A randomized masked pilot clinical trial to compare the efficacy of topical 1% voriconazole ophthalmic solution as monotherapy with combination therapy of topical 0.02% polyhexamethylene biguanide and 0.02% chlorhexidine in the treatment of Acanthamoeba keratitis

Bagga, Bhupesh; Sharma, Savitri; Gour, Ruchi Pratap Singh; Mohamed, Ashik; Joseph, Joveeta; Rathi, Varsha M; Garg, Prashant

doi:10.1038/s41433-020-1109-4

Cited by 17 publications

(13 citation statements)

References 37 publications

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“…These results suggested that combined therapy including PHMB 0.02% and chlorhexidine 0.02% was comparable in efficacy to topical voriconazole as a monotherapy in AK treatment. 119 The benefit of the PHMB in experimental fungal keratitis was also reported. 17,127,128 Behrens-Baumann et al reported 3 cases of Fusarium Keratitis sussesfully treated with PHMB 0.02%.…”

Section: Clinical Applicationmentioning

confidence: 91%

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Polyhexamethylene biguanide hydrochloride (PHMB)-properties and application of an antiseptic agent. A narrative review

Niro

Pignatelli

Fallico

et al. 2022

European Journal of Ophthalmology

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The prevention and management of ocular surface infections is still one of the great challenges for ophthalmologists. The spread of antimicrobial resistance makes it necessary to use antiseptic substances with a broad antimicrobial spectrum. Polyhexamethylene biguanide hydrochloride (Polyhexanide, PHMB) is a broad-spectrum antiseptic with excellent tolerance and a low-risk profile. Its physicochemical action on the phospholipid membrane and DNA replication or repair mechanism, prevents or impedes the development of resistant bacterial strains. PHMB revealed its effective against numerous organisms like viruses, Gram-negative and Gram-positive bacteria, and fungi. Polyhexanide is commonly used as preservative in commercially available disinfecting solutions for contact lens care and in ophthalmic formulations at different concentrations ranging from 1 µg/ml to 50 µg/ml. The administration of 0.02% (200 µg/ml) PHMB is often the first-line therapy of Acanthamoeba keratitis. However, to date, only one close-out randomized controlled study tested the efficacy of 0.02% PHMB in Acanthamoeba keratitis and a phase III study is still ongoing. This paper reviews the antiseptic agent PHMB, focusing on biochemical mechanisms, safety profile and applications in ophthalmology.

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Section: Clinical Applicationmentioning

confidence: 91%

“…These results suggested that combined therapy including PHMB 0.02% and chlorhexidine 0.02% was comparable in efficacy to topical voriconazole as a monotherapy in AK treatment. 119…”

Section: Clinical Applicationmentioning

confidence: 99%

Polyhexamethylene biguanide hydrochloride (PHMB)-properties and application of an antiseptic agent. A narrative review

Niro

Pignatelli

Fallico

et al. 2022

European Journal of Ophthalmology

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“…Median ulcer size decreased significantly in both groups. Median VA in the combination group improved from 1.79 to 1.10 ( P =0.02) and from 1.60 to 0.80 in voriconazole group ( P =0.18) 36. While the clinical response to both treatments were similar in this pilot study, a larger study with longer treatment time is needed to further study the efficacy of topical voriconazole monotherapy as first-line treatment of AK.…”

Section: Voriconazolementioning

confidence: 71%

An Update on the Initial Treatment of Acanthamoeba Keratitis

Wang¹,

Jacobs²

2022

International Ophthalmology Clinics

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Acanthamoeba keratitis (AK) is an infectious disease of the ocular surface that can be challenging to diagnose and treat and can lead to permanent loss of vision. It is most common in contact lens wearers, with reported rates of 1 to 33 cases per million contact lens wearers. 1,2 Acanthamoebae are protozoans ranging 25 to 50 um in size that can exist in either an active trophozoite or dormant cyst form. Several species of Acanthamoeba have been reported to cause AK, including A. castellanii and A. polyphaga. The cyst form can survive low temperatures and is resistant to biocides, chlorination, and antibiotics. 3 Patients can present with a variety of symptoms and signs that may be initially misdiagnosed as bacterial or viral keratitis. AK should be included in the differential diagnosis of any case presenting with unilateral keratitis, especially in the setting of contact lens wear, trauma, or contamination with soil or water. Patients typically present with pain, photophobia, and decreased visual acuity (VA). 4 Early findings include epitheliitis, with punctate keratopathy and pseudodendrites, often leading to a presumptive diagnosis of Herpes simplex keratitis. Patients may progress and develop perineural infiltrates, anterior stromal disease, deep stromal keratitis, or a ring infiltrate. 5 Although a ring infiltrate and perineural infiltrates are conventionally thought to be pathognomic for AK, they only occur in about 50% and 63% of cases, respectively, 4,6 and are findings that develop later in the disease course. Since the likelihood of medical cure is greater if diagnosis is made while the infection remains superficial, prompt recognition of the disease before the development of these later pathognomic signs is important. 5 Clinicians must consider risk factors, clinical course, and response to therapy in arriving at a preliminary

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“…Multiple studies have shown that they have the best and most constant cysticidal and amoebicidal activities. [40][41][42] We used a combination of topical propamidine isethionate 0.1% and PHMB 0.02% in most cases. The concentration of PHMB was increased in 4 eyes only, when poor response was observed.…”

Section: Discussionmentioning

confidence: 99%

Acanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes

Nasef¹,

El-Emam²,

El-Shorbagy³

et al. 2021

OPTH

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Methods: A retrospective study of 42 patients (44 eyes) with Acanthamoeba keratitis who had medical records available for review over 4 years. Results: Forty-four eyes of 42 patients were treated for AK over the study period. In 29 eyes (65.8%), AK was related to contact lens wear. Severe ocular pain was the main presenting symptom in 38 eyes (86.3%). The most common ocular signs were radial perineural corneal infiltrates (65.9%), pseudo-dendrites (43.2%), ring infiltrates (45.5%), and diffuse stromal infiltration (59%). Acanthamoeba was detected by culture, smear, and in-vivo confocal microscopy (IVCM) in 25 eyes (56.8%), while in 19 eyes (43.2%) the diagnosis was based solely on the clinical findings. IVCM was effective in detection of Acanthamoeba in cases with early presentation, while culture was more sensitive in late presentation with corneal melting. The mean duration of treatment was 73.3 ± 23.7 days. Surgical intervention in the form of tectonic grafts or amniotic membrane transplant was required in five cases (11.3%) due to progressive corneal thinning and perforation. Seventeen patients (38.6%) had 0.2 or better final best-corrected visual acuity after treatment. Conclusion:The diagnosis of AK remains a major challenge for most ophthalmologists. Contact lens abuse is the major risk factor. Early diagnosis and appropriate treatment of AK with biocidal agents can improve the final outcome and help avoid surgical intervention. IVCM is an excellent tool for early diagnosis of AK.

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A randomized masked pilot clinical trial to compare the efficacy of topical 1% voriconazole ophthalmic solution as monotherapy with combination therapy of topical 0.02% polyhexamethylene biguanide and 0.02% chlorhexidine in the treatment of Acanthamoeba keratitis

Cited by 17 publications

References 37 publications

Polyhexamethylene biguanide hydrochloride (PHMB)-properties and application of an antiseptic agent. A narrative review

Polyhexamethylene biguanide hydrochloride (PHMB)-properties and application of an antiseptic agent. A narrative review

An Update on the Initial Treatment of Acanthamoeba Keratitis

Acanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes

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