Successful medical treatment of Acanthamoeba keratitis.
OBJECTIVE
To describe the outcome of a series of Acanthamoeba keratitis treated with a similar regimen.


METHODS
All cases diagnosed with Acanthamoeba keratitis in a referral centre from June 1994 through June 1997 were included. Diagnosis of Acanthamoeba keratitis was based in clinical presentation and laboratory results. Positive laboratory identification of Acanthamoeba from corneal scraping or contact lens was required, unless the patient had very characteristic symptoms (severe pain) and signs of the infection, including perineural infiltrates. Initial intensive treatment included topical polyhexamethylene biguanide (PHMB) 0.02%, propamidine isothionate 0.1% and broad-spectrum antibiotics. The treatment was gradually tapered. After documented response to anti-acanthamoeba therapy, topical steroids were introduced; they were discontinued before cessation of the anti-Acanthamoeba regimen.


RESULTS
Six males and four females, with a mean age of 30.0 +/- 7.4 years were included in this study. All cases wore contact lenses. On presentation all cases had severe pain, and epitheliopathy was associated with stromal infiltrate in most (seven of ten) cases. Four patients had anterior uveitis. Perineural infiltrates were present in three cases and ring infiltrate in one patient. Anti-amoebic treatment was started 12.7 +/- 7.2 days after beginning of symptoms. The clinical response to therapy was very satisfactory in all patients. Within two to three weeks all patients had remarkable lessening of pain and photophobia, and improvement of clinical signs. At two to three months, visual acuity had improved in all patients. Two patients required penetrating keratoplasty for visual rehabilitation.


CONCLUSIONS
The use of PHMB and propamidine cured all cases of Acanthamoeba keratitis. Cautious introduction of steroids was associated with expedited resolution of inflammation and provided symptomatic relief.
Department of Ophthalmology, Queen's Medical Centre-University Hospital, Nottingham, UK.
A
A
Azuara-Blanco
A S
AS
Sadiq
M
M
Hussain
J H
JH
Lloyd
H S
HS
Dua
D000048:Acanthamoeba / Q000302:isolation & purification; D015823:Acanthamoeba Keratitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D000287:Administration, Topical; D000328:Adult; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D001550:Benzamidines / Q000627:therapeutic use*; D001645:Biguanides / Q000627:therapeutic use*; D003263:Contact Lenses, Hydrophilic / Q000009:adverse effects; D003315:Cornea / Q000469:parasitology; D004202:Disinfectants / Q000627:therapeutic use*; D004209:Disposable Equipment; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D009883:Ophthalmic Solutions; D014792:Visual Acuity
D000893:Anti-Inflammatory Agents; D000981:Antiprotozoal Agents; D001550:Benzamidines; D001645:Biguanides; D004202:Disinfectants; D005938:Glucocorticoids; D009883:Ophthalmic Solutions; C031233:polihexanide; C046651:propamidine isethionate