Rapid Corneal Melt From Dual Acanthamoeba and Pseudomonas aeruginosa Keratitis

Abstract:

A 27-year-old woman, contact lens wearer, visited the ophthalmology department with acute ocular pain, photophobia, and a reduction in visual acuity. A slit-lamp examination was performed, and the signs were a central corneal ulcer along with corneal thinning, hypopyon, an immune ring, and radial perineuritis. Cultures were obtained from this corneal area that grew Pseudomonas aeruginosa . Confocal microscopy revealed cystic structures suggestive of Acanthamoeba , although PCR testing yielded negative results. Therefore, immediate antibiotic and antiamoebic treatment were initiated to cover each cause. The team persisted in combined antimicrobial treatment. In every reexamination of the patient, there was a nonhealing epithelial defect with progressive stromal instability. Corneal neovascularization was becoming prominent. Given the growing risk of corneal perforation, a therapeutic penetrating keratoplasty was performed. Intrastromal bevacizumab was administered intraoperatively and at scheduled postoperative follow-up visits to control corneal neovascularization. Postoperatively, the infection was controlled with continued antibacterial treatment, and the graft remained clear. During this healing process, best-corrected visual acuity improved to 6/10. Presumed polymicrobial keratitis involving culture-proven P. aeruginosa and confocal-supported Acanthamoeba infection can cause serious corneal damage. In this type of corneal stromal thinning, therapeutic penetrating keratoplasty should be performed, and intrastromal anti-VEGF agents can control neovascularization.