management of a case of advanced acanthamoeba keratitis in a child using topical f luconazole
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Management of a Case of Advanced Acanthamoeba keratitis in a child using Topical F luconazole. Hatem Kobtan MD FRCS (Ed) ( Glasg ) Dina koptan MSC Cairo University. The Authors have no financial disclosure. Ocular History and Examination. - PowerPoint PPT PresentationTRANSCRIPT
Management of a Case of Advanced Acanthamoeba keratitis in a child
using Topical Fluconazole
Hatem Kobtan MD FRCS (Ed) (Glasg) Dina koptan MSC Cairo University
The Authors have no financial disclosure
A 14 year old girl
presented with a central 8 X 8 mm corneal ring abscess of 1 month duration. A visual acuity of hand motion.
Culture of contact lens case and solution revealed Acanthamoeba castellanii.
Ocular History and Examination
Acanthamoeba kerattis Kobtan ASCRS 2010
4 weeks 8 weeks
Fig A: shows gradual resolution of the infiltrate 4 weeks following initiation of topical Fluconazole 2%. Fig B: shows formation of a vascularized leukoma 8 weeks later. Fig C: Resolution of the ciliary injection and clearing of peripheral cornea 19 weeks later.
Follow up on Topical Fluconazole
19 weeks A B C
Acanthamoeba kerattis Kobtan ASCRS 2010
B
Fig A: shows angle occlusion on ultrasound biomicroscopy. Fig B: shows filtering bleb after subscleral trabeculectomy with MMC was performed to lower refractory elevated IOP. Fig C: A pentrating keratoplasty was performed 1 years later with vision correcting to 20/30 .
A C
Acanthamoeba kerattis Kobtan ASCRS 2010
Fluconazole is effective against some strains of acanthamoeba.
Culture CL case and solution is a corner stone in management of CL related keratitis.
Adequate control of IOP prior to performing PK to enhance graft survival.
Proper timing of PK avoiding the performance of such a procedure while the infection is active to increase the chance of graft survival.
Proper management of ambylopia in children following PK.
Regular follow up of PK cases to detect and treat early evidence of rejection.
Take Home Message
Two cases of early Acanthamoeba keratitis Nakagawa H, Kazami N, Izai K, Iwasaki M, Uchida Y, Yamaura H, Shirasaka R, Horikami H, Ishii K.Nippon Ganka Gakkai Zasshi. 1993 Apr;97(4):544-50.
Evaluation of effective treatment drugs against Acanthamoeba cystTahara K, Asari S, Shimomura Y, Endo T, Yanagihara T.Kansenshogaku Zasshi. 1997 Oct;71(10):1025-30. Japanese.
References