases. Slit lamp examination showed corneal infiltration in 2 cases, ring infiltration (Fig. 1. and 2.) in 3 cases and corneal abscess in 1 case. The diagnosis was based on corneal scraping in 2 cases, on histology in 2 cases, and on clinical findings in 2 cases.

#### **2.1.4 Medical treatment**

Treatment started with antiamoebic agents in all patients: dibromopropamide or propamidin and polihexamethilen biguanidine was administerd hourly in the first week, and then 5 times/day for at least 6 months. All patients were administered antibiotic drops 5 times a day for 2 weeks. Two patients had to use antiglaucomatic drops because of secondary glaucoma. We used steroid or non-steroid agents against the inflammation in seven cases.

medical treatment

dimopropamide +PHMB +neomycine +ciprofloxacin +diclofenac +timolol

dimopropamide +neomycine +fluorometholon +cyclopentholat

dimopropamide +PHMB +neomycine +ciprofloxacin +diclofenac

Between 2001 and 2006 we treated 11 patients with Acanthamoeba keratitis. The mean age of the patients was 30.2 years (16-65). The eight female and three male patients were all soft contact lens wearers. The right eye was affected in six and the left in five cases. 82% of the infections occurred in the summer period between June and September. The appropriate diagnosis of Acanthamoeba keratitis took 3 days to 2 months. Beside long-lasting conservative treatment perforating keratoplasty was performed in six cases. In the following

The infection was caused by poor and improper contact lens hygiene in each and every case. All lenses involved were hydrogel soft lenses: 1 daily, 4 monthly and 1 yearly disposable. None of the lenses have been applied for extended or continuous wear. Two patients rinsed the lenses in tap water, 4 patients went to swim in them. The half of the patients got the

Significant visual decrease (0.15-0.01) was seen in almost all cases. Slit lamp examination showed corneal infiltration in 2 cases, ring infiltration (Fig. 1. and 2.) in 3 cases and corneal abscess in 1 case. The diagnosis was based on corneal scraping in 2 cases, on histology in 2

Treatment started with antiamoebic agents in all patients: dibromopropamide or propamidin and polihexamethilen biguanidine was administerd hourly in the first week, and then 5 times/day for at least 6 months. All patients were administered antibiotic drops 5 times a day for 2 weeks. Two patients had to use antiglaucomatic drops because of secondary glaucoma.

We used steroid or non-steroid agents against the inflammation in seven cases.

keratoplasty surgical

after 1 month urgency keratoplasty (7.0/7.5 mm)

after 6 month urgency keratoplasty (7.5/7.5 mm)

after 2 years urgency keratoplasty (7.7/8.25 mm) treatment

corneal abrasion, phacoemulsifikation +IOL

ECCE+PCL+ trabeculectomy after 1 year

light

BCVA at latest follow up

perception

0.9

light perception

patient

age sex time till

diagnosis

4. 23 male 4 weeks 0.02 corneal

6. 65 female 2 months 0.15 clinical

we discuss these patients in details.

**2.1.3 Clinical findings and diagnosis** 

cases, and on clinical findings in 2 cases.

**2.1.4 Medical treatment** 

**2.1.1 Demographics** 

**2.1.2 Risk factors** 

5. 33 female 4 weeks 0.02 histology central

BCV A

diagnosis clinical

scrape

findings

lenses from opticians, the other half from ophthalmologists.

features

central corneal abscess

infiltration

central ringinfiltration

Table 1. Clinical data of our patients (BCVA=best corrected visual acuity)

Fig. 1. Anterior segment of patient No 5 before keratoplasty with corneal abscess

Fig. 2. Corneal scar of patient No 2 before optical keratoplasty

Keratoplasty in Contact Lens Related Acanthamoeba Keratitis 43

At the last follow up visit the visual acuity was 0.43. In 3 cases it was only light perception,

In the emergency cases the visual acuity was much worse (light perception in 3 cases and 0.9 in one case), then in the proposed cases (0.7 and 1.0). In 5 cases the cornea graft was clear,

Emergency keratoplasty or keratoplasty à chaud is often the only possible intervention to prevent complete and irreversible vision loss in patients with severe corneal disorders. The main indications for this urgent surgical procedure are corneal perforations or imminent perforations, maintaining the integrity of the globe, as well as persisting infectious keratitis. Due to acute inflammation of the anterior ocular segment, emergency keratoplasty is supposed to have a worse outcome and more postoperative complications especially more immune reactions than scheduled keratoplasty. Keratoplasty for management of the acute complications of Acanthamoeba keratitis has with few exceptions in small numbers of patients (Illingworth & Cook, 1998; Nguyen et al., 2010; Maier et al., 2007; Shi et al., 2009), generally been reported to have poor results. Graft failure due to recurrent infection is common when keratoplasty is performed in an inflamed eye. In most cases, however, keratoplasty has been successful in maintaining the integrity of the globe, and a second procedure has often resulted in a good visual outcome (Illingworth & Cook, 1998; Maier et

Fig. 4. Early postoperative status of patient No 2.

but the other 3 patients had very good visual acuity (0.7-1.0).

rejection and decompensation developed only in one case.

**2.1.8 Graft clarity and visual acuity** 

**2.2 Corneal graft surgery/keratoplasty** 

**2.2.1 Emergency keratoplasty** 

al., 2007).
