In 2016, on the day of his heart team's game, Atletico Mineiro, for the Copa Libertadores of America, engineer Kaell Braga, 37, repeated a very frequent action in his day: putting contact lenses.
Only this time he did not pay proper attention – instead of using the right products for disinfection, he chose plumbing.
From there have been more than two years of fighting against a rare and very serious disease, Acanthamoeb keratitis, chronic infection caused by protozoan parasite Acanthamoeba spp.
"Before this happened, I felt uncomfortable in my left eye. I went to the hospital, and the ophthalmologist who replied to me said that it was an epithelial defect in the broadest layer of corneal tissue, which I think was caused by a scarf my daughter" , he recalls.
Then the doctor instructed him to use grease five days a day and in that period the lens disappears. However, only three days later, on the day of his club's departure, he had already bought tickets, decided not to follow some of the recommendations, and he evaluated the glass through a contact lens.
"The inconvenience I felt earlier deteriorated, and my eye began to grow. I would restore fat because I thought it was the same problem, but this time the treatment was not successful," said a specialist in the cornea, "he recalls.
In June 2016 he received a severe diagnosis, the result of exactly that – obviously harmless – cleaning of the lens. What's happening is that Acanthamoeba spp. is widespread in the environment, especially in water, whether it is sweet or salty, and it is not yet known why it "likes" contact lenses.
The Brage treatment was initially made using five different eye drops, which had to be dropped almost an hour, even at dawn.
"My vision was completely affected, I did not see anything and I had absurd pain in my eyes. I had to get out of work for some time."
After several months he even managed to cure keratitis, but prolonged use of such powerful drugs eventually seriously damaged his cornea. There have been many attempts to recover, such as the use of autologous serum, made from your own blood, and the implantation of the amniotic membrane.
None of this has been resolved, and the final solution is corneal transplantation. Operation occurred in March of this year and, for now, he was able to recover a vision – his current sharpness of vision is in medical terminology 20/50 – partial – which is already a good index for your case.
The engineer still had to perform a cataract surgery, others Acanthamoeba spp. Because of these two procedures, he stayed for seven months.
"I can now do basic activities and drive." I also returned to work, and life finally began to return to normal, "he said.
The main risk factors for the development of Acanthamoeb keratitis are exposure to water, whether shower, sea, bath, jacuzzi and pool, using contact lenses, especially gelatinous type. It is worth pointing out that, as a parasite likes to live in this environment, any drop can pose a threat. Neglecting hand hygiene in handling lenses also helps in your preference.
Although rare, the disease has worried more and more experts around the world. The latest alarm was recently published in the British Journal of Ophthalmology, an English scientific publication. Analyzing data ranging from 1984 to 2017, researchers discovered an epidemic in the country between 2011 and 2017.
Medical literature suggests that the subjects were more common in the 1980s in the United States and England. In Brazil, the first appeared about 30 years ago.
"Today there are two to three patients present, which is a very high number," says Denise de Freitas, a member of the Brazilian Ophthalmology Council (CBO) and a professor at the Department of Ophthalmology and Visual Science at the Escola Paulista de Medicina EPM, Federal University of Sao Paulo (Unifesp).
According to the specialist, Acanthamoeba spp. has devastating potentials, and the worst can be caught in the eye. "It's so violent that it can lead to eye loss," he says.
Apart from having the worst prognosis, the worst affected patients (about a quarter of the total) end up with less than 25% of vision or become blind after prolonged treatment – they can last up to 10 months. Overall, 25% of cases require transplantation of the cornea. There are still situations in which it is necessary to remove eyes and replace with acrylic prosthesis and glass eyes.
The United States and England advocate that there are more chances for success when the infection begins to heal in the first two weeks.
"The problem is that in Brazil people are looking for a doctor after two months, so the beginning of drug use is too late," says Denise.
Symptoms and prevention
Symptoms of Acanthamoeb keratitis, which usually affect young and economically active populations, are treacherous, starting with discomfort, cracking, itching, photophobia and tearing in only one or both eyes, which makes it easily confused by other eye diseases.
"Only gradually the situation worsens and when the infection is established, it causes intense pain. In this regard, an individual can not eat, sleep, work … it is a huge suffering," says Professor EPM / Unifesp.
Keila Monteiro de Carvalho, professor of ophthalmology at the Faculty of Medicine at the State University of Campinas (Unicamp), comments that the diagnosis is difficult, and the available treatments are long and not fully effective – this is done with the help of eye drops, and some do not There are in Brazil, which must be imported from Europe or the United States and antibiotics.
"Therapy lasts for months and there is a possibility of relapse. Unfortunately, corneal transplantation remains the last solution in case of severe infection. Acanthamoeba spp. Accelerate the identification of new pharmacological goals (places in the structure of the infectious agent in which measures can act). "
It is important to note that this type of infection can still have other consequences, such as glaucoma, cataract, sclerosis, and inflammation of the retina, drying of the eyelids and blindness. Depression is more common.
To avoid Acanthamoeb keratitis, the most important thing is not to expose water when you have a contact lens and to be very careful about hand hygiene at the time of your accommodation.
Keila also recommends the removal of daily solution for disinfecting the lens, daily cleansing with fresh solution, replacing the cases every three months and replacing the lenses in certain weather conditions of the manufacturer.
"Without a doubt, a frequent visit to an ophthalmologist is also fundamental," he concludes.
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