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Management of a Case of Advanced Acanthamoeba keratitis in a child using Topical F luconazole

Management of a Case of Advanced Acanthamoeba keratitis in a child using Topical F luconazole. Hatem Kobtan MD FRCS (Ed) ( Glasg ) Dina koptan MSC Cairo University. The Authors have no financial disclosure. Ocular History and Examination.

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Management of a Case of Advanced Acanthamoeba keratitis in a child using Topical F luconazole

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  1. Management of a Case of Advanced Acanthamoeba keratitis in a child using Topical Fluconazole Hatem Kobtan MD FRCS (Ed) (Glasg) Dina koptan MSC Cairo University The Authors have no financial disclosure

  2. Ocular History and Examination • A 14 year old girl presented with a central 8 X 8 mm corneal ring abscess of 1 month duration. A visual acuity of hand motion. • Culture of contact lens case and solution revealed Acanthamoeba castellanii. AcanthamoebakerattisKobtan ASCRS 2010

  3. Follow up on Topical Fluconazole C A B 4 weeks 8 weeks 19 weeks Fig A: shows gradual resolution of the infiltrate 4 weeks following initiation of topical Fluconazole 2%.Fig B: shows formation of a vascularizedleukoma 8 weeks later. Fig C: Resolution of the ciliary injection and clearing of peripheral cornea 19 weeks later. AcanthamoebakerattisKobtan ASCRS 2010

  4. A C B Fig A: shows angle occlusion on ultrasound biomicroscopy. Fig B: shows filtering bleb after subscleraltrabeculectomy with MMC was performed to lower refractory elevated IOP. Fig C: A pentratingkeratoplasty was performed 1 years later with vision correcting to 20/30 . AcanthamoebakerattisKobtan ASCRS 2010

  5. Take Home Message • Fluconazole is effective against some strains of acanthamoeba. • Culture CL case and solution is a corner stone in management of CL related keratitis. • Adequate control of IOP prior to performing PK to enhance graft survival. • Proper timing of PK avoiding the performance of such a procedure while the infection is active to increase the chance of graft survival. • Proper management of ambylopia in children following PK. • Regular follow up of PK cases to detect and treat early evidence of rejection.

  6. References • Two cases of early Acanthamoeba keratitis Nakagawa H, Kazami N, Izai K, Iwasaki M, Uchida Y, Yamaura H, Shirasaka R, Horikami H, Ishii K.NipponGankaGakkaiZasshi. 1993 Apr;97(4):544-50. • Evaluation of effective treatment drugs against Acanthamoeba cyst • Tahara K, Asari S, Shimomura Y, Endo T, Yanagihara T. • KansenshogakuZasshi. 1997 Oct;71(10):1025-30. Japanese.

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