Mishra Kapil, Velez Gabriel, Roybal C Nathaniel, Mahajan Vinit B
Molecular Surgery Laboratory, Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, 94304, USA.
University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA.
Am J Ophthalmol Case Rep. 2022 Jan 31;25:101388. doi: 10.1016/j.ajoc.2022.101388. eCollection 2022 Mar.
Acanthamoeba chorioretinitis is a rare manifestation of the parasitic infection, and reported cases often result in enucleation. Surgical removal of Acanthamoeba chorioretinitis has not been previously described. We report a surgical case of Acanthamoeba chorioretinitis spread from keratitis that ultimately resulted in a disease-free outcome.
A healthy 80-year-old male with a history of keratoconus requiring a penetrating keratoplasty in the fellow eye presented with a severe corneal ulcer clinically consistent with Acanthamoeba keratitis. He ultimately required a penetrating keratoplasty and improved clinically until he developed vitritis on post-operative month 1 and was diagnosed with endophthalmitis. B-scan ultrasound demonstrated vitreous opacities and a large retinal mass that reduced in size following serial intravitreal injections of antibiotics, oral antibiotics, and a limited pars plana vitrectomy. He underwent a repeat pars plana vitrectomy 6 weeks later and a retinal mass in the mid-periphery with an associated tractional retinal detachment was noted. A localized retinectomy was performed around the lesion which was excised entirely, and silicone oil was instilled. Pathology of the lesion showed acute and chronic granulomatous necrotizing inflammation with the presence of several definitive amoebic organisms and numerous cells suspicious for amoebae. The patient was maintained on oral antibiotics by the Infectious Disease Service and was disease-free 1-year post-infection.
Acanthamoeba chorioretinitis is a rare, devastating disease and often leads to enucleation. We present a surgical case showing control of the infection utilizing a surgical retinectomy. Aggressive local therapy and a multidisciplinary approach with the Infectious Disease Service may lead to a successful outcome.
棘阿米巴性脉络膜视网膜炎是寄生虫感染的一种罕见表现，报告的病例常导致眼球摘除。此前尚未描述过手术切除棘阿米巴性脉络膜视网膜炎的情况。我们报告一例棘阿米巴性脉络膜视网膜炎从角膜炎蔓延而来的手术病例，最终实现了无病结局。
一名80岁健康男性，有圆锥角膜病史，对侧眼需要进行穿透性角膜移植术，出现了临床上与棘阿米巴角膜炎相符的严重角膜溃疡。他最终接受了穿透性角膜移植术，临床症状有所改善，直到术后第1个月出现玻璃体炎，并被诊断为眼内炎。B超检查显示玻璃体混浊和一个大的视网膜肿物，在多次玻璃体内注射抗生素、口服抗生素以及进行有限的玻璃体切割术后，肿物大小缩小。6周后他接受了再次玻璃体切割术，发现周边部有一个视网膜肿物，并伴有牵引性视网膜脱离。在病变周围进行了局部视网膜切除术，病变被完全切除，并注入了硅油。病变的病理显示急性和慢性肉芽肿性坏死性炎症，存在多个明确的阿米巴生物体以及许多可疑为阿米巴的细胞。患者由感染病科给予口服抗生素治疗，感染后1年无病。
棘阿米巴性脉络膜视网膜炎是一种罕见的、具有破坏性的疾病，常导致眼球摘除。我们展示了一例通过手术视网膜切除术控制感染的手术病例。积极的局部治疗以及与感染病科的多学科方法可能会带来成功的结果。
