Acanthamoeba keratitis and infectious crystalline keratopathy
R. M. Davis, R. P. Schroeder, J. J. Rowsey, H. G. Jensen and R. C. Tripathi
Department of Ophthalmology, Dean A. McGee Eye Institute, University of Oklahoma, Oklahoma City.
Two cases of Acanthamoeba keratitis and infectious crystalline keratopathy,
occurring simultaneously, are presented. Three and 12 months after
initiating topical corticosteroid therapy in cases 1 and 2, respectively,
alpha-hemolytic Streptococcus viridans was cultured from each cornea.
Topical corticosteroid therapy was initiated for the treatment of an
annular stromal opacity, presumably secondary to herpes simplex keratitis.
Acanthamoeba was identified in culture following penetrating keratoplasty
in case 1, and Acanthamoeba polyphaga, Acanthamoeba rhysodes, and
Acanthamoeba castellanii were identified using indirect fluorescent
antibody staining in case 2. Histopathologic examination and electron
microscopy demonstrated sheets of cocci within stromal lamellae
characteristic of infectious crystalline keratopathy and double-walled
encysted organisms typical of Acanthamoeba. These case reports alert one to
the possibility of developing bacterial keratitis, such as infectious
crystalline keratopathy, following the use of topical corticosteroids for
the treatment of Acanthamoeba keratitis.
