Diagnosis and treatment of acanthamoeba keratitis with confocal laser scaning microscope

Abstract

Objective To study the characteristics of the acanthamoeba keratitis,and to evaluate the value of confocal laser scanning microscope in the diagnosis and treatment. Methods The morphological characteristics and distribution were observed by confocal laser scanning microscope in 9 patients with acanthamoeba keratitis.The changes of acanthamoeba cysts,inflammatory cells and dendritic cells in the course of anti-acanthamoeba drug treatment were observed.Each patient had corneal scraping inspection and culture,3 patients had corneal pathological examination.Results Typical acanthamoeba cysts of 9 eyes were found in the superficial stroma or in the stroma with circular double-wall and well defined.Cysts distributed bead-like structure in 7 eyes.The patient had corneal ring infiltrates with more inflammatory cells and dendritic cells in the ring infiltrates than the central,but had no significant difference in the distribution of the central cysts.The patient had central corneal infiltrates with the same distribution of cysts,inflammatory cells and dendritic cells,and the main were inflammatory cells and dendritic cells at the early stage.After 1 month anti-Acanthamoeba drugs,a slight decline in dendritic cells,density of inflammatory cells and cysts was significantly decreased.After 2 months only a small amount of dendritic cells and inflammatory cells,the cysts rarely were detected.The number of positive result in corneal scrapping; in culture and pathological examination were 4,6 and 3.Conclusions The acanthamoeba cyst has a typical form of beaded distribution in the confocal laser scanning microscope.It will be a guide in the anti-acanthamoeba treatment with the changes of the acanthamoeba cysts,inflammatol cells and dendritic cells. Key words: Acanthamoeba keratitis; Confocal laser scanning microscope; Dendritic cells; Inflammatory cells; Cyst