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Results of a trial of combined propamidine isethionate and neomycin therapy for Acanthamoeba keratitis. Brolene Study Group.

AbstractPURPOSE:
To characterize patients with Acanthamoeba keratitis and to evaluate the safety and efficacy of propamidine isethionate 0.1% ophthalmic solution (Brolene) when administered concomitantly with neomycin-polymyxin B-gramicidin ophthalmic solution (Neotricin) in the treatment of Acanthamoeba keratitis.
DESIGN:
Prospective, noncomparative case series.
METHODS:
The authors report the clinical characteristics and outcomes of patients who entered this multicentered, open-label, clinical trial. Eighty-three patients with Acanthamoeba keratitis representing 87 infected eyes entered the trial.
RESULTS:
Sixty (69%) of the 87 eyes enrolled had data analyzed for treatment efficacy and safety. Of these 60 eyes, 50 (83%) experienced treatment success. Thirty (60%) patients successfully treated adhered to treatment protocol guidelines. Patients who broke protocol had disease exacerbation during the maintenance therapy phase. The only eyes lost/enucleated were 7 of 17 in which penetrating keratoplasty was performed before eradication of the infectious agent.
CONCLUSION:
Propamidine isethionate and neomycin are an effective treatment for Acanthamoeba keratitis. Penetrating keratoplasty should be performed only for visual rehabilitation and not to "debulk" an active infection. The authors advocate treating patients with topical medications, mainly Brolene, until all organisms are eradicated. There should be no signs of infection for at least 3 months in the patients not receiving antiamebic medications before penetrating keratoplasty is performed.
AuthorsS L Hargrave, J P McCulley, Z Husseini
JournalOphthalmology (Ophthalmology) Vol. 106 Issue 5 Pg. 952-7 (May 1999) ISSN: 0161-6420 [Print] United States
PMID10328395 (Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
Chemical References
  • Anti-Bacterial Agents
  • Antiprotozoal Agents
  • Benzamidines
  • Ophthalmic Solutions
  • propamidine isethionate
  • Neomycin
Topics
  • Acanthamoeba Keratitis (drug therapy, etiology, surgery)
  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents (therapeutic use)
  • Antiprotozoal Agents (therapeutic use)
  • Benzamidines (therapeutic use)
  • Contact Lenses (adverse effects)
  • Drug Therapy, Combination
  • Eye Enucleation
  • Female
  • Humans
  • Keratoplasty, Penetrating
  • Male
  • Middle Aged
  • Neomycin (therapeutic use)
  • Ophthalmic Solutions (therapeutic use)
  • Prospective Studies
  • Safety
  • Treatment Outcome

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