Titre du document / Document title

Outcome of Acanthamoeba keratitis treated with polyhexamethyl biguanide and propamidine

Auteur(s) / Author(s)

DUGUID I. G. M. ⁽¹⁾ ; DART J. K. G. ⁽¹⁾ ; MORLET N. ⁽¹⁾ ; ALLAN B. D. S. ⁽¹⁾ ; MATHESON M. ⁽²⁾ ; FICKER L. ⁽¹⁾ ; TUFT S. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Moorfields Eye Hospital, City Road, London EC1V 2PD, ROYAUME-UNI
⁽²⁾ Department of Pathology, Institute of Ophthalmology, Bath Street, London, EC1V 9EL, ROYAUME-UNI

Résumé / Abstract

Objective: This study investigates the clinical outcome of Acanthamoeba keratitis treated with polyhexamethyl biguanide (PHMB) and propamidine isethionate (Brolene). Design: A retrospective review of all patients treated for Acanthamoeba keratitis between September 1992 and February 1995 was carried out. All patients were treated with PHMB 0.02% and propamidine 0.1% hourly for 3 days, the frequency reduced to four to six times daily according to clinical response. Main Outcome Measures: Age, gender, result of laboratory investigation, duration of disease before diagnosis, visual acuity (VA) pretreatment and post-treatment, need for keratoplasty, and presence of adverse reaction were measured. Results: One hundred eleven cases were identified in 105 patients (60 male, 45 female; mean age, 32). Ninety-two percent of infections were in contact lens wearers. The clinical diagnosis was confirmed by corneal culture or histopathology in 64 cases (57.7%). The diagnosis was made early (within 28 days) in 65 cases (58.6%). Twenty-one (18.9%) were intermediate (28 days-2 months) and 20 (18%) were late (>2 months) diagnoses. Overall post-treatment VA was 6/12 or better in the majority (88/ 111, 79.3%) of cases, and 18 (16.2%) had VA of 6/36 or worse. The VA of ≥6/12 was achieved by 90.8% of the early, 71.4% of the intermediate, and 65% of the late groups. Clinical relapses occurred in 19 patients on reducing the therapy. Treatment toxicity was never serious and consisted only of stinging or superficial punctate keratopathy. Keratoplasty was indicated in only ten patients, and disease activity was controlled adequately in all patients before grafting. Conclusions: Combined treatment with PHMB and propamidine is well tolerated, nontoxic, and effective. Typically, visual outcome is favorable and the requirement for keratoplasty reduced markedly.

Revue / Journal Title

Ophthalmology   ISSN 0161-6420   CODEN OPHTDG 

Source / Source

1997, vol. 104, n^o10, pp. 1587-1592 (16 ref.)

Langue / Language

Anglais

Editeur / Publisher

Elsevier, New York, NY, ETATS-UNIS  (1976) (Revue)

Mots-clés anglais / English Keywords

Keratitis ; Acanthamoeba ; Protozoal disease ; Chemotherapy ; Treatment ; Propamidine ; Parasiticid ; Antiprotozoal agent ; Drug combination ; Treatment efficiency ; Prognosis ; Human ; Lobosea ; Protozoa ; Parasitosis ; Infection ; Eye disease ; Keratopathy ;

Mots-clés français / French Keywords

Kératite ; Acanthamoeba ; Protozoose ; Chimiothérapie ; Traitement ; Propamidine ; Antiparasitaire ; Antiprotozoaire ; Association médicamenteuse ; Efficacité traitement ; Pronostic ; Homme ; Polyhexamethyl biguanide ; Lobosea ; Protozoa ; Parasitose ; Infection ; Oeil pathologie ; Kératopathie ;

Mots-clés espagnols / Spanish Keywords

Queratitis ; Acanthamoeba ; Protozoosis ; Quimioterapia ; Tratamiento ; Propamidina ; Antiparasitario ; Antiprotozoario ; Asociación medicamentosa ; Eficacia tratamiento ; Pronóstico ; Hombre ; Lobosea ; Protozoa ; Parasitosis ; Infección ; Ojo patología ; Queratopatía ;

Localisation / Location

INIST-CNRS, Cote INIST : 18914, 35400006853619.0110