title: Double-biguanide therapy for resistant acanthamoeba keratitis.
abstract: OBJECTIVE
  To report the clinical and diagnostic findings of a patient with Acanthamoeba keratitis resistant to both polyhexamethylene biguanide (PHMB)-hexamidine and chlorhexidine-hexamidine treatment.
  
  
  METHODS
  Slit-lamp biomicroscopy, corneal cell scraping and histopathology were performed on a 39-year-old woman presenting with corneal ulcer in her left eye.
  
  
  RESULTS
  The patient was successfully treated with PHMB-chlorhexidine association therapy. Subsequent perforating keratoplasty remained clear at the last follow-up visit after 7 months and increased visual acuity to 20/20 with correction.
  
  
  CONCLUSIONS
  This case emphasizes the proteiform aspects of Acanthamoeba drug resistance, and suggests that PHMB-chlorhexidine association might represent an additional option for cases resistant to standard therapy.
authors.affiliation: Bietti Eye Foundation, Rome, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Ferrari
authors.forename: Stanislav
authors.initials: S
authors.lastname: Matuska
authors.forename: Paolo
authors.initials: P
authors.lastname: Rama