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OPHTHALMIC IMAGES
Year : 2018  |  Volume : 66  |  Issue : 11  |  Page : 1623-1624

Corneal “Plaque” formation after anti-acanthamoeba therapy in acanthamoeba keratitis


1 Cornea and Anterior Segment Services, Ahooja Eye and Dental Institute, Gurugram, Haryana, India
2 Department of Microbiology, Dr. Sapra's Lab, Gurugram, Haryana, India

Date of Web Publication25-Oct-2018

Correspondence Address:
Dr. Rashmi Mittal
Ahooja Eye and Dental Institute, 560/1, New Railway Road, Dayanand Colony, Gurugram - 122 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_734_18

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How to cite this article:
Mittal R, Ahooja H, Sapra N. Corneal “Plaque” formation after anti-acanthamoeba therapy in acanthamoeba keratitis. Indian J Ophthalmol 2018;66:1623-4

How to cite this URL:
Mittal R, Ahooja H, Sapra N. Corneal “Plaque” formation after anti-acanthamoeba therapy in acanthamoeba keratitis. Indian J Ophthalmol [serial online] 2018 [cited 2024 Mar 29];66:1623-4. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2018/66/11/1623/244076



A 48-year-old woman presented to us with left eye microbial keratitis. Corneal scraping revealed acanthamoeba cysts on microbiology examination. After 4.5 months of treatment with chlorhexidine 0.02% and polyhexamethylene biguanide (PHMB) 0.02% eye drops she presented with a tough “plaque” lesion involving the inferior cornea. The plaque was carefully excised in toto and sent for laboratory tests. Both microbiology and histopathology examinations revealed presence of numerous acanthamoeba cysts within the plaque along with dystrophic calcification [Figure 1].
Figure 1: (a) Slit lamp photograph demonstrating a double ring infiltrate of acanthamoeba keratitis at presentation. (b) “Plaque” formation following 4.5 months of anti-acanthamoeba therapy. (c and d) Numerous double-walled acanthamoeba cysts visible on microbiology and histopathology examination of the plaque lesion

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Plaque lesions in acanthamoeba keratitis is an uncommon feature.[1] Topical anti-acanthamoeba medications alone are unlikely to result in a plaque formation, but its interaction with other drugs like dexamethasone can lead to its precipitation on the ocular surface.[2] When encountered they should be surgically excised as they may harbor acanthamoeba cysts that can lead to persistence or recurrence of the infection.

Plaque lesion in acanthamoeba, though rare, mandates surgical removal in order to decrease the infective load and allow better drug penetration.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sahu SK, Das S, Sharma S, Vemuganti GK. Acanthamoeba keratitis presenting as a plaque. Cornea 2008;27:1066-7.  Back to cited text no. 1
    
2.
Livingstone I, Stefanowicz F, Moggach S, Connolly J, Ramamurthi S, Mantry S, et al. New insight into non-healing corneal ulcers: Iatrogenic crystals. Eye (Lond) 2013;27:755-62.  Back to cited text no. 2
    


    Figures

  [Figure 1]


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