Comparison of polyhexamethylene biguanide and chlorhexidine as monotherapy agents in the treatment of Acanthamoeba keratitis.

PURPOSE: To compare the therapeutic outcomes of polyhexamethylene biguanide (PHMB) and chlorhexidine for Acanthamoeba keratitis. DESIGN: Prospective, double-masked, randomized comparative study. METHODS: Fifty-six eyes of 55 patients with Acanthamoeba keratitis were randomized to receiving PHMB 0.02% or chlorhexidine 0.02%. Diagnosis was made based on positive culture results (cornea or contact lens case) or on clinical grounds. The primary outcome measure was treatment failure defined as failure to induce a favorable clinical response within two weeks. Secondary outcomes were: 1) recovery of visual acuity (VA), 2) the degree of corneal scarring posttreatment, or 3) the need for penetrating keratoplasty. RESULTS: Fifty-one eyes completed the study. Twenty-three eyes received PHMB and 28 received chlorhexidine. Ninety-eight percent were contact lens wearers. Eighteen (78%) PHMB patients were treatment successes compared with 24 (85.7%) chlorhexidine patients (P = .71). Diagnosis was confirmed by positive corneal culture results in 26 cases (51%). Diagnosis was made within 28 days in 29 cases (56.9%), between one and two months in 13 cases (25.5%), and after more than two months in eight cases (15.7%). Improvement in VA was seen in 13 eyes (56.5%) receiving PHMB vs 20 eyes (71.4%) receiving chlorhexidine. Mild one-quadrant corneal scarring was seen in 43.5% of eyes receiving PHMB and 71.4% of eyes receiving chlorhexidine, whereas moderate corneal scarring in two or three quadrants was seen in 21.7% of eyes receiving PHMB and in 10.7% of eyes receiving chlorhexidine. Five eyes worsened while receiving PHMB vs four eyes worsening while receiving chlorhexidine. Penetrating keratoplasty was required in three eyes from PHMB group and in two eyes from chlorhexidine group. CONCLUSIONS: Outcomes were similar when using PHMB and chlorhexidine as monotherapy agents in treating Acanthamoeba keratitis.

Astigmatic keratotomy for post-keratoplasty astigmatism.

PURPOSE: To assess astigmatic keratotomy as a means of managing post-keratoplasty astigmatism in the era of excimer laser refractive surgery. SETTING: Moorfields Eye Hospital, London, England. METHODS: Fifty paired arcuate keratotomies were performed with refractive and topographic guidance. Refraction, uncorrected visual acuity, best corrected visual acuity, and visual acuity with the patient's preferred correction were measured before and after surgery. RESULTS: The median follow-up was 34 months. The mean cylinder was 9.13 diopters (D) preoperatively and 4.85 D postoperatively. The mean spherical equivalent refraction was -4.21 D preoperatively and -4.26 D postoperatively. The amount of cylinder reduction was correlated with the amount of pre-existing cylinder (P<.001). Thirty eyes (60%) gained and 1 eye (2%) lost Snellen acuity with preferred correction. In the remaining 19 eyes (38%), there was no change in acuity with preferred correction. The mean change in visual acuity with preferred correction was a gain of 1.5 Snellen lines. Three patients intolerant of spectacles or contact lenses before surgery became tolerant. Ten patients (20%) previously unsuitable for laser in situ keratomileusis (LASIK) because of high cylindrical error went on to have LASIK. CONCLUSIONS: Astigmatic keratotomy remains a useful, safe, relatively simple surgical procedure for treating post-keratoplasty astigmatism. Reduction in cylinder was correlated with pre-existing cylinder. Vision with preferred correction was improved in 60% of cases. High astigmatism reduced to a level at which more definitive refractive surgery such as LASIK became feasible.

Bevacizumab (avastin) for corneal neovascularization--corneal light shield soaked application.

PURPOSE: To describe a case where topical bevacizumab (Avastin) was used in an attempt to reduce corneal neovascularization before corneal graft. METHODS: Topical bevacizumab was applied through a corneal light shield for 20 minutes once a week for 11 weeks to the cornea. RESULTS: Corneal vascularization was not reduced. CONCLUSIONS: Topical bevacizumab was not effective in this case at reducing corneal neovascularization.