Modern Approaches in the Diagnosis and Treatment of Corneal Lesions in Children. Clinical Case

Objective. To present the results of successful treatment of a patient with corneal lesions caused by Acanthamoeba spp. receiving long-term conservative treatment.

Methods. A child with corneal ulcer of mixed etiology with a history of wearing orthokeratology lenses and long-term ineffective treatment in Moscow hospitals was referred to Moscow in S.N. Fyodorov Eye Microsurgery Federal State Institution. The patient underwent a complete ophthalmological examination, including confocal microscopy.

Results. The condition of the child’s eye was extremely severe, live and dead cysts of Acantamoeba spp were found in the central zone of the cornea at the depth of 113–149 μm, Along with intensive conservative treatment with catheterisation of the retrobulbar space and introduction of drugs into the irrigation system, UV corneal crosslinking was performed twice.

Conclusion. Treatment according to the proposed method allowed to achieve excellent results: there was no corneal syndrome, complete epithelialisation of the corneal defect, disappearance of corneal edema and remission of uveitis manifestations. According to the data of confocal microscopy there is no growth of microflora and acanthamoeba cysts.

1. Malyugin BE, Borzenok SA, Moroz ZI, Shatskikh AV, Gorokhov MV. Experimental investigation of the enzymatic stability of the donor cornea, treated by the method of UV cross-linking. Ophthalmosurgery. 2014;1:20–23 (In Russ.).

2. Kasparova EA, Marchenko NR, Narbut MN, Surnina ZV, Krivolapova DA. Acute Purulent Keratitis of Mixed Etiology Developed during Contact Lens Wearing. Clinical Case. Ophthalmology in Russia. 2022;19(4):898–905 (In Russ.). doi: 10.18008/1816-5095-2022-4-898-905.

3. Kasparova E, Biao Y, Sobkova OI. Мodified crosslinking in treatment of Festering ulcer of the cornea. A clinical case. Ophthalmology. 2017;14(3):274–277 (In Russ.). doi: 10.18008/1816-5095-2017-3-274-277.

4. Kasparova EA, Fedorov AA, Biao Yang. Clinical results of modified crosslinking in the treatment of purulent keratitis and corneal ulcers. Vestnik Oftalmologii. 2020;136(3):64–73 (In Russ.). doi: 10.17116/oftalma202013603164.

5. Markova EYu, Avakyants GV. Keratoconus in children. Russian pediatric ophthalmology. 2021;2:56–60 (In Russ.). doi: 10.25276/2307-6658-2021-2-56-60.

6. Trufanov SV, Zaitsev AV, Shakhbazyan NP. Crosslinking and Fulguration in the Treatment of Acanthamoebic Keratitis. Ophthalmology in Russia. 2020;17(4):725– 732 (In Russ.). doi: 10.18008/1816-5095-2020-4-725-732.

7. Pleskova AV, Katargina LA, Iomdina EN, Mamakaeva IR, Panova AYu. First Experience of Combined Treatment of Corneal and Graft Ulcers in Preschool Children Using Local Ultraviolet Crosslinking (Clinical Cases). Ophthalmology in Russia. 2023;20(2):358–362 (In Russ.). doi: 10.18008/1816-5095-2023-2-358-362.

8. Yani EV, Iomdina EN, Pozdniakova VV, Golikova VA, Seliverstova KE. Treating protracted corneal ulcers with UVA corneal collagen crosslinking: clinical cases. Russian Ophthalmological Journal. 2021;14(3):106–112 (In Russ.). doi:21516/20720076-2021-14-3-106-112.

9. Markova EYu, Ovchinnicova AV, Truphanov SV. Femtosecond laser-assisted keratoplasty in a child with corneal opacity:case report. Ophthalmology in Russia. 2014;11(1):79–83 (In Russ.). doi: 10.18008/1816-5095-2014-1-79-83.

10. Neroev VV, Yani EV, Iomdina EN, Khoroshilova-Maslova IP, Golikova VA, Kiryukhin AV. Treatment of corneal ulcers by local ultraviolet crosslinking (an experimental study). Russian Ophthalmological Journal. 2020;13(4):48–57 (In Russ.). doi: 10.21516/2072-0076-2020-13-4-48-57.

11. Arora R, Gupta D, Goyal JL, Jain P. Results of corneal collagen cross-linking in pediatric patients. J Refract Surg. 2012;28:759–762. doi: 10.3928/1081597X20121011-02.

12. Markova EYu, Avakyants GV..Corneal collagen crosslinking in a child with keratoconus. Russian pediatric ophthalmology. 2021;3:33–38 (In Russ.). doi: 10.25276/23076658-2021-3-33-38.

13. Markova EYu, Avakyants GV, Kechin EV. Keratoconus in Children. Мodern Treatment Options. Ophthalmology in Russia. 2021;18(4):840–844 (In Russ.). doi: 10.18008/1816-5095-2021-4-840-844.

14. Musayeva A, Riedl JC, Schuster AK, Wasielica-Poslednik J, Pfeiffer N, Gericke A. Topical Voriconazole as Supplemental Treatment for Acanthamoeba Keratitis. Cornea. 2020 Aug;39(8):986–990. doi: 10.1097/ICO.0000000000002315.

15. Marciano-Cabral F, Cabral G. Acanthamoeba spp. as agents of disease in humans. Clin Microbiol Rev. 2003:16(2):273–307. doi: 10.1128/CMR.16.2.273-307.2003.

16. Lorenzo-Morales J, Martín-Navarro CM, López-Arencibia A, Arnalich-Montiel F, Piñero JE, Valladares B. Acanthamoeba keratitis: an emerging disease gathering importance worldwide? Trends in Parasitology. 2013;29(4):181–187. doi: 10.1016/j.pt.2013.01.006.

17. Buzzonetti L, Petrocelli G. Transepithelial corneal cross-linking in pediatric patients: Early results. J Refract Surg. 2012;28:763–767. doi: 10.3928/1081597X-20121011-03.

18. Wittig-Silva C, Chan E, Islam FM, Wu T, Whiting M, Snibson GR. A randomized, controlled trial of corneal collagen cross-linking in progressive keratoconus: three-year results. Ophthalmology. 2014;121(4):812–821. doi: 10.1016/j.ophtha.2013.10.028.

19. Tabibian D, Richoz O, Hafezi F. PACK-CXL: Corneal cross-linking for treatment of infectious keratitis. Journal of ophthalmic & vision research. 2015;10(1):77–80. doi: 10.4103/2008-322X.156122.

20. Spoerl E, Hoyer A, Pillunat LE, Raiskup F. Corneal crosslinking and safety issues. Open Ophthalmol J. 2011;5:14–16. doi: 10.2174/1874364101105010014.

21. Alio JL, Abbouda A, Valle DD, Del Castillo JM, Fernandez JA. Corneal cross linking and infectious keratitis: a systematic review with a meta-analysis of reported cases. J Ophthalmic Inflamm Infect. 2013 May 29;3(1):47. doi: 10.1186/1869-5760-3-47.

22. Hafezi F, Randleman JB. PACK-CXL: defining CXL for infectious keratitis. J. Refract. Surg. 2014; 30: 438–439. doi: 10.3928/1081597X-20140609-01.

23. Lietman AA, Rose-Nussbaumer J. Update on the management of infectious keratitis. Ophthalmology. 2017 Nov;124(11):1678–689. doi: 10.1016/j.ophtha.2017.05.012.

24. Makdoumi K, Mortensen J, Sorkhabi O, Malmvall BE, Crafoord S. UVAriboflavin photochemical therapy of bacterial keratitis: A pilot study. Graefes Arch. Clin. Exp. Ophthalmol. 2012;250(1):95–102. doi: 10.1007/s00417-011-1754-1. PMID: 21874347.

25. Li Z, Jhanji V, Tao X, Yu H, Chen W, Mu G. Riboflavin/ultravoilet light-mediated crosslinking for fungal keratitis. Br J Ophthalmol. 2013 May;97(5):669–671. doi: 10.1136/bjophthalmol-2012-302518.

26. Carnt N, Robaei D, Watson SL, Minassian DC, Dart JK. The Impact of Topical Corticosteroids Used in Conjunction with Antiamoebic Therapy on the Outcome of Acanthamoeba Keratitis. Ophthalmology. 2016;123(5):984–990. doi: 10.1016/j.ophtha.2016.01.020.

27. Khan YA, Kashiwabuchi RT, Martins SA, Castro-Combs JM, Kalyani S, Stanley P, Flikier D, Behrens A. Riboflavin and ultraviolet light a therapy as an adjuvant treatment for medically refractive Acanthamoeba keratitis: report of 3 cases. Ophthalmology. 2011;118(2):324–331. doi: 10.1016/j.ophtha.2010.06.041.