Surgical Therapies for Acanthamoeba Keratitis by Phototherapeutic Keratectomy and Deep Lamellar Keratoplasty

Abstract

PTK and DLKP were found to be effective surgical procedures, especially for advanced Acanthamoeba keratitis that fails to respond to medical therapy and corneal debridement.

Update on phototherapeutic keratectomy

“…Recent literature that confirms its successful use even in cases with active acanthamoeba infection [14] or in postherpetic corneal scars [3] may encourage a most liberal use of PTK in these cases. The finding that different genotypes of corneal dystrophies affect the result of PTK [11 ] can inspire further studies that may identify certain genotypes that predict better response to PTK.…”

“…A recent study from Japan proposed PTK as an effective surgical treatment of advanced acanthamoeba keratitis that does not respond to medical therapy or corneal debridement [14]. They reported a case of a patient with ring-shaped subepithelial infiltrate not responding after 3 weeks of combination topical chlorhexidine gluconate and fluconazole, and oral itraconazole treatment.…”

Phototherapeutic keratectomy

“…PTK has been tried in eyes with both healed as well as active corneal ulcers. PTK has been used as an adjunctive therapy in the eyes with nonresponsive acanthamoeba keratitis, 1,2,196 fungal keratitis, 101,103 post-LASIK atypical mycobacterial infections, 95,104 postburn persistent corneal ulcers, 97 and shield ulcer after vernal keratoconjunctivitis. 26 Advantages include reduction in the duration of ongoing treatment, faster reepithelialization, and debulking of stroma, resulting in improved drug penetration.…”

“…Yeung and coworkers 221 performed combined implantation of intracorneal ring segments with TE-PTK, followed by CXL, and found significant improvement in UDVA and corrected visual acuity at 6-month follow-up (Table 1). 196 A combined procedure is advantageous in terms of reduced stromal scarring, caused by separate procedures, 77 better patient compliance, and an additive effect obtained with combined procedures compared with sequential treatment. 77…”

Keratoplasty in Contact Lens Related Acanthamoeba Keratitis

“…Advantages of DLK in infectious keratitis include less risk of intraocular entry of infectious organisms at the time of surgery and the potential for improved graft survival rates caused by less endothelial rejection and failure. In patients with severe disease involving the visual axis, earlier surgery with DLK would allow debulking of the organisms as well as preservation of autogenous endothelial cell function (Parthasarathy & Tan, 2007;Por et al, 2009;Taenaka et al, 2007). In some cases enucleation or evisceration is needed, because of inflammation, infection or secundary glaucoma (Bacon et al, 1993;Radford et al, 1998;Reinhard & Sundmacher, 2000).…”