Abstract ID: 26-343
Evisceration in Refractory Acanthamoeba Sclerokeratitis: A Case Highlighting Surgical Decision-Making in Advanced Infection
Author: Shehnaz Bazeer Base Hospital / Institution: Moorfields Eye Hospital
Presentation Type: ePoster Presentation
Purpose
Acanthamoeba keratitis is a rare but potentially devastating sight-threatening infection. In refractory cases, surgical intervention is often required, with published reports over the past decade more commonly describing enucleation. The role of evisceration in this setting remains less clearly defined.
Methods
A 48-year-old female soft contact lens wearer presented with a two-week history of pain OS, with VA of 1/60. Confocal microscopy and corneal scraping confirmed Acanthamoeba infection. Despite intensive topical therapy with polyhexamethylene biguanide (PHMB), later transitioned to chlorhexidine, alongside systemic corticosteroid therapy, the disease followed a protracted and relapsing course. The patient developed progressive sclerokeratitis with biopsy-proven scleral involvement and a scleral abscess requiring drainage. Ongoing inflammation and severe pain persisted despite maximal medical therapy, and VA deteriorated.Definitive surgical management was elected. Intraoperatively, the sclera appeared clinically uninvolved, and an evisceration was performed rather than enucleation. This decision was influenced by the absence of gross scleral necrosis and a theoretical concern that optic nerve transection during enucleation may increase the risk of intracranial dissemination.
Results
While recent literature describing refractory/panophthalmitis cases predominantly reports enucleation, our case demonstrates that evisceration may be a viable alternative. Given the lack of evidence-based guidance comparing these approaches in Acanthamoeba infection, surgical decision-making remains individualised. Further reporting of similar cases is needed to better inform practice.
Conclusion
Refractory Acanthamoeba keratitis may progress to scleral involvement despite prolonged therapy.Most published cases of advanced disease culminate in enucleation.Evisceration may be considered in selected cases where scleral integrity is preserved.Theoretical concerns regarding intracranial dissemination continue to influence surgical choice despite limited data.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Carlos | Cuadros Sanchez | |
| Martin | Watson | |
| Jimmy | Uddin | |
| Raj | Das-Bhaumik |