Acanthamoeba Keratitis After Corneal Refractive Surgery: A Case Series and Literature Review

Abstract

PURPOSE: To report three cases with Acanthamoeba keratitis after laser vision correction and their treatment course and outcomes, and to compare these with the existing literature. METHODS: Case series and literature review. RESULTS: Three eyes of three patients presented with Acanthamoeba keratitis after laser vision correction and were treated with a high concentration of anti-amoebic medication after a timely diagnosis. In the first case, which occurred after laser in situ keratomileusis, there was an excellent recovery 1 month after treatment. In the second case, the uncorrected distance visual acuity (UDVA) after laser-assisted subepithelial keratectomy (LASEK) returned to 8/20 after similar anti-amoebic treatment, but for a period of 4 months. Despite using the same treatment regimen, the third case of Acanthamoeba keratitis after LASEK required a penetrating keratoplasty. This was deemed necessary because the cornea was completely infiltrated. There was no recurrence of the infection and the UDVA achieved 6 months postoperatively was 4/20. CONCLUSIONS: Early diagnosis and standardized postoperative management is the top priority in Acanthamoeba keratitis after laser vision correction. Glucocorticoids should stop when the infection is suspected and Acanthamoeba keratitis should always be considered, particularly when pain is severe and standard antibiotics fail. Intensive anti-amoebic treatment in the early period and judicious use of penetrating keratoplasty in Acanthamoeba keratitis after laser vision correction may benefit prognosis. [ Journal of Refractive Surgery Case Reports. 2022;2(2):e32–e37.]