What are available treatments for post-LASIK Acanthamoeba keratitis?

Post-LASIK infections are extremely rare, and Acanthamoeba keratitis is quite rare too. It is theoretically possible, but I have never come across such a case (of post-LASIK Acanthamoeba keratitis). Having something like this happen could possibly point to a breakdown of sterilisation measures.

Classically, Acanthamoeba keratitis is associated with contact lens wear, especially when the contact lens wearer uses tap water or homemade saline to wash/rinse their lenses.

If a post-LASIK patient does develop Acanthamoeba keratitis, the treatment is quite similar to someone who has not had LASIK before.

This would involve very intensive, hourly, administration of eye drops such as Chlorhexidine 0.02%, and Desomedine. Chlorhexidine is quite irritating and must be used in a particular concentration under close supervision, otherwise significant side effects can occur.

Depending on the situation, other measures may be necessary, including surgical procedures, to firstly clear the infection and secondly to provide as good a visual outcome as possible.

Treatment of Acanthamoeba keratitis is difficult, even in post-Lasik patients. This is due to the resilient nature of the cyst form. Current treatment regimens usually include a topical cationic antiseptic agent such as polyhexamethylene biguanide (0.02%) or chlorhexidine (0.02%) with or without a diamidine such as propamidine (0.1%) or hexamidine (0.1%).

In severe cases of infection, therapeutic corneal transplantation to reduce the pathogen load may even be required.