Lens epithelial cell death secondary to acanthamoeba keratitis: absence of capsular bag opacification six years after cataract surgery

Abstract

Purpose: To show the evolution of anterior chamber structures 6 years after cataract surgery in a case with Acanthamoeba keratitis (AK).

Methods: A 37-year-old woman with AK receiving long-term treatment with chlorhexidine, propamidine isethionate and steroids developed a white cataract and iris atrophy. Penetrating keratoplasty and cataract surgery were performed with subsequent intraocular pressure elevation requiring Molteno shunt implantation. Two years after the last surgery, endothelial decompensation developed and another penetrating keratoplasty was performed. Intraoperatively, the anterior and posterior capsules were completely transparent.

Results: Six years after cataract surgery, the intraocular lens was centered with clear anterior and posterior capsules without lens epithelial cells proliferation. No Soemmering's ring formation or posterior capsule opacification was found. Also, no zonular damage or pseudophacodonesis was observed.

Conclusions: This case suggests that AK infection and AK treatment not only cause white progressive cataract but also lens epithelial cell death. The capsules may be completely clear 6 years after cataract surgery, with a good quality of vision regardless of intraocular lens material or design.

Keywords: Acanthamoeba keratitis; Cataract; Glaucoma; Iris atrophy; Lens epithelial cells; Penetrating keratoplasty.

Fig. 1

White cataract, conjunctival hyperemia, corneal abscess, and iris atrophy (arrows) secondary to AK.

Fig. 2

Clear capsules observed during vitrectomy using a Landis temporary keratoprosthesis. This procedure was performed 2 years after cataract surgery with IOL implantation.

Fig. 3

Haptic and optic (white arrows) of the CZ-70-BD rigid IOL. No LEC proliferation is observed. The capsules are clear 6 years after cataract surgery. Note the absence of Soemmering's ring formation outside the IOL optic.