Resumen:
Purpose: To report a case of Acanthamoeba keratitis diagnosed using confocal microscopy in a patient corrected by orthokeratology and treated with corneal crosslinking (CXL) after failure to respond to medical treatment.
Methods: After diagnosis, the patient was treated with several medications until CXL was applied during one 30-min session using ultraviolet A radiation and application of riboflavin. The clinical signs of the disease observed using slit-lamp biomicroscopy and confocal microscopy were evaluated and the visual acuity was measured during the course of the infection and treatment over a period of 30 months including 12 months of medical treatment, 9 months after cross-linking and amniotic membrane transplant and 9 months after penetrating keratoplasty and cataract extraction.
Results: In this case, confocal microscopy facilitated early diagnosis of an Acanthamoeba infection even if other signs and symptoms might be confounding. CXL was more effective than aggressive medication against the microorganism. After CXL, the symptoms and the corneal appearance improved significantly but the ulcer did not heal completely. After amniotic membrane transplantation, the patient underwent pene...