Eleven patients with Acanthamoeba keratitis (AK) were treated by early therapeutic deep anterior lamellar keratoplasty (DALK). All surgeries were performed in patients who had no response to standard medical therapy of chlorhexidine gluconate, propamidine isethionate and neomycin sulphate, within 10-15 days of starting the medical therapy and within 30 to 60 days from the onset of symptoms. All patients had visually disabling ulcers within a central optical zone of 6mm. There were no graft rejections or recurrences of AK with follow-up of 24.8 +/- 9.6 months. The only postoperative complication of delayed epithelialisation, a result of the use of anti-acanthamoebic topical drops, has been successfully managed by eye patching, with epithelium healing within 15 days. This small case series describes an interesting approach that seems to be more successful in terms of reduced graft rejections and operative risks compared to penetrating keratoplasty performed late in the disease course. Although this case series is small, early therapeutic DALK can be considered in patients affected by visually disabling central AK and no response to medical therapy. The rationales to treat surgically so promptly are to eradicate medically unresponsive infection and visually rehabilitate patients, who would have required a corneal graft at a later stage. 

Early deep anterior lamellar keratoplasty (DALK) for Acanthamoeba keratitis poorly responsive to medical treatment.
Sarnicola E, Sarnicola C, Sabatino F, et al.
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Magdalena Popiela

Royal Gwent Hospital, Cardiff, UK.

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