[Delayed course of Acanthamoeba keratitis]. / Protrahierter Verlauf einer Akanthamöbenkeratitis.

A 35-year-old male presented with corneal ulceration on the left eye with a history of treatment over several months. At the first visit in our department we saw an elliptically shaped ulcerative stromal keratitis with circular peripheral neovascularization. There was organized hypopyon with hyphemia. The best corrected visual acuity (BCVA) was light perception. The patient had used contact lenses for many years. Under the suspicion of herpetic keratitis due to a positive "dendrite" the patient had undergone antiviral therapy for 6 months in a different department. Our diagnosis was Acanthamoeba keratitis. We performed penetrating excimer laser keratoplasty-à-chaud (8.0 × 7.0 mm/8.1 × 7.1 mm) with simultaneous cryotherapy of the mid-peripheral cornea. The topical therapy was polyhexamethylene biguanide, propamidine isoethionate, neomycin and steroids in intervals. A repeat penetrating excimer laser keratoplasty (8.5 × 7.5 mm/8.6 × 7.6 mm) with simultaneous amniotic membrane patch and lateral tarsorrhaphy was performed 2 months later due to melting of the graft with positive Seidel test. After successful surgery of the mature cataract the BCVA was 20/25. In a patient with a positive contact lens history acanthamoeba keratitis should always be considered as a differential diagnosis to herpes simplex keratitis in the early course of the disease.

[Delayed loss of vision after hammer and chisel injury]. / Verzögerte Visusminderung nach Hammer-Meissel-Verletzung.

Eye injuries caused by foreign bodies are a common diagnosis in many patients with an ocular emergency. A high percentage of foreign bodies are located in the cornea and are easily removed, but an intralenticular foreign body after eye injury is very rare. A 28-year-old man referred to our department with increasing loss of vision in the right eye 1 month after an accident with a hammer and chisel. At the time of admission the patient complained of a significant loss of vision and a traumatic cataract was diagnosed. The examination showed a deep stromal corneal scar and an anterior subcapsular cataract with posterior contusional rosette. Slit-lamp examination in mydriasis aroused the suspicion of an intralenticular foreign body. An X-ray examination of the right orbit was performed, but apart from a shadow, which was interpreted by the radiologists as a "pixel artefact", it revealed no presence of a foreign body. A computed tomography examination was also undertaken and confirmed the suspicion of an intralenticular foreign body, which was confirmed by an ultrasound scan. The intralenticular foreign body was removed during cataract surgery and an IOL was successfully implanted in the intact capsular bay. The day after the surgical intervention BCVA was 1.0. Every ocular trauma with a foreign body should be examined in mydriasis in order to exclude an intralenticular foreign body. Conventional X-ray images may not always be efficient enough to detect a foreign body. If an intraocular foreign body is suspected a thin-slice computed tomography examination of the orbit should be performed.