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.