title: Doxycycline in the management of pseudomonas corneal melting: two case reports and a review of the literature.
abstract: BACKGROUND
  Pseudomonas keratitis can result in the breakdown of collagen with subsequent corneal melting and perforation. The use of antimetalloproteinases may help to stabilize melting and prevent imminent perforation of the cornea. The use of topical protease inhibitors and neutrophil inhibitors is of limited value. Tetracyclines, however, have been shown to have anticollagenolytic activity and inhibit metalloproteinases, and they may suppress connective tissue breakdown.
  
  
  OBJECTIVE
  To establish the stabilization of corneal melting in cases of Pseudomonas keratitis.
  
  
  METHODS
  Two young patients with severe contact lens-associated Pseudomonas keratitis and corneal melting were treated with oral doxycycline and standard topical treatment.
  
  
  RESULTS
  Corneal melting was stabilized in each patient, and perforation was avoided.
  
  
  CONCLUSIONS
  Tetracyclines have an anticollagenolytic action in addition to their antimicrobial activity. The use of doxycycline as an adjunctive therapy in the management of Pseudomonas corneal melting may help to stabilize corneal breakdown and prevent subsequent perforation.
authors.affiliation: Epsom and St. Helier University Hospitals NHS Trust, St. George's Hospital Medical School, London, United Kingdom. amce@doctors.org.uk
authors.forename: Andrena M
authors.initials: AM
authors.lastname: McElvanney
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D003094:Collagen / Q000378:metabolism; D003263:Contact Lenses, Hydrophilic / Q000009:adverse effects; D003315:Cornea / Q000187:drug effects* / Q000378:metabolism; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology*; D004318:Doxycycline / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D003094:Collagen; D004318:Doxycycline