Akademik Veri Yönetim Sistemi
World Glaucoma Congress, Rome, İtalya, 27 Haziran - 01 Temmuz 2023, sa.406, ss.596
Purpose
Acanthamoeba spp. often causes painful keratitis.In this study, we aimed to present a case
that developed Acanthamoeba endophthalmitis and treatment-resistant glaucoma after an
intravitreal dexamethasone implant injection.
Methods
The patient who presented with severe pain in the eye and decreased vision after intravitreal
dexamethasone implant application due to diabetic macular edema was evaluated. Differential diagnoses were determined by taking the patient’s history and performing a detailed
eye examination. Vitreous samples were evaluated for the diagnosis of bacterial, fungal, and
amoebic agents with the preliminary diagnosis of endophthalmitis after intravitreal injection
Results
The patient, who had an intravitreal dexamethasone implant applied to his left eye had
a visual acuity of counting fingers from 4 meters and an intraocular pressure (IOP) of 47
mmHg at the 1st-week follow-up. There were +2 cells in the anterior chamber, posterior synechia, and pigmented keratic precipitates and striae in the endothelium. His conjunctiva
was mildly hyperemic, and he had severe pain. Fundus could not be evaluated due to +1
vitritis. Herpetic endothelitis, bacterial endophthalmitis, fungal endophthalmitis, and low
virulence endophthalmitis were considered in the initial differential diagnosis. When the patient did not benefit from the antiviral and endophthalmitis treatment protocol respectively,
diagnostic pars plana vitrectomy was performed together with dexamethasone implant removal. Acanthamoeba cysts were observed in the direct smear of the vitreous sample with
the Calcaflour stain. Systemically azithromycin, metronidazole, and fluconazole; topically,
Propamidineisetionate 0.1%, ofloxacin, cyclopentolate, and dexamethasone drops were administered. Systemic treatment and topical treatment were continued for 6 and 4 months
respectively. At the post-op 6-month clinical evaluation of the patient, anterior and posterior segment findings improved, and IOP was reduced to 19 mmHg.
Conclusions
Inflammation caused by the microorganism in the anterior segment by acanthamoeba can
further contribute to the elevation of IOP together with the intravitreal dexamethasone implant. It should be noted that Acanthamoeba endophthalmitis, although very rare, should
be examined in detail by performing diagnostic vitrectomy in cases with refractory glaucoma and unresponsive to standard endophthalmitis treatment by evaluating the differential
diagnoses correctly.