Treatment of Acanthamoeba keratitis with chlorhexidine

Abstract

Objective To evaluate the efficacy of chlorhexidine solution in the treatment of patients with Acanthamoeba keratitis. Design Prospective nonrandomized study. Participants Five patients infected with culture-proven Acanthamoeba keratitis. Intervention Chlorhexidine solution was used hourly on six eyes and gradually reduced to four times a day after 1 month. Follow-up ranged from 1 to 10 months (mean, 4 months). Main outcome measures Severity of symptoms and signs, time for healing, and final visual acuity. Results Clinical results in four patients showed improved visual acuity, with a rapid recovery within 1 week. No adverse drug reaction was encountered, but one patient with a perforated ulcer developed glaucoma. Eighty-three percent of 6 eyes were medically cured with chlorhexidine and recovered visual acuity 6/18 or better. Four of five patients improved within 3 weeks, with resolution of infiltration and healing of epithelial defects. By 2 to 3 weeks, visual acuity 6/18 or better had improved in four (66.7%) of six eyes and recovered 6/6 in two eyes (33.3%). Bacterial coinfection occurred in one eye. Conclusion Chlorhexidine dramatically hastened clinical improvement in all eyes and is a successful medical therapy that has excellent results in patients who are diagnosed early.