Acanthamoeba keratitis is uncommon and rarely reported in Korea. It has been reported in world literature as a very severe, progressive necrotizing stromal keratitis due to a non-parasitic free-living amoeba. It is frequently associated with minimal corneal trauma especially from contact lens but sometimes occurs in patients without any past history. We report a case of acanthamoeba keratitis without a specific past history in a 42-year-old man. Light and electron microscopy demonstrated severe stromal keratitis with numerous thick-walled cysts, 10~15 m in diameter, scattered in the superficial and deep stroma. Because this keratitis is most often mistaken for fungal, bacterial or herpetic keratitis, early confirmatory diagnosis by direct smear, biopsy or culture is essentially required for the prevention of visual loss or devastating eyeball loss.
Acanthamoeba Keratitis* ; Acanthamoeba* ; Adult ; Amoeba ; Biopsy ; Diagnosis ; Humans ; Keratitis ; Keratitis, Herpetic ; Korea ; Microscopy, Electron

We experienced a case of chronic keratitis with corneal ulcer and conjunctival injection while wearing contact lens. In spite of broad-spectrum antibiotics therapy, corneal lesion was not improved, and bacterial smear and culture were negative. Specimens from corneal scraping were examined with Giemsa-Wright stain and H and E(Hematoxylin-Eosin) stain. We could find double walled acanthamoebic cysts. The specimens were cultured on 1.5% non-nutrient agar with E, coli suspension, and aeanthamoebic cysts and trophozoites were found with H and E stain. Aeanthamoebic cysts and trophozoites were cultured from the specimens of ulcered cornea. So we report this case.
Acanthamoeba Keratitis* ; Acanthamoeba* ; Agar ; Anti-Bacterial Agents ; Cornea ; Corneal Ulcer ; Keratitis ; Trophozoites ; Ulcer

The clinical and statistical review were carried out with 92 cases of herpetic keratitis at the Dept. of Ophthalmology, St. Mary's Hospital, Catholic Medical College from Jan. 1974 to Aug. 1976. The results were as follow: 1. Herpetic keratitis was most prevalent at the age of 30's and least at those under 10 and 60'. 2. Male and female ratio was about 3 : 1 but the ratio under the age of 20 was even. 3. The most epidemic season was from March to June, amounting to about 56.5% of the total, and exhaustion was the most significant predisposing factor. 4. The simple type of herpetic keratitis was 45 cases (48.9%) of the total while the complicated type was 47 cases(51.1%). Four fifth of simple type was dendritic keratitis with 36cases (39.1%) and disciform keratitis was most frequent among the complicated type with 20 cases (21.7%). 5. Involvement was even between left and right eyes. 80% of binocular cases was primarily involved at the age of over 20's. Among binocular cases, both eyes showed similar signs and course. 6. Vision in the early stage depends on the location of keratitis invloved. Twenty two out of twenty three cases with duration over 3 years displayed and obvious decreased vision less than 0.1 which implied that the longer the duration is, the more evident the disturbance in vIsion is. 7. In 30 cases the effect of 5-ido-2'-deoxyuridine (I.D.U.) was excellent while there was no effective response to the 5-iodo-2'-deoxyuridine (I.D.U.) in 29 cases. In cases resistant against I.D.U., cryotherapy and keratoplasty proved to be very effective.
Causality ; Corneal Transplantation ; Cryotherapy ; Female ; Humans ; Idoxuridine ; Keratitis* ; Keratitis, Dendritic ; Keratitis, Herpetic ; Male ; Ophthalmology ; Seasons ; Telescopes

To identify risk factors and causative organisms, and to evaluate clinical manifestations, methods and results of treatment in infectious keratitis, an epidemiological study was performed prospectively under the identical protocol from April 1995 to March 2000.Logistic regression analysis was used to evaluate possible risk factors. The 1474 cases of infectious keratitis reported from 22 hospitals were studied. Five hundred forty-four organisms(442 bacteria, 82 fungi, 20 A c a n t h a m o e b a)were detected in 1320 eyes with infectious keratitis excluding 154 herpetic keratitis. The Pseudomonas aeruginosa was the most common organism in bacterial keratitis, and Fusariumspp. was the major isolate in fungal keratitis. Contact lens wear and occupation(industry, forester, miner, fisherman)were the risk factors for bacterial keratitis. Risk factors in fungal keratitis were fifth decade of age, farmer, and systemic diseases(diabetes mellitus etc.). Risk factors in herpetic keratitis were male and occupation(office worker, service, student, housewife). Risk factors in Acanthamoeba keratitis was contact lens wear.
Acanthamoeba Keratitis ; Bacteria ; Epidemiologic Studies ; Epidemiology* ; Fungi ; Humans ; Keratitis ; Keratitis, Herpetic ; Male ; Prospective Studies ; Pseudomonas aeruginosa ; Risk Factors

Herpes simplex virus keratits(HSK) is one of the most common external eye diseases that cause corneal blindness, Therefore early diagnosis and proper treatment of HSK are essential. However it is frequently misdiagnosed because it shows non-specific corneal lesion than other infectious corneal disease. And also diagnosis of HSK mostly rely on clinical examination and patient history. We evaluated suspicious HSK patients by indirect immunofluofluorescent(IF) antibody test and analyzed its efficacy in the early diagnosis of HSK. Among 47 patients(47 eyes), 37 patients were suspicious heretic keratitis and others not. Dendritic keratitis patients existed in 17 out of 37 patients and they were evaluated with virus culture and indirect IF test. The result of indirect IF test was confirmed under the immunofluorescent microscope and for virus culture the specimens were inoculated on Vero cells(monkey kidney cells). The positive results of indirect IF test was 28 out of 37 suspicious HSK patients and 1 out of 10 non-suspicious HSK patients. Dendritic HSK patients showed IF positive in 15 out of 17 patients(82.3%). Sensitivity of indirect IF test in suspicious HSK patients was 75.7%(2837) and 88.2%(15/17) in dendritic HSK patients. Indirect IF test was all positive(14/14) in dendritic HSK patients that showed culture positive. From these results, indirect IF test has a high sensitivity in early diagnosis of HSK and might be ussful as a rapid diagnostic tool in HSK patients.
Blindness ; Corneal Diseases ; Diagnosis ; Early Diagnosis ; Eye Diseases ; Herpes Simplex* ; Humans ; Keratitis ; Keratitis, Dendritic ; Keratitis, Herpetic* ; Kidney ; Simplexvirus

Herpes simplex virus keratits(HSK) is one of the most common external eye diseases that cause corneal blindness, Therefore early diagnosis and proper treatment of HSK are essential. However it is frequently misdiagnosed because it shows non-specific corneal lesion than other infectious corneal disease. And also diagnosis of HSK mostly rely on clinical examination and patient history. We evaluated suspicious HSK patients by indirect immunofluofluorescent(IF) antibody test and analyzed its efficacy in the early diagnosis of HSK. Among 47 patients(47 eyes), 37 patients were suspicious heretic keratitis and others not. Dendritic keratitis patients existed in 17 out of 37 patients and they were evaluated with virus culture and indirect IF test. The result of indirect IF test was confirmed under the immunofluorescent microscope and for virus culture the specimens were inoculated on Vero cells(monkey kidney cells). The positive results of indirect IF test was 28 out of 37 suspicious HSK patients and 1 out of 10 non-suspicious HSK patients. Dendritic HSK patients showed IF positive in 15 out of 17 patients(82.3%). Sensitivity of indirect IF test in suspicious HSK patients was 75.7%(2837) and 88.2%(15/17) in dendritic HSK patients. Indirect IF test was all positive(14/14) in dendritic HSK patients that showed culture positive. From these results, indirect IF test has a high sensitivity in early diagnosis of HSK and might be ussful as a rapid diagnostic tool in HSK patients.
Blindness ; Corneal Diseases ; Diagnosis ; Early Diagnosis ; Eye Diseases ; Herpes Simplex* ; Humans ; Keratitis ; Keratitis, Dendritic ; Keratitis, Herpetic* ; Kidney ; Simplexvirus

PURPOSE: To report 4 cases of Acanthamoeba keratitis related to orthokeratology lens overnight wear. METHODS: Four patients had histories of overnight orthkeratology lens wear of 10 months to 3 years when they presented with corneal ulcers. RESULTS: The organism isolated by corneal scraping was Aanthamoeba. The patients were treated with polyhexamethylene biguanide (PHMB), and chlorhexidine, resulting in a resolution of ocular inflammation. CONCLUSION: The risk of Acanthamoeba keratitis as a potential complication of overnight orthkeratology should be considered.
Acanthamoeba Keratitis* ; Acanthamoeba* ; Chlorhexidine ; Humans ; Inflammation ; Ulcer

We experienced chronic relapsing central corneal ulcer and chronic conjunctivitis with mucoid discharge. Both patients were transfered to our hospital because of no improvement with long term treatment of broad spectrum antibiotics topically and systemically Specimens from corneal scraping and conjunctival mucoid discharge were examined with calcofluor white staining method. We could find a narrow rim of light green colored cystic wall and orange red colored cytoplasm in dark field fluorescent microscopy in both cases, and those were diagnosed as Acnthamoebic cyst by pathologist. We couldn't find any report about ocular Aanthamoeba infections in Korea. To our knowledge, this is the first case report about ocular Acanthamoebic infections in Korea.
Acanthamoeba Keratitis* ; Acanthamoeba* ; Anti-Bacterial Agents ; Citrus sinensis ; Conjunctivitis ; Corneal Ulcer ; Cytoplasm ; Humans ; Korea ; Methyl Green ; Microscopy

PURPOSE: We report the therapeutic effect of ganciclovir gel instead of acyclovir ointment usually used in the case of herpes simplex superficial ocular disease such as herpetic dendritic keratitis and erosive blepharitis. METHODS: Three patients clinically diagnosed with herpes simplex dendritic keratitis and one as erosive blepharitis were treated with the topical ophthalmic gel of 0.15% ganciclovir three times a day for 2 to 4 weeks. Ocular complications and recurrence were evaluated under slit-lamp examination for the follow-up periods. RESULTS: Dendritic keratitis and erosive blepharitis were completely recovered with no recurrence during the 5 months follow-up. There is no respective comparison here. In one case of herpes simplex keratitis, the keratitis wound was repaired after debridement of corneal epithelial layer and application of ganciclovir gel. Complications including burning sensation and superficial punctate keratitis did not develop and visual acuity improved. CONCLUSIONS: Ganciclovir ophthalmic gel should be considered one of the effective therapeutic drugs for the herpes simplex ocular disease.
Acyclovir ; Blepharitis ; Burns ; Debridement ; Follow-Up Studies ; Ganciclovir* ; Herpes Simplex* ; Humans ; Keratitis ; Keratitis, Dendritic ; Keratitis, Herpetic ; Recurrence ; Sensation ; Visual Acuity ; Wounds and Injuries

To evaluate amoebicidal efficacy of various disinfectants, we treated four ocular isolates of Acanthamoeba with three kinds of commercial available contact lens(CL) disinfectants, chlorhexidine, thimerosal, polyhexamethylene biguanide(PHMB) and hexamidine, Acanthamoeba cysts were collected from axenic nonnutrient agar plates from 4-week cultures. Cyst suspension(100microliter) was inoculated on 96-well microplate with concentration of 5x103 cyssts/ml. Each well was treated with three kinds of CL disinfectants(100microliter each, 4, 8, 12, 24hrs) and two-fold diluted chlorhexidine, PHMB and hexamidine(100microliter each, 8 and 48hrs). Only one CL disinfectant containing chlorhexidine(0.005%) and thimerosal(0.001%) showed cysticidal effect. Minimal cysticidal concentration(MCC) of PHMB, chlorhexidine, hexamidine ranged 1.17-3.12microgram/ml, 3.12-12.50microgram/ml, 8.64-52.07microgram/ml respectively with 48hr treatment. In 8hr treatment, MCC of PHMB and chlorhexidine were 4.42-12.50microgram/ml and 9.31-25.0microgram/ml respectively, but hexamidine did not demonstrate cysticidal effect. Therefore for proper sterilzation of contact lens and CL caes, effective disinfectant should be included in the composition of CL cleaning solution. Among the currently used topical amoebicidal agents, PHMB was the most potent cysticidal agent in in vitro study with four ocular stains of Acanthamoeba.
Acanthamoeba Keratitis* ; Acanthamoeba* ; Agar ; Chlorhexidine ; Coloring Agents ; Disinfectants* ; Thimerosal