Treatment of Acanthamoeba keratitis combined with fungal infection with polyhexamethylene biguanide.

From July 1996 to March 1997, three cases of Acanthamoeba keratitis combined with fungal infection were diagnosed and treated at our ophthalmic department. Specimens from all of these cases were obtained by corneal scraping, keratectomy and anterior chamber paracentesis. The diagnosis was confirmed by either the results of smear test or pathology reports. All of these patients received aggressive treatment with polyhexamethylene biguanide (PHMB) 0.02%, fluconazole, and anegyn eye drops. After the infection had been controlled without extension, therapeutic penetrating keratoplasty was performed on all of these patients despite the existence of infiltration beyond the edge of the graft. Postoperatively, eye drops were tapered gradually, and treatment was continued for 1 to 2 months. All three cases achieved good results and there was no recurrence of infection. Two cases had visual acuity of 20/100 and 20/20, while the other one perceived hand movement only due to later graft rejection. These cases suggest that early diagnosis and immediate use of PHMB and anti-fungal agents are effective in the treatment of Acanthamoeba keratitis combined with fungal infection.

Vanidilol: a vanilloid-type vasorelaxant and ocular hypotensive beta-adrenoceptor blocker with partial beta-2-agonist activity.

Vanidilol, [4'-(2-hydroxy-3-(tert-butylamino)propoxy)-3'-methoxyphenyl] -benzaldehyde, newly synthesized from vanillin, is a vanilloid-type beta-adrenoceptor blocker. The beta-adrenoceptor-blocking properties of vanidilol were studied both in vivo and in vitro. Intravenous injection of vanidilol (1.0, 3.0, 5.0 mg/kg) in anesthetized Wistar rats produced a decrease in blood pressure and a dose-dependent bradycardia response. Vanidilol inhibited the tachycardia effects induced by (-)isoproterenol, but had no blocking effect on the arterial pressor responses induced by phenylephrine. In isolated guinea-pig tissues, vanidilol attenuated the (-)isoproterenol-induced positive chronotropic and inotropic effects of the atria and trachea relaxation responses in a concentration-dependent manner. The parallel shift to the right of the concentration-response curve of (-)isoproterenol suggested that the agent was a beta-adrenoceptor competitive antagonist. The apparent pA2 values for vanidilol on the right atria, left atria and trachea were 7.67 +/- 0.03, 7.89 +/- 1.02 and 7.66 +/- 0.15, respectively, denoting that vanidilol was a nonselective beta-blocker. The intrinsic sympathomimetic activity of vanidilol and propranolol was determined on isolated atria and trachea from reserpinized guinea pigs. Propranolol caused significantly negative inotropic and chronotropic effects at 10(-6) mol/l or above, whereas vanidilol possessed less cardiodepressant activities than propranolol. In reserpinized tracheal strips, vanidilol produced dose-dependent relaxant responses, but propranolol was ineffective. Preincubating the preparations with ICI 118,551 (0.1-10 nmol/l), a beta 2-adrenoceptor antagonist, significantly shifted the concentration-relaxation curves of vanidilol to a region of higher concentrations. In isolated guinea-pig thoracic aorta, vanidilol (0.1-10 mumol/l) inhibited the phenylephrine (10(-5) mol/l)-induced tonic contraction in vascular smooth muscle which was related to the block of calcium influx. In 20% saline-perfused rabbits, vanidilol showed a marked delay in intraocular pressure recovery, demonstrating an ocular hypotensive action. Binding characteristics of vanidilol and propranolol were evaluated in [3H]dihydroalprenolol binding to porcine ventricular membranes. Vanidilol was less potent than propranolol in competing for the beta-adrenoceptor-binding sites. On the other hand, vanidilol had a high hydrophilicity in comparison with propranolol. In conclusion, vanidilol exhibited nonselective beta-adrenoceptor blocking, vasorelaxant and ocular hypotensive activities, but was devoid of alpha-adrenoceptor blocking and beta 1-agonist activity. Partial beta 2-adrenoceptor agonist activity and inhibitory activity on calcium influx may share in the vasorelaxant activity.