Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study

OBJECTIVE: Fungal keratitis is a major ophthalmic public health problem, particularly in low-income and middle-income countries. The options for treating fungal keratitis are limited. Our study aimed to describe the outcomes of using chlorhexidine 0.2% eye-drops as additional treatment in the manage...

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Autores principales: Arunga, Simon, Mbarak, Tumu, Ebong, Abel, Mwesigye, James, Kuguminkiriza, Dan, Mohamed-Ahmed, Abeer H A, Hoffman, Jeremy John, Leck, Astrid, Hu, Victor, Burton, Matthew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258663/
https://www.ncbi.nlm.nih.gov/pubmed/34368461
http://dx.doi.org/10.1136/bmjophth-2020-000698
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author Arunga, Simon
Mbarak, Tumu
Ebong, Abel
Mwesigye, James
Kuguminkiriza, Dan
Mohamed-Ahmed, Abeer H A
Hoffman, Jeremy John
Leck, Astrid
Hu, Victor
Burton, Matthew
author_facet Arunga, Simon
Mbarak, Tumu
Ebong, Abel
Mwesigye, James
Kuguminkiriza, Dan
Mohamed-Ahmed, Abeer H A
Hoffman, Jeremy John
Leck, Astrid
Hu, Victor
Burton, Matthew
author_sort Arunga, Simon
collection PubMed
description OBJECTIVE: Fungal keratitis is a major ophthalmic public health problem, particularly in low-income and middle-income countries. The options for treating fungal keratitis are limited. Our study aimed to describe the outcomes of using chlorhexidine 0.2% eye-drops as additional treatment in the management of patients with recalcitrant fungal keratitis. METHODS: This study was nested within a large cohort study of people presenting with microbial keratitis in Uganda. We enrolled patients with recalcitrant fungal keratitis not improving with topical natamycin 5% and commenced chlorhexidine 0.2%. Follow-up was scheduled for 3 months and 1 year. The main outcome measures were healing, visual acuity and scar size at final follow-up. RESULTS: Thirteen patients were followed in this substudy. The patients were aged 27–73 years (median 43 years). Filamentous fungi were identified by microscopy of corneal scrape samples in all cases. Isolated organisms included Aspergillus spp, Fusarium spp, Candida spp, Bipolaris spp and Acremoninum spp. At the final follow-up, nine patients (75%) had healed; three had vision of better than 6/18. Three patients lost their eyes due to infection. In the remaining nine cases, corneal scarring was variable ranging from 4.6 to 9.4 mm (median 6.6 mm, IQR 5.9–8.0 mm); of these five had dense scars, three had moderate scars and one had a mild scar. None of the patients demonstrated signs of chlorhexidine toxicity during the follow-up. CONCLUSION: Chlorhexidine 0.2% was found to be a useful sequential adjunctive topical antifungal in cases of fungal keratitis not responding to natamycin 5%, which warrants further evaluation.
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spelling pubmed-82586632021-08-05 Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study Arunga, Simon Mbarak, Tumu Ebong, Abel Mwesigye, James Kuguminkiriza, Dan Mohamed-Ahmed, Abeer H A Hoffman, Jeremy John Leck, Astrid Hu, Victor Burton, Matthew BMJ Open Ophthalmol Cornea and Ocular Surface OBJECTIVE: Fungal keratitis is a major ophthalmic public health problem, particularly in low-income and middle-income countries. The options for treating fungal keratitis are limited. Our study aimed to describe the outcomes of using chlorhexidine 0.2% eye-drops as additional treatment in the management of patients with recalcitrant fungal keratitis. METHODS: This study was nested within a large cohort study of people presenting with microbial keratitis in Uganda. We enrolled patients with recalcitrant fungal keratitis not improving with topical natamycin 5% and commenced chlorhexidine 0.2%. Follow-up was scheduled for 3 months and 1 year. The main outcome measures were healing, visual acuity and scar size at final follow-up. RESULTS: Thirteen patients were followed in this substudy. The patients were aged 27–73 years (median 43 years). Filamentous fungi were identified by microscopy of corneal scrape samples in all cases. Isolated organisms included Aspergillus spp, Fusarium spp, Candida spp, Bipolaris spp and Acremoninum spp. At the final follow-up, nine patients (75%) had healed; three had vision of better than 6/18. Three patients lost their eyes due to infection. In the remaining nine cases, corneal scarring was variable ranging from 4.6 to 9.4 mm (median 6.6 mm, IQR 5.9–8.0 mm); of these five had dense scars, three had moderate scars and one had a mild scar. None of the patients demonstrated signs of chlorhexidine toxicity during the follow-up. CONCLUSION: Chlorhexidine 0.2% was found to be a useful sequential adjunctive topical antifungal in cases of fungal keratitis not responding to natamycin 5%, which warrants further evaluation. BMJ Publishing Group 2021-07-05 /pmc/articles/PMC8258663/ /pubmed/34368461 http://dx.doi.org/10.1136/bmjophth-2020-000698 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Cornea and Ocular Surface
Arunga, Simon
Mbarak, Tumu
Ebong, Abel
Mwesigye, James
Kuguminkiriza, Dan
Mohamed-Ahmed, Abeer H A
Hoffman, Jeremy John
Leck, Astrid
Hu, Victor
Burton, Matthew
Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study
title Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study
title_full Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study
title_fullStr Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study
title_full_unstemmed Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study
title_short Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study
title_sort chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in uganda: a pilot study
topic Cornea and Ocular Surface
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258663/
https://www.ncbi.nlm.nih.gov/pubmed/34368461
http://dx.doi.org/10.1136/bmjophth-2020-000698
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