diagnosis of 2 cases of acanthamoeba keratitis using confocal scan and their successful medical treatment

purpose: to present 2 cases of acanthamoeba keratitis diagnosed by confocal scanning before positive results of smear and culture, and their successful treatment with combined medical therapy and corneal epithelial debridment. patients and findings: confocal scan was carried out in 2 contact lens wearers with a clinical diagnosis of acanthamoeba keratitis followed by corneal epithelial debridment for debulking of the corneal lesion and preparing specimens for smear and culture. medical therapy was initiated subsequently. wet mount preparations of the contact lens preservative fluid were also evaluated under dark field microscopy. confocal scan in both patients revealed reflective round to oval-shaped structures 15 to 25 μ in diameter in the sub-epithelial and anterior stromal areas. smear and culture results were positive for acanthamoeba and the motility of the trophozoites was easily observed using wet mount preparations. both cases were treated successfully by combined medical therapy and debulking of the lesion. conclusion: confocal scan is a very helpful, non-invasive procedure in the early diagnosis of acanthamoeba keratitis before positive results of smear and culture. corneal epithelial debulking in the early stages of acanthamoeba keratitis is of diagnostic value and has high therapeutic importance when combined with anti-acanthamoeba medical therapy.