Results of penetrating keratoplasty for visual rehabilitation after Acanthamoeba keratitis

PURPOSE: To assess the results of penetrating keratoplasty in quiet eyes after resolution of Acanthamoeba keratitis. DESIGN: A retrospective interventional case series. METHODS: Penetrating keratoplasty was undertaken in 13 eyes of 13 patients with an average age of 29 +/- 13 years and a history of Acanthamoeba keratitis that was diagnosed by culture and/or confocal microscopy between January 1995 and September 2004. All eyes were ob, served for at least 3 months (average, 5 months) after the discontinuation of antiamebic therapy that had been administered for at least 4.5 months. In vivo confocal microscopy was used to ensure that no residual amoeba were present before the operation. Two keratoplasties were combined with a valve insertion; five keratoplasties were combined with cataract extraction, and one keratoplasty was preceded by a ciliary laser ablation. RESULTS: Postoperative best-corrected visual acuity ranged from 20/40 to 20/15, with the exception of one eye with advanced glaucoma that did not improve from a preoperative vision of light perception. No eye experienced rejection or amoebic recurrences, and 12 grafts remained clear throughout the follow-up period (8 months to 9 years; median, 23 months). One graft failed at 4 months because of uncontrolled glaucoma. The eye was regrafted, and the graft remained clear during the 28 months of follow,up evaluation. Two eyes with preoperatively diagnosed glaucoma needed subsequent surgery to control their intraocular pressure. CONCLUSION: Penetrating keratoplasty for visual restoration after Acanthamoeba keratitis appears to have an excellent long,term prognosis, provided amoebic infection has resolved and concurrent glaucoma is controlled.