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K. L. Masselam, R. Pineda; Topical Voriconazole as an Effective Co-Agent Against Acanthamoeba Keratitis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5537.
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To evaluate the use of topical voriconazole 1% in combination with topical polyhexamethyl biguanine (PHMB) 0.02% for the treatment of Acanthamoeba keratitis (AK).
A retrospective chart review was performed on five patients with AK. Patients were diagnosed with AK by one or more of the following methods: confocal microscopy, corneal cultures, and clinical examination. The amount of time patients were treated with topical voriconazole was reviewed in addition to evaluation of the efficacy and tolerability of the medication. Efficacy was determined by improvement of the AK both clinically and symptomatically. Clinical evaluation included visual acuity and slit lamp examination.
All five patients treated with topical voriconazole 1% in combination with PHMB 0.02% showed clinical improvement or complete medical resolution of the AK. Length of medications treatment ranged from 2.5 months to 7 months. All patients reported excellent tolerability on their medication regimen. No side effects from the topical combination medication were reported.
Acanthamoeba keratitis is a growing problem with limited therapeutic options. We have described the safe and effective use of topical voriconazole as a co-agent for the treatment of acanthamoeba keratitis. Topical voriconazole 1% has been known to effectively treat fungal keratitis whose mechanism of action blocks the synthesis of ergosterol, which is also found in amoeba cell membranes. In combination with PHMB, it clinically appears to have a synergistic action against acanthamoeba sp., . We believe this has significant clinical value to current and future patients with AK.
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