Abstract：
Acanthamoeba keratitis (AK) is a rare but potentially sight-threatening complication of corneal collagen crosslinking (CXL) for keratoconus. In this report, we describe an early adolescent male who underwent routine CXL for progressive keratoconus in his left eye. Preprocedural left visual acuity (VA) was 6/9. At day 5 postprocedure, multifocal corneal infiltrates were identified. Corneal scrape, bandage contact lens cultures and herpetic and Acanthamoeba PCR were negative. In vivo, confocal microscopy (IVCM) identified Acanthamoeba cysts within the corneal stroma. Intensive amoebicidal therapy was initiated, but recovery was complicated by significant inflammation, resulting in widespread aggressive corneal vascularisation necessitating topical steroids and steroid-sparing agents. At 10 months, his left VA was 6/24. This report emphasises the importance of maintaining a high index of suspicion for AK in cases of post-CXL microbial keratitis and highlights the diagnostic value of IVCM, particularly in culture-negative and PCR-negative cases.
摘要：
棘阿米巴角膜炎（AK）是圆锥角膜的角膜胶原交联（CXL）的一种罕见但潜在的视力威胁并发症。在这份报告中,我们描述了一名青春期早期男性因左眼进行性圆锥角膜接受常规CXL治疗.术前左侧视力（VA）为6/9。手术后第5天,确定了多灶性角膜浸润。角膜刮伤,绷带接触镜培养和疱疹和棘阿米巴PCR均为阴性。在体内,共聚焦显微镜（IVCM）确定了角膜基质内的棘阿米巴囊肿。开始了强化的杀变形虫治疗，但是严重的炎症使恢复变得复杂，导致广泛的侵袭性角膜血管化，需要局部类固醇和类固醇保护剂。10个月时,他的左VA是6/24。该报告强调了在CXL后微生物性角膜炎病例中保持对AK的高度怀疑的重要性，并强调了IVCM的诊断价值。特别是在培养阴性和PCR阴性病例中。
