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    Grand Rounds

    A patient with history of dry eye disease utilizing PROSE contact lenses presents with a 4-week history of blurry vision, red eye, and eye pain. They were previously treated for presumed herpetic viral keratitis with no improvement. Patient was culture-positive for acanthamoeba trophozoites and was subsequently started on PHMB and chlorhexidine eye drops. After achieving quiescence for nearly one year following medical cure, they underwent a deep anterior lamellar keratoplasty (DALK) with improvement in vision. Pathology evaluation of the host cornea did not reveal any organisms. Slowly over the course of days, they noticed worsening redness, pain, and blurry vision. The transplanted cornea rapidly progressed to complete stromal melting and with recurrent positive acanthamoeba cultures, the patient was taken back to the OR for repeat DALK. The tissue was again analyzed for acanthamoeba and was found to have cysts within the deep stroma. The patient was restarted on topical therapy as well as oral miltefosine. They subsequently developed a severe inflammatory reaction that was initially believed to be a paradoxical reaction to dying amoeba following miltefosine initiation. However, the patient continues to produce persistently positive acanthamoeba cultures and is currently awaiting a full thickness penetrating keratoplasty.

    Presentation Date: 05/14/2026
    Issue Date: 05/15/206