Chorioretinitis after keratitis caused by Acanthamoeba - Case report and review of the literature

Objective: A clinicopathologic study to evaluate the histopathologic featur es associated with Acanthamoeba keratitis and chorioretinitis. Design: Retrospective observational case report. Methods: On the basis of the clinical history and histologic appearance, th e enucleated eye and native corneal button were examined using hematoxylin- eosin stains and special periodic acid-Schiff and Gomori methenamine silver stains. Results: Results of histologic examination of the cornea and retina showed numerous Acanthamoeba cysts in the cornea stromal layers, the necrotic reti na, and preretinal and subretinal spaces. Conclusions: To the authors' knowledge, this is the first proven histologic case of ipsilateral chorioretinitis secondary to primary chronic keratitis caused by Acanthamoeba. The patient had a 30-month history of recurrent ke ratitis requiring four penetrating keratoplasties. We believe the chorioret initis resulted from direct spread of the corneal amebic infection. The spr ead of the Acanthamoeba may have been facilitated by a combined keratoplast y, extracapsular cataract extraction, and intraocular lens insertion. In bo th specimens, the native corneal button and the enucleated eye with a corne al transplant, the general pathologists overlooked the presence of Acantham oeba. (C) 2001 by the American Academy of Ophthalmology.