Driving in Fog without Headlight: Management of a Challenging Case of Presumed Ocular Toxoplasmosis.

Purpose: To describe a case of presumed ocular toxoplasmosis.Method: A retrospective chart review.Result: This case report describes a 35-year-old male who presented hypopyon anterior uveitis in his left eye. Fundus examination revealed severe vitritis which precluded the view of retina. His serum anti-toxoplasma immunoglobulin (Ig)G was significantly raised, with a normal anti-toxoplasma IgM level and PCR from nested primers targeting B1 gene of Toxoplasma gondii was positive. He was started on empirical anti-toxoplasma therapy. Undiluted vitreous specimen collected during lensectomy and diagnostic vitrectomy in left eye was also positive for nested primers targeting B1 gene of T. gondii.Conclusion: Ocular toxoplasmosis without retinochoroiditis, though extremely rare, can occur.

Cluster of Post-Operative Endophthalmitis Caused by Acanthamoeba T10 Genotype - A First Report.

PURPOSE: To report a cluster of postoperative Acanthamoeba endophthalmitis after routine cataract surgeries. METHODS: A brief summary of sentinel events leading to the referral of 4 patients of postoperative endophthalmitis to our hospital is followed by clinical descriptions and the various diagnostic approaches and interventions used. Genotyping and phylogenetic analysis are also discussed. RESULTS: Four cases of postoperative cluster endophthalmitis, presumed to be bacterial and treated as such, were referred to our hospital. The presence of an atypical ring infiltrate in the first case facilitated the diagnosis of Acanthamoeba endophthalmitis. All patients had vitritis, corneal involvement, and scleral inflammation. Multiple diagnostic methods, such as corneal scrapings, confocal microscopy, aqueous and vitreous taps, scleral abscess drainage, histopathological studies, polymerase chain reaction, and genotyping and phylogenetic analyses of isolated Acanthamoeba, were used to confirm the diagnosis of endophthalmitis and to establish the extent of ocular involvement. Various medical and therapeutic interventions used to control the infections were also documented. The isolated Acanthamoeba were confirmed as belonging to the T10 genotype, an environmentally and clinically rare variety. CONCLUSIONS: This is the first report of a cluster of postoperative T10 genotype Acanthamoeba endophthalmitis, occurring after routine cataract surgery in immunocompetent individuals. Contrary to current perceptions, a rapidly evolving infection can occur with Acanthamoeba.

Fulminant Acanthamoeba Endophthalmitis After Cataract Surgery-A Case Report.

PURPOSE: To report a case of Acanthamoeba endophthalmitis after an uneventful cataract surgery. METHODS: Description, management, and outcomes of a biopsy-proven case of Acanthamoeba endophthalmitis. RESULTS: Two days after a routine cataract surgery elsewhere, the patient presented with acute endophthalmitis diagnosed as a bacterial infection based on timing and severity. When conventional methods of management failed, the patient was referred to us. Only the presence of an atypical ring infiltrate suggested Acanthamoeba as a probable cause. Subsequent diagnostic evaluations confirmed the initial suspicion. Management with topical antiamoebics and intracameral and intravitreal voriconazole was attempted. Systemic voriconazole and metronidazole were also administered. However, because of relentless disease progression, the eye had to be eviscerated. The cornea, aqueous, vitreous, and sclera were positive by culture and/or polymerase chain reaction and histopathology. CONCLUSIONS: Acanthamoeba usually causes a chronic smoldering keratitis and, very rarely, scleritis. This report, which is the first of its kind, emphasizes the fact that fulminant endophthalmitis with associated scleritis can occur after ocular surgery in an immunocompetent individual, with no significant ophthalmic history.

Acanthamoeba endophthalmitis during treatment for cutaneous disease in a renal transplant patient.

Acanthamoeba infections are difficult to diagnose and treat. We present a renal transplant patient who developed Acanthamoeba endophthalmitis on therapy with posaconazole and miltefosine for cutaneous acanthamobiasis. The patient was maintained on intracameral voriconazole injections, and oral azithromycin, fluconazole, and flucytosine. This case highlights novel presentations and treatments for acanthamoebic infection.

ACANTHAMOEBA ENDOPHTHALMITIS AFTER RECURRENT KERATITIS AND NODULAR SCLERITIS.

PURPOSE: To describe the clinical course of a patient with Acanthamoeba keratitis, who despite prompt treatment progressed to histopathology-confirmed Acanthamoeba retinitis and endophthalmitis. METHODS: Case report. RESULTS: A healthy 30-year-old male wearing soft contact lens was diagnosed with Acanthamoeba keratitis and treated medically and surgically over the course of 1 year with presumed resolution of the infection. Yet, his infection recurred with documented spread to sclerokeratitis, and overwhelming endophthalmitis. Concerns about extra-ocular spread prompted a therapeutic enucleation with histopathologic evidence of Acanthamoeba organisms throughout the globe. CONCLUSION: This is a case of a severe recurrent Acanthamoeba infection presenting initially as keratitis, followed by sclerokeratitis and histolopathology-confirmed endophthalmitis. This case demonstrates that despite persistent medical and surgical intervention, eradication of organisms may not be possible.

Ocular toxocariasis: new diagnostic and therapeutic perspectives.

PURPOSE: To provide an updated insight of concepts regarding the overview, epidemiology, risk factors, clinical manifestations, diagnosis, treatment and prevention of ocular toxocariasis. DESIGN: Perspective of literature review. METHODS: Review and synthesis of literature about toxocariasis, with interpretation and perspective. A literature search for "ocular toxocariasis" was performed using PubMed, ScienceDirect, Scopus, SciELO and LILACS databases. RESULTS: Mild to moderate infections are frequently reported in ocular toxocariasis which usually occurs in children and typically presents as unilateral vision impairment, blindness is common and could present invasion of the retina. There are three groups of presentation of toxocariasis (according to the physical examination): chronic endophthalmitis, posterior granuloma and peripheral granuloma. Standard diagnosis of ocular toxocariasis is based on the identification of clinical signs, supported by additional diagnostic methods. Regarding treatment, there is no commonly accepted regimen but most of the authors prefer to use steroids and anthelminthic agents, but nowadays there are no standardized parameters in terms of dosage, duration and route of administration. Surgery has been recommended in some cases. CONCLUSION: Toxocariasis is still a problem of public health, particularly in developing countries with an increasing epidemiological burden in terms of morbidity and mortality and most of the authors agree on the utmost relevance of its prevention. Clinical experience and suspicion of ophthalmologists make an important role in its diagnosis, but always with supportive diagnostic methods. Additional studies should explore new therapeutic options for toxocariasis.

Diagnosis of intraocular lesions using vitreous humor and intraocular perfusion fluid cytology: Experience with 83 Cases.

OBJECTIVE: The objective of the study was to evaluate the use of vitreous humor and/or intraocular perfusion fluid (IPF) from pars plana vitrectomy as a diagnostic and therapeutic procedure for intraocular diseases. METHODS: The cytologic findings with respect to the clinical data, the anatomical findings, and the final diagnosis in 83 cases that underwent intraocular cytologic examinations at the Kansai Medical University Takii Hospital were evaluated. For cytologic examination, the Papanicolaou stain, Giemsa stain, and in some cases, molecular biology and immunocytochemical techniques were used. RESULTS: Most of the clinical diagnoses were uveitis or endophthalmitis. Sixty-eight cases (81.9%) were negative on cytodiagnosis, while 15 cases (18.9%) were positive or suspicious for malignancy. Negative cases included infections and intraocular sarcoidosis (IOS), and all of the positive or suspicious cases were intraocular lymphomas. Some of these latter cases were also diagnosed using immunocytochemical staining or molecular biological procedures as ancillary techniques, performed using vitreous body cytology from IPF. CONCLUSIONS: An early diagnosis and treatment of intraocular diseases is necessary to maintain an acceptable degree of quality of life. For an accurate diagnosis, it is necessary to understand the anatomy of the eye. Giemsa staining is recommended in addition to Papanicolaou staining for cytologic diagnostic evaluation of intraocular diseases. Furthermore, for the diagnosis of clonality in intraocular lymphomas, it is often necessary to use ancillary molecular biological procedures, using vitreous fluid.

Diffuse infiltrating retinoblastoma coexisting with ocular toxoplasmosis.

A 4-year-old boy presented with unilateral endophthalmitis and echography revealed an abscess in the vitreous cavity. A pars plana vitrectomy with intravitreal antibiotic injections was performed with a presumed diagnosis of endophthalmitis; however, the patient returned after 10 days with fibrin reaction in the anterior chamber, iris nodules and cataract. The vitreous sample from the vitrectomy showed Toxoplasma gondii parasite, so he was treated with intravitreal clindamycin and lensectomy. The postoperative fundus examination revealed multifocal white patches with calcified deposits and cytology proved the diagnosis of retinoblastoma. Enucleation was performed in addition to systemic chemotherapy. To our knowledge, this is the first reported case of the coexistence of retinoblastoma and ocular toxoplasmosis.

[Ocular toxocariasis--case report]. / TOXOCAROZA OCULARA (PREZENTARE DE CAZ).

Ocular Toxocariasis is a parasitosis caused by Toxocara catis/canis larvae localized in the eye. The most frequent clinical manifestations are the central retinal granuloma, peripheral retinal granuloma and chronic endophthalmitis. Secondary complications due to the presence of parasite in the posterior segment of the eye may have significant consequences on visual function. We present the case of a 23 years old patient, admitted for progressive decrease of the right eye BCVA during the last 6 months. After performing clinical examination and serological tests we established the diagnosis of ocular Toxocariasis. The patient presented a particular form of the disease consisting in the presence of both a central retinal granuloma and a peripheral one. We performed 23G pars plana vitrectomy and membrane peeling. VA improved as soon as the first month after surgery.

Use of a comprehensive polymerase chain reaction system for diagnosis of ocular infectious diseases.

PURPOSE: To measure the genomic DNA of ocular infectious pathogens in ocular fluids and to analyze the clinical relevance of these pathogens in uveitis and endophthalmitis. DESIGN: Prospective clinical case series. PARTICIPANTS: A total of 500 patients with infectious uveitis and endophthalmitis were examined at Tokyo Medical and Dental University, Tokyo Medical University, Kyushu University, Osaka University, and Kyoto Prefectural University, all in Japan. METHODS: Genomic DNA of bacteria, fungi, parasites, and viruses in collected intraocular samples were examined by comprehensive polymerase chain reaction (PCR). Samples were analyzed first by multiplex PCR and quantitative real-time PCR for human herpes viruses (HHVs) 1 through 8 and toxoplasma. Subsequently, samples were examined by broad-range real-time PCR for bacterial 16S and fungal 18S/28S ribosomal DNA (rDNA). MAIN OUTCOME MEASURES: Infectious uveitis and endophthalmitis diagnoses were obtained when using the PCR system. Calculations of the positivity and the diagnostic parameters such as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) also were evaluated. RESULTS: In all of the tested infectious uveitis and endophthalmitis patients, either herpes simplex virus type 1 (n = 18), herpes simplex virus type 2 (n = 4), varicella-zoster virus (n = 55), Epstein-Barr virus (n = 17), cytomegalovirus (n = 68), HHV type 6 (n = 2), toxoplasma (n = 6), bacterial 16S (n = 33), or fungal 18S/28S (n = 11) genome was detected. Neither HHV type 7 nor HHV type 8 DNA was detected in any of the samples. Of the 21 false-negative results found during the PCR analyses, 12 cases were negative for patients clinically suspected of having bacterial endophthalmitis. Conversely, false-positive results for the comprehensive PCR examinations occurred in only 3 cases that subsequently were found to have bacterial 16S rDNA. Diagnostic parameters for the sensitivity, specificity, PPV, and NPV of our PCR examinations were 91.3%, 98.8%, 98.6%, and 92.4%, respectively. CONCLUSIONS: Use of our comprehensive PCR assay to examine ocular samples in patients with endophthalmitis and uveitis seems to be clinically useful for detecting infectious antigen DNA. Thus, this PCR method is a reliable tool for both diagnosing ocular disorders and further screening of patients for intraocular infections. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Clinical and pathological characteristics of intraocular cysticercosis.

This study aimed to explore the clinical, radiological, and pathological characteristics of intraocular cysticercosis due to Taenia solium metacestode infection. Total 8 patients diagnosed with intraocular cysticercosis at the Red Cross Hospital of Yunnan Province, China were examined retrospectively. Patients with clear dioptic media had undergone fundus chromophotography. All patients underwent B ultrasonography of the ocular region (CT) successive scanning of the orbit and cerebral tissues. Parasites were extracted surgically and then examined pathologically. The fundus chromophotography showed a white and condensing scolex package in the vesicle. The B ultrasonic examination showed a vesicle-like echogenic mass in the vitreous chamber, in which the high-level echo spot was the cysticercus scolex. The pathological examinations showed that the vesicle wall exhibited hyaline degeneration, inflammatory cell infiltration, neuroglial fiber, and glial cell proliferation layers from the inside to the outside. The scolex is round and is composed of the outer tissue (the body wall) and the inner furrow tissue; these tissues migrated together. Primordially differentiated sucking discs were found in one case, but no hooklets were found. The inner scolex tissue was folded like a paper flower. The severity of intraocular disease is closely correlated with the pathophysiological processes of the cysticercus worm. Pathological examination of the intraocular lesions can help to evaluate the course of the disease as well as to provide a scientific basis for effective antiparasitic medication.

[Ultrasonographic findings in ocular toxocariasis]. / Achados ultrassonográficos em toxocaríase ocular.

PURPOSE: To evaluate ophthalmic ultrasound findings in the three presentation forms of ocular toxocariasis (peripheral or posterior pole granulomas and chronic endophthalmitis), in patients with confirmed diagnosis of ocular toxocariasis. METHODS: 11 patients (11 eyes) with clinical and confirmed diagnosis of active ocular toxocariasis, presented positive ELISA test, were analyzed, prospectively, in the study. The patients were submitted to an ocular ultrasound examination (10-MHz transducer, contact technique). RESULTS: In the series of 11 patients, mean age was 7.9 years-old (range from 2 to 17 y), 73% male, referring previous contact with dogs (91%), and with the soil (50%), no referral of appetite perversion. In the analyses of compromised eyes (11 eyes), the ophthalmoscopic examination revealed the following distribution of the 3 forms of ocular toxocariasis: 7 cases (63.6%), posterior pole granuloma; 1 (9.1%), chronic endophthalmitis; 2 (18.2%), peripheral granuloma; and 1 (9.1%), posterior pole granuloma associated with chronic endophthalmitis. Visual acuity impairment: no light perception (3 eyes, 27.3%); hand motion (4 eyes, 36.4%); counting fingers at 10 cm (1 eye, 9.1%); 20/200 (1 eye, 9.1%); 20/70 (1 eye, 9.1%); undefined (1 eye, 9.1%). Serology was positive to Toxocara canis (ELISA test) in 100% of the cases. Ophthalmoscopy was difficult or impossible in 64% of the cases due to the media opacity. Ultrasound findings noted were vitreous membranes with retinal attachment (100%); parietal lesions (granulomas) with high (80%) or medium (20%) reflectivity. CONCLUSION: The most consistent ultrasound finding in the eye with toxocariasis was a high-reflectivity retinal mass, located in posterior pole or periphery, which may be calcified, and which has as main characteristic the adherence of vitreous membranes. In addition to clinical history, systemic evaluation and serology, the ultrasound can help in the diagnosis of ocular toxocariasis, especially in media opacities.

Clinical characteristics of ocular toxocariasis in Eastern China.

PURPOSE: To explore the clinical characteristics of patients with ocular toxocariasis in eastern China. METHODS: The medical records of 35 cases of ocular toxocariasis in Fudan University Eye & ENT Hospital between May 2009 and April 2011 were retrospectively reviewed and analyzed. UBM, RetCam or fundus imaging, and high-frequency or conventional ultrasonography were performed in these patients. RESULTS: The mean patient age in our series of ocular toxocariasis was 11.86 ± 8.80 years. There were 28 children and seven adults, the majority residing in a rural area (88.57%). All cases were classified into three clinical subtypes: granuloma in the peripheral retina (60% of cases); granuloma in the posterior pole (28.57% of cases); and vitreous inflammation mimicking chronic endophthalmitis (5.71% of cases). We also identified an additional subtype with unique clinical features that we termed "combined type" presenting in 5.71% of our patients. This subtype exhibited granulomas in both the posterior pole and peripheral retina. RetCam fundus imaging was able to identify granulomas in the posterior and peripheral subtypes, 100% and 80.95% of cases respectively. Moreover, UBM combined with conventional ultrasonography identified granulomas in 95% of the peripheral subtype cases and in 100% of the posterior pole subtype cases. CONCLUSIONS: This is the first ocular toxocariasis series described in Chinese patients. Compared with reports from developed countries, the ocular features in our series were more severe and complicated, presenting with poorer visual acuity and a high rate of retinal detachment (45.7%). The application of RetCam and UBM during examination in ocular toxocariasis can provide valuable information in determining the severity of disease and features important in considering surgical procedures in such patients.

Achados ultrassonográficos em toxocaríase ocular / Ultrasonographic findings in ocular toxocariasis

OBJETIVO: Avaliar achados ultrassonográficos nas três principais formas de apresentação da toxocaríase ocular (granulomas de periferia e polo posterior e endoftalmite crônica), em pacientes com diagnóstico confirmado de toxocaríase ocular. MÉTODOS: Foram analisados no estudo 11 pacientes (11 olhos), de forma prospectiva, com diagnóstico de toxocaríase forma ativa, com teste ELISA positivo. Os pacientes foram submetidos ao exame de ultrassonografia ocular (transdutor 10 MHz, técnica de contato). RESULTADOS: Na série de 11 pacientes, com idade média de 7,9 anos (variando de 2 a 17 anos), 73% homens, referiram contato prévio com cães (91%), e com solo (50%), sem referência à perversão do apetite. Na avaliação dos olhos comprometidos (11 olhos), o exame oftalmológico revelou a seguinte distribuição das três formas de toxocaríase ocular: 7 (63,6%), granuloma de polo posterior; 1 (9,1%), endoftalmite crônica; 2 (18,2%), granuloma periférico; e 1 (9,1%), quadro associado de granuloma de polo posterior e endoftalmite crônica. Acuidade visual comprometida: sem percepção luminosa (3 olhos, 27,3%); visão de vultos (4 olhos, 36,4%); contar dedos a 10 cm (1 olho, 9,1%); 20/200 (1 olho, 9,1%); 20/70 (1 olho, 9,1%); indeterminado (1 olho, 9,1%). Sorologia para Toxocara canis foi positiva (teste ELISA) em 100% dos casos. Oftalmoscopia foi difícil ou impossível em 64% dos casos devido à opacidade de meios. Características ultrassonográficas observadas: membranas vítreas com retina aplicada (100%); lesões de parede (granulomas) com refletividade alta (80%) ou média (20%). CONCLUSÃO: O achado ultrassonográfico mais consistente no olho portador de toxocaríase foi a presença de massa retiniana de alta refletividade, localizada no polo posterior ou periferia, que pode ser calcificada, e que apresenta como principal característica a aderência de membranas vítreas. Em combinação com a história, exame clínico e sorologia, a ultrassonografia pode ajudar no diagnóstico da toxocaríase ocular, principalmente nos casos com opacidade de meios.

PURPOSE: To evaluate ophthalmic ultrasound findings in the three presentation forms of ocular toxocariasis (peripheral or posterior pole granulomas and chronic endophthalmitis), in patients with confirmed diagnosis of ocular toxocariasis. METHODS: 11 patients (11 eyes) with clinical and confirmed diagnosis of active ocular toxocariasis, presented positive ELISA test, were analyzed, prospectively, in the study. The patients were submitted to an ocular ultrasound examination (10-MHz transducer, contact technique). RESULTS: In the series of 11 patients, mean age was 7.9 years-old (range from 2 to 17 y), 73% male, referring previous contact with dogs (91%), and with the soil (50%), no referral of appetite perversion. In the analyses of compromised eyes (11 eyes), the ophthalmoscopic examination revealed the following distribution of the 3 forms of ocular toxocariasis: 7 cases (63.6%), posterior pole granuloma; 1 (9.1%), chronic endophthalmitis; 2 (18.2%), peripheral granuloma; and 1 (9.1%), posterior pole granuloma associated with chronic endophthalmitis. Visual acuity impairment: no light perception (3 eyes, 27.3%); hand motion (4 eyes, 36.4%); counting fingers at 10 cm (1 eye, 9.1%); 20/200 (1 eye, 9.1%); 20/70 (1 eye, 9.1%); undefined (1 eye, 9.1%). Serology was positive to Toxocara canis (ELISA test) in 100% of the cases. Ophthalmoscopy was difficult or impossible in 64% of the cases due to the media opacity. Ultrasound findings noted were vitreous membranes with retinal attachment (100%); parietal lesions (granulomas) with high (80%) or medium (20%) reflectivity. CONCLUSION: The most consistent ultrasound finding in the eye with toxocariasis was a high-reflectivity retinal mass, located in posterior pole or periphery, which may be calcified, and which has as main characteristic the adherence of vitreous membranes. In addition to clinical history, systemic evaluation and serology, the ultrasound can help in the diagnosis of ocular toxocariasis, especially in media opacities.

A case of naso-ophthalmic myiasis.

Myiasis is defined as an occupational disease and it is mainly seen in people who are in contact with animals, in particular sheep. We detected nasal and external ophthalmomyiasis caused by Oestrus ovis in a 33-year-old male who worked as a research assistant in the faculty of agriculture. The presenting complaints were severe foreign body sensation and discharge in the nose, cough, and foreign body sensation in the right eye. Ophthalmologic examination revealed many moving larvae in the right eye of the patient. Larvae were removed and nasolacrimal duct irrigation was performed through the inferior canaliculus. Endoscopic nasal examination also showed larvae colonies. The larvae were removed under local anesthesia and were taken to the parasitology laboratory, wherein Oestrus ovis was identified. Minimal endoscopic sinus surgery showed nonspecific chronic inflammation.

[Clinical features, the effectiveness of treatment and function of vision organ in children and adolescents with ocular toxocariasis]. / Ocena obrazu klinicznego, skutecznosci leczenia oraz funkcji narzadu wzroku u dzieci i mlodziezy z toksokaroza oczna.

PURPOSE: Toxocariasis is caused by Toxocara canis, the intestinal nematode commonly found in dogs. Patients are mostly young children, with an average age of 7.5 years. Patients have unilateral progressive painless vision loss and occasional leukocoria. Ocular toxocariasis has a variable presentation, from localized peripheral or macular granulomas to chronic endophthalmitis. MATERIAL AND METHODS: Clinical features, the effectiveness of treatment and function of vision organ in 19 children and adolescents with ocular toxocariasis were analyzed retrospectively. RESULTS: The mean patient age was 10.3 years. Inflammation was unilateral in all patients. In 11 cases (57.9%) there was peripheral granuloma, in 3 cases (15.8%) posterior pole granuloma and endophthalmitis in 5 cases (26.3%). Zentel was applied in 14 patients, Hetrazan in 3 patients and Mintezol in 2 patients. Improvement of visual acuity was achieved in 11 eyes (57.9%), no improvement in 7 eyes (36.8%), deterioration in 1 eye (5.3%). CONCLUSIONS: Ocular toxocariasis is the disease with differentiated clinical presentation. Toxocara uveitis can cause significant vision loss. In some cases quick diagnosis and effective treatment with corticosteroids and antihelminthics allowed to obtain clinical improvement.

Failure of Acanthamoeba castellanii to produce intraocular infections.

PURPOSE: This study examined possible mechanisms to explain why Acanthamoeba castellanii remains restricted to the cornea and rarely produces intraocular infections. The first hypothesis proposed that trophozoites cannot penetrate Descemet's membrane and the corneal endothelium to enter the anterior chamber (AC). The second hypothesis proposed that the trophozoites can enter the AC; however, the aqueous humor (AH) contains factors that either induce encystment or kill the amoebae. METHODS: Descemet's membrane was isolated from pig corneas and was used to determine whether Acanthamoeba trophozoites could penetrate this membrane in vitro. In addition, the capacity of trophozoites to survive in AH was determined in vitro. Trophozoites (10(6)) were injected into the AC of hamster eyes, and the number of amoebae in the AC was determined by histopathology 1 to 15 days later. RESULTS: The amoebae penetrated Descemet's membrane within 24 hours of in vitro culture. Penetration was prevented by addition of serine protease inhibitors or a chicken monoclonal antibody against the Acanthamoeba serine protease MIP-133. Although AH induced encystment of the amoebae, cysts remained viable. Injection of amoebae into the AC induced a robust neutrophil infiltrate, which was associated with complete clearance by day 15 after AC injection. CONCLUSIONS: The findings suggest that A. castellanii is capable of penetrating Descemet's membrane and entering the AC. However, a robust neutrophil response is associated with the disappearance of intraocular trophozoites and suggests that cells of the innate immune apparatus are important in preventing Acanthamoeba keratitis from progressing to become an intraocular infection.