Objectives: We report ultrasound biomicroscopy (UBM) evidence of Descemet's membrane rupture in a patient affected by Acanthamoeba keratitis without corneal perforation.
Methods: A 38-year-old woman who was a habitual wearer of monthly disposable soft contact lens was admitted to our unit for a severe ulcerated corneal abscess. Two days after admission, the patient presented acute stromal hydrops. Ultrasound biomicroscopy examination revealed a Descemet's membrane rupture and an inflammatory reaction in the anterior chamber. Smears with Gram 17 staining and cultural examination revealed the presence of Acanthamoeba. We started specific therapy with propamidine 0.1% and polyhexamethylene biguanide 0.02% eyedrops; we suspended propamidine therapy after 2 weeks form the onset, when the ulcer had recovered, and we continued topical therapy with polyhexamethylene biguanide 0.02% for 6 months. We performed UBM examinations at each control visit during the follow-up that lasted for 18 months.
Results: At 1-month's follow-up, the symptoms and corneal alterations had significantly improved, while UBM revealed a spontaneous reattachment of the endothelium-Descemet layer. At 12 months' follow-up, best-corrected visual acuity had improved from hand movements at onset to 20/40, and no sign of intraocular involvement was evidenced.
Conclusions: Acanthamoeba is a ubiquitous protozoan that can affect the cornea, even colonizing the deep layers, causing rupture of the Descemet's membrane. Ultrasound biomicroscopy examination confirmed the severe pathogenicity of this parasite and confirmed that only a prompt diagnosis can limit the damage caused by this affection.