Fig. 2.

In vivo confocal microscopy images taken during the course of treatment. (A) Acanthamoeba infection is detected 7 weeks after first PACK-CXL by the presence of hyper-reflective round structures in the epithelium (arrows) indicative of cysts. (B) Two weeks after second PACK-CXL, round structures in the epithelium (arrows) with typical appearance and distribution indicating Acanthamoeba cysts, but with diffuse reflectivity. (C) 5 weeks after the second PACK-CXL, small hyper-reflective round structures (arrows) are observed in the anterior stroma, possibly indicative of inactive cysts or apoptotic/necrotic debris. Note the absence of stromal keratocytes which take a longer time to repopulate following CXL. (D–F) 5 months after second PACK-CXL. No cysts were found in the regenerated superficial epithelium (D), in regenerated epithelial wing cell layers (E), or in the anterior stroma (F).