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2009 OMIG, Abstract 8

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Acanthamoeba Endophthalmitis following Penetrating Keratoplasty for Acanthamoeba Keratitis.
M.J. Davis1,2, K.H. Packo1,2, R.J. Epstein1,3, R.J. Grostern1, J.A. Cohen1,2
1 Rush University Medical Center, Department of Ophthalmology , Chicago IL
2 Illinois Retina Associates, Chicago, IL
3 Chicago Cornea Consultants, Chicago, IL

Objective:  To present a case of and review the literature on Acanthamoeba endophthalmitis.
Methods:  Case report and literature review
Results:  A 61-year-old female contact lens wearer developed Acanthamoeba keratitis and subsequently underwent penetrating keratoplasty (PK) for impending corneal perforation.  Two weeks after the PK, she presented with pain, decreased vision and a hypopyon.  Initially she was treated for presumed sterile inflammation without improvement.  She subsequently underwent a vitreous tap with injection of antibiotics.  After her condition worsened, she underwent pars plana vitrectomy with lensectomy.  Her vitreous cultures from the tap were positive for Acanthamoeba.  Her inflammation never subsided.  Because of persistently positive cultures, she was enucleated.  There is only one case of chorioretinitis in the literature secondary to Acanthamoeba keratitis that was confirmed by histological examination.  In addition, there are a few cases likely secondary to hematogenous spread of Acanthamoeba or other amoebae.
Conclusions:  Our patient had clear evidence of intraocular inflammation with a hypopyon.  Acanthamoeba was isolated from the vitreous tap, and no other organisms were isolated from any cultures.  The spread was directly from the cornea. As our patient developed endophthalmitis secondary to Acanthamoeba keratitis, we caution other practitioners to consider this possibility in patients who present with intraocular inflammation associated with Acanthamoeba keratitis with or without a history of prior penetrating keratoplasty.

Grant/Financial Support:  None
Disclosure Code: N

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