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OPHTHALMIC IMAGES |
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Year : 2018 | Volume
: 66
| Issue : 11 | Page : 1623-1624 |
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Corneal “Plaque” formation after anti-acanthamoeba therapy in acanthamoeba keratitis
Rashmi Mittal1, Hitendra Ahooja1, Neelam Sapra2
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 Publication | 25-Oct-2018 |
Correspondence Address: Dr. Rashmi Mittal Ahooja Eye and Dental Institute, 560/1, New Railway Road, Dayanand Colony, Gurugram - 122 001, Haryana India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/ijo.IJO_734_18
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 |
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 | | |
1. | Sahu SK, Das S, Sharma S, Vemuganti GK. Acanthamoeba keratitis presenting as a plaque. Cornea 2008;27:1066-7. |
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. |
[Figure 1]
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