title: Treatment with voriconazole in 3 eyes with resistant Acanthamoeba keratitis.
abstract: OBJECTIVE
  To report the use of topical voriconazole 1% (Vfend; Pfizer Inc, New York, New York, USA) ophthalmic solution for Acanthamoeba keratitis (AK) resistant to treatment with chlorhexidine (PerioChip; Dexel Pharma Technologies, Jerusalem, Israel).
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Three eyes of 2 patients with culture-proven AK were treated at a tertiary care institution, and their charts were reviewed. Topical voriconazole 1% was instituted as second-line treatment for AK unresponsive to standard treatment with chlorhexidine and hexamidine. Treatment with voriconazole 1% was started at 1-hour intervals. Improvement was assessed and defined by absence of clinical signs of active infection and visual improvement.
  
  
  RESULTS
  One patient with unilateral AK and 1 patient with bilateral AK who remained culture-positive for Acanthamoeba despite ongoing treatment with chlorhexidine and hexamidine were treated with voriconazole 1% topical solution as an adjuvant. Both patients were contact lens wearers. Of 3 eyes additionally treated with voriconazole, 2 eyes had clinical resolution of disease. One eye demonstrated recurrent disease after penetrating keratoplasty that resolved after intrastromal injection of voriconazole.
  
  
  CONCLUSIONS
  We report the use of topical and intrastromal voriconazole in successfully treating AK in cases of chlorhexidine- and hexamidine-resistant Acanthamoeba. Voriconazole may be a promising adjuvant agent in treating AK.
authors.affiliation: Cataract, Cornea and External Disease Service, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Stacy
authors.initials: S
authors.lastname: Bang
authors.forename: Erica
authors.initials: E
authors.lastname: Edell
authors.forename: Allen O
authors.initials: AO
authors.lastname: Eghrari
authors.forename: John D
authors.initials: JD
authors.lastname: Gottsch
mesh_terms: D000048:Acanthamoeba / Q000302:isolation & purification; D015823:Acanthamoeba Keratitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D000287:Administration, Topical; D000293:Adolescent; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003261:Contact Lenses / Q000469:parasitology; D003315:Cornea / Q000469:parasitology; D004351:Drug Resistance; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000008:administration & dosage / Q000627:therapeutic use; D011743:Pyrimidines / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D014792:Visual Acuity; D065819:Voriconazole
chemical_list: D000981:Antiprotozoal Agents; D009883:Ophthalmic Solutions; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole