TREATMENT OF ACANTHAMOEBA-KERATITIS

Purpose. To review the available treatment modalities for Acanthamoeba keratitis and to assess the most effective regimens. Methods. The eff icacy of therapeutic modalities and chemotherapeutic agents used in th e treatment of Acanthamoeba keratitis was reviewed. Potential synergis tic or additive drug interactions were documented both in vitro and in vivo. Results. Early diagnosis of Acanthamoeba keratitis plays a cruc ial role in successful medical treatment. The cationic antiseptic agen ts, chlorhexidine and polyhexamethylene biguanide (PHMB) have the lowe st minimal amoebicidal concentrations. Synergistic effects are seen wh en used with pentamidine, and additive effects are seen with propamidi ne or neomycin. Penetrating keratoplasty should be deferred if at all possible until a medical cure has been achieved. Conclusion. Early dia gnosis and wide epithelial debridement are important elements in the s uccessful treatment of Acanthamoeba keratitis. Recommended therapy wou ld include the cationic antiseptic agents, chlorhexidine or PHMB in co mbination with propamidine isethionate and neomycin as part of triple therapy. Surgical intervention should be avoided until a medical cure has been achieved.