new mangement in acanthameba keratiti

1. 
THEnewold corneamonster

3. 
Objectives
 Introduction
 Epidemiology
 Clinical presentation
 Diagnosis
 Management
 Cases

4. 
Introduction
 Acanthamoeba keratitis, first
recognized in 1973, is a rare,
vision threatening, parasitic
infection seen in contact lens
wearers( not exclusive ) . It is
often characterized by pain out
of proportion to findings . It is
both difficult to diagnose and
difficult to treat.

5. 
Introduction

6. 
Epidemiology

7. 
 Acanthamoeba keratitis is rare. In the US, only one to two people per
million contact lens wearers develop the condition each year. It’s even
more rare in people who don’t wear contact lenses.
 now it is related to contaminated water, it is wide spread
Epidemiology

8. 
Who is at risk ?!

9. 
 soft contact lenses wearers have
greater risk of this condition if :
 tap water
 Come into contact with water .
 store contact lenses improperly.
 damage to cornea.
 Swim, shower with contact
lenses.
Risk Factors

10. 
Microbiology

11. 
Microbiology

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13. 
 Blurred vision or vision loss.
 pain
 redness.
 FBs Sensation.
 Sensitivity to light.
 Lacrimation.
 Whitish rings on the surface of the eye.
 It can take several days to several weeks for symptoms to show up after
the acanthamoeba enters your eye.
Symptoms

14. 
 Early signs may be mild and non-specific
 epithelial irregularities
 epithelial or anterior stromal infiltrates
 Pseudo dendrites
 Deep stromal infiltrates (ring-shaped)
 corneal perforation
 satellite lesions
 persistent epithelial defects
 radial keratoneuritis
 anterior uveitis with hypopyon, peripheral anterior synechiae
 Advanced signs include stromal thinning and corneal perforation.
Signs

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Early epith lesions

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Ring infilterate

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Advanced signs

18. 
DIAGNOSIS
 Don’t trust all History from the patient’s mouth.

19. 
 It’s easy to misdiagnose this infection because the symptoms
are similar to those of other corneal diseases. So, it’s very
important to tell your healthcare provider if you’ve been in
contact with any potentially contaminated water or other
substances.
DIAGNOSIS

20. 
DIAGNOSIS

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 Corneal scraping:
This the most important step of
diagnosis
Corneal scraping is a procedure to
remove cells from the surface of the
cornea. We use a small blade or
brush to remove cells. Study the cells
under a microscope.
Give up the proper diagnosis
Corneal scraping

22. 
 After scraping the cornea
 Fixate smear by 70% alcohol
 Wait until it is dry
 Stain it with eosin for 5 seconds , repeat it 5 times
 Stain it with crystal violet for 5 seconds , repeat it 5 times
 Wash smear by water
 Wait until it is dry
 Now u are ready to see smear under microscope
Giemsa stain

23. 
Cysts by giemsa stain

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 Confocal microscopy:
This exam uses laser light to
create highly detailed images
of every layer in your cornea.
Your healthcare provider
uses a special microscope to
see corneal cells, nerves and
any parasites, such as the
acanthamoeba
Confocal microscopy

25. 
Management

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 Medical treatment for Acanthamoeba keratitis is still evolving.
 Success has been reported with various combinations of antibiotic, antiviral,
antifungal, and ant parasitic drugs.
 Different regimens include combinations of diamidines, biguanides,
antibiotics and antifungals. Some topical preparations of diamidines are
propamidine-isethionate (0.1)
 Biguanides include polyhexamethylene biguanide (PHMB)
 chlorhexidine ( 0.02—0.08)
 Neomycin-polymyxin B-gramicidin is thought to kill bacteria which provides
a food source for the acanthamoeba
 Antifungals include topical and oral preparations of voriconazole as well as
ketoconazole, fluconazole
Medical therapy

27. 
Available drugs

28. 
Available drugs

29. 
PTK
Mostly we use PTK
When lesion is
superficiel

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 Injection of voriconazole ( vfend 200mg) 1%
 Injection of amphotercine B 0.05 mg
Intra_stromal injection

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 DALK --------- In deep stromal infiltration
 Penetrating keratoplasty (PKP) ------- if perforated.
Keratoplasty

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Cases

33. 
 Female patient 58 ys
 Referred by bil ulcer // melt od
 By Medical ( diflucan &chlorh 0.02) + Alchol delamination
 +od selfsealed
 os improved
 was advised by dr/ehab to go for therapeutic graft
Case 1

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Case 1

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Case 1

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Referred from oculeoplastic clinic and was treated as
viral by ganvair
After smear treated by medical (difl +chlorhex 0.02) +
antiblephritis +antigluacomatos
healed then returned from oculeoplastic clinic with
descmatocele //perforated then sealed
Case 2

37. 
Case 2

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 female patient 22 ys with contact lens wear
After smear ( it was +ve for acanthameba cysts )
 with Medical ( dif + chlorh 0.02 ) // delamination
She is healed
Case 3

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Case 3

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Thank You