OUTCOME OF ACANTHAMOEBA-KERATITIS TREATED WITH POLYHEXAMETHYL BIGUANIDE AND PROPAMIDINE

Objective: This study investigates the clinical outcome of Acanthamoeb a keratitis treated with polyhexamethyl biguanide (PHMB) and propamidi ne isethionate (Brolene). Design: A retrospective review of all patien ts treated for Acanthamoeba keratitis between September 1992 and Febru ary 1995 was carried out. All patients were treated with PHMB 0.02% an d 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 (6 0 male, 45 female; mean age, 32). Ninety-two percent of infections wer e in contact lens wearers. The clinical diagnosis was confirmed by cor neal 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 greater than or equal to 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. Tr eatment toxicity was never serious and consisted only of stinging or s uperficial punctate keratopathy. Keratoplasty was indicated in only te n patients, and disease activity was controlled adequately in all pati ents before grafting. Conclusions: Combined treatment with PHMB and pr opamidine is well tolerated, nontoxic, and effective. Typically, visua l outcome is favorable and the requirement for keratoplasty reduced ma rkedly.