Outcome of acanthamoeba keratitis treated with polyhexamethyl biguanide and propamidine.
OBJECTIVE
This study investigates the clinical outcome of Acanthamoeba keratitis treated with polyhexamethyl biguanide (PHMB) and propamidine isethionate (Brolene).


METHODS
A retrospective review of all patients treated for Acanthamoeba keratitis between September 1992 and February 1995 was carried out. All patients were treated with PHMB 0.02% and propamidine 0.1% hourly for 3 days, the frequency reduced to four to six times daily according to clinical response.


METHODS
Age, gender, result of laboratory investigation, duration of disease before diagnosis, visual acuity (VA) pretreatment and post-treatment, need for keratoplasty, and presence of adverse reaction were measured.


RESULTS
One hundred eleven cases were identified in 105 patients (60 male, 45 female; mean age, 32). Ninety-two percent of infections were in contact lens wearers. The clinical diagnosis was confirmed by corneal culture or histopathology in 64 cases (57.7%). The diagnosis was made "early" (within 28 days) in 65 cases (58.6%). Twenty-one (18.9%) were "intermediate" (28 days-2 months) and 20 (18%) were "late" (> 2 months) diagnoses. Overall post-treatment VA was 6/12 or better in the majority (88/111, 79.3%) of cases, and 18 (16.2%) had VA of 6/36 or worse. The VA of > or = 6/12 was achieved by 90.8% of the early, 71.4% of the intermediate, and 65% of the late groups. Clinical relapses occurred in 19 patients on reducing the therapy. Treatment toxicity was never serious and consisted only of stinging or superficial punctate keratopathy. Keratoplasty was indicated in only ten patients, and disease activity was controlled adequately in all patients before grafting.


CONCLUSIONS
Combined treatment with PHMB and propamidine is well tolerated, nontoxic, and effective. Typically, visual outcome is favorable and the requirement for keratoplasty reduced markedly.
Duguid
I G
IG
Moorfields Eye Hospital, London, England.
Dart
J K
JK
Morlet
N
N
Allan
B D
BD
Matheson
M
M
Ficker
L
L
Tuft
S
S
D000048:Acanthamoeba / Q000302:isolation & purification; D015823:Acanthamoeba Keratitis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D001550:Benzamidines / Q000627:therapeutic use*; D001645:Biguanides / Q000627:therapeutic use*; D003261:Contact Lenses; D003315:Cornea / Q000187:drug effects* / Q000469:parasitology / Q000503:physiopathology; D004202:Disinfectants / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity
D000981:Antiprotozoal Agents; D001550:Benzamidines; D001645:Biguanides; D004202:Disinfectants; C031233:polihexanide; C046651:propamidine isethionate