PMC3422145_01
Slit lamp and in vivo laser confocal microscopic examination of case 15. (A) The right cornea on initial presentation to our hospital. Epithelial defects and subepithelial opacities were observed in the central cornea by slit-lamp biomicroscopy. Radial keratoneuritis lesions (arrows) and inflamed conjunctiva were also observed. (B) Recurrence of AK one month after treatment. Subepithelial opacity and anterior chamber reaction were increased. (C) In vivo laser confocal microscopy of recurrent AK showed a number of highly reflective, high-contrast round-shaped particles 10-15 mum in diameter (arrows), suggestive of Acanthamoeba cysts in the epithelial basal cell layer (bar 50 mum). Double-walled cysts were not detectable. (D) In the epithelial basal cell layer, numerous dendritic cells (putative Langerhans cells) were observed. A decrease in subbasal nerves (arrows) was also noted. (E and F) At the Bowman's layer level, numerous Acanthamoeba cysts were observed as highly reflective, high-contrast particles with an approximate diameter of 10 mum. Some of the Acanthamoeba cysts were present in small clusters (arrows). Note the diameter of the cysts in Bowman's layer (10 mum) was smaller than that observed in the epithelial cell layer (10-15 mum). (G) Activated keratocytes forming a honeycomb pattern were observed in the stromal layer. However, Acanthamoeba cysts were not detectable in the deep stroma in this case. (H) Clusters of leukocytes (arrows) were observed in the endothelial layer. (I) Slit-lamp photograph 9 months after treatment.. Notes: The AK healed after 13 epithelial debridements with topical micafungin 0.1% and topical chlorhexidine 0.05%. Despite slight stromal scar formation, the best corrected visual acuity recovered to 20/32 OD.. Abbreviations: AK, Acanthamoeba keratitis; OD, oculus dexter (right eye).
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AK was made by conjunctival injection, radial keratoneuritis, and subepithelial infiltration observed on slit-lamp biomicroscopy (Figure 1A). At the same time, many Acanthamoeba cysts were identified in the epithelial cell layer by HRT 2-RCM. HRT 2-RCM, low-dose topical corticosteroid (fluorometholone 0.1% 4 times a day) was started on suspicion of residual noninfectious corneal inflammation and/or a drug toxicity reaction. However, deterioration of the conjunctival injection and corneal stromal cloudiness were observed (Figure 1B). Acanthamoeba cysts were detected in the epithelial cell layer (Figure 1C). Additionally, many Acanthamoeba cysts in the Bowman's layer were observed (Figure 1E and F). In the basal epithelial cell layer, numerous dendritic cells (putative Langerhans cells) with a decrease of subbasal nerves were observed (Figure 1D). An increase in background intensity of the stroma with honeycomb formation of activated keratocytes was observed (Figure 1G). Clusters of leukocytes were observed at the depth of the endothelial cell layer (Figure 1H). The AK was cured with slight stromal scar formation (Figure 1I).
PMC3422145_02
Slit-lamp and in vivo laser confocal microscopic examination of case 16. (A) The left cornea at initial presentation to our hospital. Subepithelial opacities and radial keratoneuritis lesions (arrows) were observed by slit-lamp biomicroscopy. Inflamed conjunctiva was also observed. (B) AK recurred 50 days after treatment. Ring-form infiltration appeared. Anterior chamber reaction increased. (C) In vivo laser confocal microscopy of recurrent AK showed a number of highly reflective, high-contrast particles 10-15 mum in diameter, suggesting Acanthamoeba cysts in the epithelial basal cell layer (bar 50 mum). (D) Oblique view of the superficial cornea. Acanthamoeba cysts (arrows) were clearly recognized in Bowman's layer. (E and F) In Bowman's layer, characteristic clusters of Acanthamoeba cysts were observed as highly reflective, high-contrast particles with a diameter of approximately 10 mum. (G) The superficial stroma showed high reflectivity without Acanthamoeba cysts. (H) In the endothelial layer, leukocytes were observed. (I) Slit-lamp photograph 12 months after treatment.. Notes: The AK healed after 20 epithelial debridements with topical micafungin 0.1% and topical chlorhexidine 0.05%. Despite stromal scar formation, the best corrected visual acuity had recovered to 20/60 OS.. Abbreviations: AK, Acanthamoeba keratitis; OS, oculus sinister (left eye).
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AK was made by conjunctival injection, radial keratoneuritis, and subepithelial infiltration observed on slit-lamp biomicroscopy (Figure 2A). At the same time, many Acanthamoeba cysts were identified in the epithelial cell layer by HRT 2-RCM. However, radial keratoneuritis ring infiltration appeared (Figure 2B). Acanthamoeba cysts were detected in the epithelial cell layer (Figure 2C). Additionally, many Acanthamoeba cysts in the Bowman's layer were observed (Figure 2D-F). An increase in background intensity of the stroma with honeycomb formation of activated keratocytes was observed (Figure 2G). Clusters of leukocytes were observed at the depth of the endothelial cell layer (Figure 2H). Finally, the AK was cured, with dense stromal scar formation (Figure 2I).