Combined Acanthamoeba and Stenotrophomonas maltophilia Keratitis Treated With a Conjunctival Flap Followed by Penetrating Keratoplasty

Abstract

To describe whether a technique of treatment of a combined acanthamoeba-stenotrophomonas keratitis with a conjunctival flap followed by a penetrating keratoplasty is successful. A case of chronic ring-shaped keratitis in which Stenotrophomonas maltophilia was isolated with corneal scrapings, and acanthamoeba cysts were found with a corneal biopsy. The infection was resistant to conventional medical treatment. It was treated with a conjunctival flap combined with corneal cryo treatment, followed by a penetrating keratoplasty 6 months later. The patient achieved immediate pain relief after the conjunctival flap. All medications were tapered off over 3 months. A penetrating keratoplasty was performed after 6 months. The cornea remained clear and the best-corrected visual acuity is 20/25 2 years after surgery. A combined acanthamoeba-stenotrophomonas keratitis, which is resistant to medical therapy, can be treated successfully with a conjunctival flap followed by a penetrating keratoplasty.