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S.H. Yoo, A.C. Romano, E.C. Alfonso, D. Miller, R.K. Forster; LIGHTENING FLASH RADIAL KERATONEURITIS IN ACANTHAMOEBA KERATITIS VISUALIZED WITH CONFOCAL MICROSCOPY . Invest. Ophthalmol. Vis. Sci. 2004;45(13):112.
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Purpose: Acanthamoeba keratitis can be difficult to diagnose despite adequate corneal cultures and use of special stains. Delayed diagnosis and treatment can lead to a devasting ocular outcome. Radial keratoneuritis is an important "pathognomonic" sign in the early phase of this disease easily missed with slit lamp examination. The purpose of this study is to characterize the findings of radial keratoneuritis in acanthamoeba keratitis using a scanning confocal microscope Methods: We present a case report of a patient with subclinical radial keratoneuritis that was detected early by scanning confocal microscopy. This patient had corneal cultures taken which subsequently grew Acanthamoeba organisms. Results: We found several Acanthamoeba cysts, trophozoites and perineural infiltrates (radial keratoneuritis) in the anterior stroma and sub–epithelial regions. The nerves appeared irregular, distorted and thickened and resemble a pattern of a "lightening flash." Along these nerves we found several high contrast structures believed to be Acanthamoeba trophozoites. Conclusions: The pattern visualized with a scanning confocal microscope can heighten the index of suspicion for Acanthamoeba keratitis in patients with subclinical radial keratoneuritis.
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