Rapid progression of amebic keratitis 1 week after corneal trauma and 1 year after LASIK

PURPOSE: To report a case of amebic keratitis that showed unusually rapid clinical progression after corneal trauma in a patient 1 year after successful laser in situ keratomileusis (LASIK) surgery. METHODS: A 42-year-old pilot with a previous history of 20/20 uncorrected vision 1 year after LASIK surgery developed a clinical picture suggestive of acute microbial keratitis 7 days after the eye was traumatized by an ice chip. The correct diagnosis of amebic keratitis was confirmed by tissue biopsy 17 days after initial trauma when rapid progression of the keratitis necessitated excision of the LASIK flap. RESULTS: Pathology from the excised LASIK flap showed a mean of 30 amebic cysts per high power field. Thirty-three days after beginning 0.02% polyhexamethylene biguanide every hour, the patient developed culture negative hypopyon and an endothelial inflammatory plaque. Six months after starting antiamebic treatment, he developed sterile iris nodules and focal hemorrhages in the anterior chamber. Penetrating keratoplasty revealed persistence of amebic cysts in the anterior corneal stroma. Fifteen months after his initial injury, his vision remains hand motion. CONCLUSIONS: Amebic keratitis presented atypically and progressed rapidly to a stage of severe ring infiltrate within 10 days of trauma in a patient whose only risk factor was a history of uncomplicated LASIK more than 1 year before the trauma. Amebic keratitis should be included in the differential diagnosis of rapidly progressive corneal ulcer after trauma in patients with a history of LASIK.