{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:10:04Z","timestamp":1756311004965,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,4,3]]},"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:p>Two months following penetrating keratoplasty for <jats:italic>Acanthamoeba<\/jats:italic> keratitis, a 76-year-old man was referred due to inability to wean high-dose topical steroids. Despite a very healthy graft and minimal pain, a scleral abscess involving three clock hours of the superior conjunctiva was present. The patient underwent conjunctival and scleral excision of the area of apparent infection with adjuvant mitomycin C and double freeze\u2013thaw cryotherapy treatment followed by amniotic membrane graft. Recurrence was confirmed with PCR. Following a multimonth regimen of oral voriconazole and topical polyhexamethylene biguanide, chlorhexidine and moxifloxacin, the patient was weaned from all anti-infectious agents. After cataract surgery and scleral lens fitting, the patient is now 20\/20 in the affected eye. This case highlights the need for judicious use of immunosuppressive agents as well as the necessary vigilance to monitor for recurrence with <jats:italic>Acanthamoeba<\/jats:italic> infection. It also represents the first reported use of adjuvant mitomycin C and double freeze\u2013thaw cryotherapy for treatment of <jats:italic>Acanthamoeba<\/jats:italic> scleral abscess.<\/jats:p>","DOI":"10.1136\/bcr-2021-241864","type":"journal-article","created":{"date-parts":[[2021,6,21]],"date-time":"2021-06-21T14:30:23Z","timestamp":1624285823000},"page":"e241864","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["<i>Acanthamoeba<\/i> scleral abscess reoccurring after penetrating keratoplasty"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8301-404X","authenticated-orcid":false,"given":"Brad","family":"Barnett","sequence":"first","affiliation":[{"name":"Ophthalmology, Duke Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle","family":"McCloskey","sequence":"additional","affiliation":[{"name":"University Health Systems of Eastern Carolina, Greenville, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,6,21]]},"reference":[{"key":"2025082708383063000_14.6.e241864.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.310.6994.1567"},{"key":"2025082708383063000_14.6.e241864.2","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1097\/ICO.0b013e31829ded51","article-title":"Scleral and intraocular amoebic dissemination in Acanthamoeba keratitis","volume":"32","author":"Arnalich-Montiel","year":"2013","journal-title":"Cornea"},{"key":"2025082708383063000_14.6.e241864.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00436-014-3932-7"},{"key":"2025082708383063000_14.6.e241864.4","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1986.01050210067027"},{"key":"2025082708383063000_14.6.e241864.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(14)70007-8"},{"key":"2025082708383063000_14.6.e241864.6","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-008-0955-8"},{"key":"2025082708383063000_14.6.e241864.7","doi-asserted-by":"publisher","DOI":"10.1007\/s00436-007-0858-3"},{"key":"2025082708383063000_14.6.e241864.8","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2014-208536","article-title":"Use of multiple immunosuppressive agents in recalcitrant Acanthamoeba scleritis","volume":"2015","author":"Igras","year":"2015","journal-title":"BMJ Case Rep"},{"key":"2025082708383063000_14.6.e241864.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(02)01039-4"},{"key":"2025082708383063000_14.6.e241864.10","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1007\/s00347-020-01080-y","article-title":"Nekrotisierende Skleritis nach Akantham\u00f6benkeratitis [Necrotizing scleritis after acanthamoeba keratitis]","volume":"118","author":"Lang","year":"2021","journal-title":"Ophthalmologe"},{"key":"2025082708383063000_14.6.e241864.11","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0b013e31812e61e4"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-241864","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:38:39Z","timestamp":1756309119000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-241864"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6]]},"references-count":11,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,21]]},"published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1136\/bcr-2021-241864"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-241864","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,6]]}}}