Supplementary Material for: Use of amniotic membrane transplant and deep anterior keratoplasty in a patient with bilateral acanthamoeba infectious keratitis: a case report

To report a case with the use of amniotic membrane transplant and deep anterior keratoplasty in a patient with bilateral acanthamoeba infectious keratitis as a treatment. A 20-year-old male presented with bilateral acanthamoeba keratitis (AK) who was initially diagnosed with herpetic keratitis receiving full antiviral and corticosteroids topical treatment without any improvement. Corneal biopsy was performed to confirm the suspected diagnosis and Acanthamoeba stromal cysts were identified in the sample. Treatment was initiated with 0.02% chlorhexidine, 0.1% propamidine isethionate, neomycin, and tropicamide/phenylephrine. Symptoms and clinical improvement were achieved between the 8th-10th week so corticosteroids were initiated. Treatment was continued until we observed a poor response in the left eye therefore, an epithelial scraping and amniotic membrane placement were performed. Lately, Right eye underwent a deep anterior lamellar keratoplasty (DALK). A challenging case of bilateral acanthamoeba keratitis managed with topical medications, amniotic membrane, and cornea keratoplasty. The earlier the disease is diagnosed, the better the outcome. If the diagnosis is delayed, the amoebas have penetrated deep into the corneal stroma and successful therapy becomes difficult. A surgical option can be an early solution with a good prognosis for these cases.