case_images: PMC10601850_01
case_images: a Slit-lamp photograph of RE at initial presentation showing patchy stromal infiltrates with radial keratoneuritis. b Slit-lamp photograph of LE showing an epithelial defect along with a ring-shaped infiltrate with radial keratoneuritis and stromal edema. c Slit-lamp photograph of RE at 1-month follow-up showing resolving stromal infiltrates with early stromal scarring with radial keratoneuritis. d Slit-lamp photograph of LE at 1 month follow-up showing resolving stromal infiltrates with central stromal scarring with radial keratoneuritis. e Slit-lamp photograph of RE at 8 weeks of follow-up after complete resolution showing the faint stromal scar. f Slit-lamp photograph of LE at 15 weeks of follow-up showing central stromal scarring with amniotic membrane placement. g Anterior stroma biopsy specimen stained with 10% potassium hydroxide and 0.1% calcofluor white showing multiple bluish-white polygonal double-walled structures suggestive of Acanthamoeba cysts observed under x20 magnification in the fluorescent microscope. h Acanthamoeba cysts in clusters isolated on non-nutrient agar overlaid with Escherichia coli from one of the contact lenses culture.
case_images: cop-2023-0014-0001-533988_F01.jpg
case_images: PMC10601850_01_cop-2023-0014-0001-533988_F01.jpg
case_images: F1
case_images: Biomicroscopy of both eyes revealed palpebral edema, diffuse ciliary injection, conjunctival congestion, 360-degree limbitis, corneal stromal edema associated with whitish annular infiltrate extending toward the posterior stroma (Fig. 1a, b); fluorescein staining showed an epithelial defect extending throughout the lesion. We underwent corneal biopsy of the LE to confirm the suspected diagnosis, and Acanthamoeba cysts were identified in the sample (Fig. 1g). By this time, we gained symptomatic and clinical improvement, with less pain and better visual acuity (Fig. 1e). LE diminished; therefore, we decided to perform epithelial scraping with amniotic membrane placement (Fig. 1f). Likewise, the possibility of a RE corneal transplant was raised, and the patient was enrolled in the eye bank.
case_images: a Slit-lamp photograph of RE showing DALK of the RE. b LE showing central stromal scarring.
case_images: cop-2023-0014-0001-533988_F02.jpg
case_images: PMC10601850_01_cop-2023-0014-0001-533988_F02.jpg
case_images: F2
case_images: At week 25, RE underwent a deep anterior lamellar keratoplasty (DALK) (Fig. 2a).