PMC5359378_01
a Color photographic image at initial presentation showing a large central corneal ring infiltrate and a second smaller anterior stromal infiltrate in the superior peripheral cornea. b In vivo confocal microscopic image showing the presence of numerous double-walled Acanthamoeba cysts (white arrows) and presumed trophozoites (asterisks) in the central anterior corneal stroma. Field size 400 x 400 microm, focus depth set at 58 microm. c Photomicrograph of an immunohistochemical staining for CD45, showing dense choroidal lymphocytic infiltration in proximity to a choroidal vein. Original magnification, x400. d Photomicrograph of the anterior cornea demonstrating Acanthamoeba cysts embedded between stromal lamellae, ectocysts with retracted endocyst (arrows). Periodic acid-Schiff stain; original magnification, x200
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Fig1
Biomicroscopic examination revealed a large ring-shaped corneal stromal infiltrate, a central corneal epithelial defect in the absence of a hypopyon (Fig. 1a). In vivo confocal microscopy (IVCM) of the cornea was performed and confirmed the clinically suspected diagnosis of AK, showing a large number of Acanthamoeba cysts in the anterior stroma (Fig. 1b). Intraocular findings included lymphocytic infiltrates in the choroidal stroma, around the choroidal veins and the short posterior ciliary arteries, diffuse retinal atrophy, but no evidence of retinal vascular thrombosis (Fig. 1c, d).