Treatment of Acanthamoeba keratitis.
OBJECTIVE
To review the available treatment modalities for Acanthamoeba keratitis and to assess the most effective regimens.


METHODS
The efficacy of therapeutic modalities and chemotherapeutic agents used in the treatment of Acanthamoeba keratitis was reviewed. Potential synergistic or additive drug interactions were documented both in vitro and in vivo.


RESULTS
Early diagnosis of Acanthamoeba keratitis plays a crucial role in successful medical treatment. The cationic antiseptic agents, chlorhexidine and polyhexamethylene biguanide (PHMB) have the lowest minimal amoebicidal concentrations. Synergistic effects are seen when used with pentamidine, and additive effects are seen with propamidine or neomycin. Penetrating keratoplasty should be deferred if at all possible until a medical cure has been achieved.


CONCLUSIONS
Early diagnosis and wide epithelial debridement are important elements in the successful treatment of Acanthamoeba keratitis. Recommended therapy would include the cationic antiseptic agents, chlorhexidine or PHMB in combination with propamidine isethionate and neomycin as part of triple therapy. Surgical intervention should be avoided until a medical cure has been achieved.
Lindquist
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TD
Cornea and External Disease Service, Virginia Mason Medical Center, Seattle, Washington 98111-0900, USA.
D015823:Acanthamoeba Keratitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D000818:Animals; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003315:Cornea / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D003452:Cryosurgery; D004202:Disinfectants / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D015948:Keratoplasty, Penetrating; D009883:Ophthalmic Solutions
D000981:Antiprotozoal Agents; D004202:Disinfectants; D009883:Ophthalmic Solutions