Treatment of advanced acanthamoeba keratitis with deep lamellar keratectomy and conjunctival flap.

摘要

PURPOSE To describe whether deep lamellar keratectomy with a conjunctival flap is effective for the treatment of keratitis.METHODS Two patients (three eyes) had at least a 4-week history of painful keratitis misdiagnosed as herpetic keratitis and bacterial keratitis. Both patients were started on multiple topical antiamoebic drugs after infection was confirmed. No improvement was observed after 3-4 weeks. Surgery was then performed. Peribulbar anesthesia was given, and the infected tissue was removed by deep lamellar keratectomy. A bipediculate conjunctival flap was put in place and secured with interrupted 10-0 nylon sutures.RESULTS Both patients experienced immediate pain relief. The infection was controlled and all medications were tapered. There were neither necrosis nor retraction of the flap. Final examination revealed a Best-corrected visual acuity (BCVA) of 20/100 in each eye in the patient described in case number one at 30 months, and 20/100 in the patient described in case number two at 13 months.CONCLUSION Deep lamellar keratectomy with a conjunctival flap is a suitable approach to help control the infection and to help relieve pain in patients with advanced keratitis.