Treatment of advanced Acanthamoeba keratitis with deep lamellar keratectomy and conjunctival flap

Purpose. To describe whether deep lamellar keratectomy with a conjunctival flap is effective for the treatment of Acanthamoeba 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 Acanthamoeba 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 Acanthamoeba keratitis.