Arunga Simon, Mbarak Tumu, Ebong Abel, Mwesigye James, Kuguminkiriza Dan, Mohamed-Ahmed Abeer H A, Hoffman Jeremy John, Leck Astrid, Hu Victor, Burton Matthew
Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda.
BMJ Open Ophthalmol. 2021 Jul 5;6(1):e000698. doi: 10.1136/bmjophth-2020-000698. eCollection 2021.
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.
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.
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 spp, spp, spp, spp 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.
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.
真菌性角膜炎是一个主要的眼科公共卫生问题，在低收入和中等收入国家尤为突出。治疗真菌性角膜炎的选择有限。我们的研究旨在描述使用0.2%洗必泰滴眼液作为难治性真菌性角膜炎患者管理的辅助治疗的效果。
本研究嵌套于乌干达一项针对微生物性角膜炎患者的大型队列研究中。我们纳入了使用5%那他霉素局部治疗效果不佳的难治性真菌性角膜炎患者，并开始使用0.2%洗必泰。计划随访3个月和1年。主要结局指标为最终随访时的愈合情况、视力和瘢痕大小。
本亚研究共随访了13例患者。患者年龄在27 - 73岁之间（中位数43岁）。所有病例通过角膜刮片样本显微镜检查均鉴定出丝状真菌。分离出的微生物包括 spp、 spp、 spp、 spp spp。在最终随访时，9例患者（75%）已愈合；3例患者视力优于6/18。3例患者因感染而失明。在其余9例病例中，角膜瘢痕大小不一，范围为4.6至9.4毫米（中位数6.6毫米，四分位间距5.9 - 8.0毫米）；其中5例有致密瘢痕，3例有中度瘢痕，1例有轻度瘢痕。随访期间所有患者均未表现出洗必泰毒性迹象。
发现0.2%洗必泰在对5%那他霉素无反应的真菌性角膜炎病例中是一种有用的序贯辅助局部抗真菌药物，值得进一步评估。
