Acanthamoeba keratitis: early diagnosis, rational drug intervention and prevention
Recognition of the protean clinical manifestations of Acanthamoeba keratitis is required by ophthalmologists in the Far East, due to the emergence of this protozoan as an ocular pathogen in both wearers and non-wearers of contact lenses in Asia. If unrecognized, progressive keratitis occurs that is not only extremely painful but also sight-threatening. A treatment regimen has been pioneered which comprises topical delivery of the combination of chlorhexidine as the digluconate salt (0.02% w/v) and propamidine isethionate (0.1% w/v), that has been successful in eradicating the corneal infection, especially if the diagnosis is made early in the course of the disease. Prevention of Acanthamoeba keratitis must be emphasized for soft contact lens wearers, especially as this modality of correcting myopia is rapidly increasing in Asia. This involves avoiding the use of domestic tap water in the lens storage case, regularly changing storage cases on a monthly basis, maintaining storage cases dry at all times when the lenses are worn and use of an effective acanthamoebicidal disinfectant such as a proprietary solution of 3% (v/v) hydrogen peroxide.
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