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Acanthamoeba keratitis successfully treated with prolonged propamidine isethionate and neomycin-polymyxin-gramicidin
Abstract:
We report a case of Acanthamoeba castellanii keratitis that was successfully treated with intense propamidine isethionate and neomycin-polymyxin-gramicidin over 11 and nine days, respectively. The frequency with which the medications were applied, once every 30 minutes with each medication, has been surpassed only once before in reported cases. Additional medical treatment included topical miconazole 1% drops for five days and clotrimazole 1% drops for one day; the latter was discontinued due to corneal epithelial toxicity. Intense treatment of Acanthamoeba keratitis with these medications has not been reported before for as long as 11 days. Our aggressive approach was successful, and no clinically detectable significant side effects were observed. There has been no recurrence to date.
Insights
This case study shows successful treatment of Acanthamoeba keratitis using intensive propamidine isethionate and neomycin-polymyxin-gramicidin eye drops. The aggressive treatment regimen, applied frequently over extended periods, resolved the infection without significant side effects.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Acanthamoeba keratitis (AK) is a severe microbial infection of the cornea.
- Prompt and effective treatment is crucial to prevent vision loss.
Observation:
- A patient presented with Acanthamoeba castellanii keratitis.
- An intensive treatment protocol was initiated, involving frequent application of propamidine isethionate and neomycin-polymyxin-gramicidin eye drops.
- Topical miconazole and clotrimazole were used as adjunctive therapies.
Findings:
- The aggressive, prolonged treatment regimen (11 days for propamidine isethionate, 9 days for neomycin-polymyxin-gramicidin) resulted in successful resolution of the Acanthamoeba keratitis.
- No significant, clinically detectable side effects were observed despite the intensity of the treatment.
- No recurrence of the infection was noted at the time of reporting.
Implications:
- This case demonstrates the efficacy of an aggressive, high-frequency, and prolonged therapeutic approach for Acanthamoeba keratitis.
- The findings suggest that such intensive treatment strategies can be safe and effective, even in severe cases.
- This approach may offer a valuable option for managing challenging Acanthamoeba keratitis cases.