PMC3897317_01
(A-D) Clinical findings of a patient with severely reduced vision and severe pain in his right eye. Findings at the initial visit (A and B) and 1 month later (C and D). (A) Corneal ring-shaped infiltration with epithelial defects can be seen 6 months after onset. (B) Scleral area is highly injected, and a nodule (arrow) can be seen beneath the conjunctiva. (C) Despite the antiamoebic therapy, a corneal perforation developed 1 month after the first examination. The cornea has an abscess. (D) Uveal tissue can be seen through the thin sclera.
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The visual acuity in his right eye was hand motion, and the cornea had a ring-shaped opacity with extensive epithelial defects (Figure 1A). A nodule was observed beneath the highly injected conjunctiva at the superior sclera close to the limbus (Figure 1B, arrow). The corneal region was debrided several times; however, the injection of the conjunctiva and sclera worsened, leading to necrotizing scleritis 1 month after the first examination (Figure 1C). An 8 mm-diameter ring-shaped abscess developed in the corneal lesion, and soon after that the cornea perforated (Figure 1D).
(A-D) Histological sections of the cornea, corneal limbus, and anterior sclera. (A) Histopathological section showing the corneal stroma. Cysts of Acanthamoeba (arrows) can be seen throughout the corneal stroma. Periodic acid-Schiff, 400x. (B) An abscess is seen in the limbal area (square) and granulation tissue (oval circle) at the sclera close to the pars plicata of the ciliary body. (C) Polymorphonuclear leukocytes can be seen aggregated, indicating the possibility of active infection and acute inflammation (high magnification of square area in B). 400x. (D) Accumulation of monocytes associated with congested blood vessels and fibrous tissue, indicating the phase of chronic inflammation and the repair reaction (high magnification of oval area in B). 400x.
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Cysts of Acanthamoeba and polymor-phonuclear leukocytes (PMNLs) were observed throughout the corneal stroma, indicating an active invasion of the protozoan (Figure 2B). The anterior sclera in the limbal area was acutely inflamed with an infiltration of PMNLs, and an abscess was observed at the limbus (Figure 2B and C). However, the sclera close to the ciliary body appeared different: granulation tissue consisting of congested blood vessels surrounded by macrophages and lymphocytes was observed in this area (Figure 2D).