Two Cases of Corneal Toxicity in Acanthamoeba Keratitis by Combined Topical Anti-Acanthamoeba Keratitis Eye Solution

Ja Kyun Lee; Jong Soo Lee

doi:10.3341/jkos.2015.56.2.280

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Lee and Lee: Two Cases of Corneal Toxicity in Acanthamoeba Keratitis by Combined Topical Anti-Acanthamoeba Keratitis Eye Solution

Original Article

J Korean Ophthalmol Soc 2015;56(2):280-284.

Published online: 6 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.2.280

Two Cases of Corneal Toxicity in Acanthamoeba Keratitis by Combined Topical Anti-Acanthamoeba Keratitis Eye Solution

Ja Kyun Lee, MD¹, Jong Soo Lee, MD, PhD^1,^2,

¹Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea

²Biomedical Research Institute, Pusan National University Hospital, Busan, Korea

Address reprint requests to Jong Soo Lee, MD, PhD, Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 602-739, Korea, Tel: 82-51-240-7321, Fax: 82-51-240-7341 E-mail: jongsool@pusan.ac.kr

Received 21 July 201430 October 2014 Accepted 15 January 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To present a case of corneal toxicity caused by therapeutic duplication during treatment of acanthamoeba keratitis as a complication of contact lens use.

Case summary

A 12-year-old girl with a history of wearing orthokeratology contact lenses and a 14-year-old girl with a history of wearing cosmetic contact lenses presented with ocular pain, injection, and decreased visual acuity. They were diagnosed as having acanthamoeba keratitis based on slit lamp examination, confocal microscopy and culture. After the patients were treated with polyhexamethylene biguanide (PHMB) and chlorhexidine, corneal epithelial defect and erosion occurred. Use of chlorhex-idine was stopped, and PHMB was used to treat patients and recovery of the corneal epithelium with improvement in symptoms of acanthamoeba keratitis was found.

Conclusions

Using PHMB and chlorhexidine together in treating acanthamoeba keratitis increases the risk of corneal toxicity. Therefore, these drugs should be avoided in combination.

Keywords: Acanthamoeba, Chlorhexidine, Human corneal keratocyte, Polyhexamethylene biguanide

References

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Figure 1.

(A) Slit-lamp photograph and flurescein stain of the right cornea of a 12-years-old girl with a history of wearing orthoker-atology contact lenses. (B) Acanthamoeba track on the culture on E. coli plated agar media from contact lens. (C) In vivo laser confocal microscopic images of the right cornea. In the stroma numerous highly reflective, spindle-shaped materials were aggravated (arrows). (D) Slit-lamp photograph and ulcerated lesion was stained under PHMB and chlorhexidine administration. (E) After 1 day of stopping chlorhexidine use, corneal and conjunctival lesion improved. (F) After 2 months, residual corneal subepithelial opacity remained, and no corneal stain lesion is seen. PHMB = polyhexamethylene biguanide.

Figure 2.

(A) A 14-year-old girl with a history of wearing cosmetic contact lenses presented with corneal circinate infiltrate in the left eye. (B) In vivo laser confocal microscopic images of the cornea of the left eye of case 2. In the stroma around the keratoneuritis, highly reflective activated keratocytes formed a honeycomb pattern (arrows). (C) Punctate epithelial keratitis, corneal haze, con-junctival injection, and perilimbal vascularization are observed under PHMB and chlorhexidine administration. (D) After 5 months; residual mild corneal opacity remains. PHMB = polyhexamethylene biguanide.

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