Abstract

Purpose
To report the clinical course and postoperative management strategy for emergency therapeutic penetrating keratoplasty (PKP) in a patient with rapidly progressive Acanthamoeba keratitis.
Case
summary: A 23-year-old female patient with a history of long-term orthokeratology lens wear presented with Acanthamoeba keratitis in the right eye. The diagnosis had been established at a referring hospital based on characteristic clinical findings, and topical antiamoebic therapy was initiated, resulting in initial clinical improvement. After polyhexamethylene biguanide was discontinued, an epithelial defect recurred. Amniotic membrane transplantation with adjunctive topical corticosteroids was then performed, after which corneal infiltration and inflammation worsened. At presentation to our clinic, best-corrected visual acuity (BCVA) was light perception, and intraocular pressure was elevated to 34.1 mmHg. Slit-lamp biomicroscopic examination revealed extensive corneal infiltration accompanied by hypopyon. Emergency therapeutic PKP was performed the following day because of uncontrolled infection with severe stromal thinning. Postoperatively, intensive antiamoebic therapy was administered, and topical corticosteroids were initially withheld. Systemic immunosuppression was introduced 1 week postoperatively to manage early graft rejection. Management required careful balancing of immunosuppression for graft survival against the risk of recurrent Acanthamoeba infection. Extensive inferior corneal neovascularization was observed and required additional interventions, including subconjunctival bevacizumab injection. At 5 to 6 months postoperatively, the graft remained clear, with no evidence of recurrent infection, and BCVA had improved to 0.7.
Conclusion
Timely emergency therapeutic PKP with careful postoperative management may serve as a vision-preserving strategy in patients with rapidly progressive Acanthamoeba keratitis.

• Keywords: Acanthamoeba keratitis; Penetrating keratoplasty; Corneal neovascularization; Disease progression; Treatment outcome