Jornal de cirurgia ocular e de catarata Acesso livre

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Aminoglucoside/Imidazols In the Treatment of Acanthamoeba Keratitis

Virginia Vanzzini Zago

Introduction: Aminoglycosides and its derivatives have been recommended for Acanthamoeba keratitis (AK) treatment, Neosporin (Neomycin, Polymyxin and B-Gramicidin) since 2005 or tobramycin. Ishibashi in 1990 published 3 cases successfully resolved using imidazoles alone. Topical aminoglucosides in combination with oral imidazoles, itraconazole has been sowed a good medical treatment too. We describe five cases of culture proved AK and medically treated with netilmicin, a semisynthetic derivative drug of recent medical use, available in intravenous presentation, and useful in ophthalmic topical drops 0.3% concentration (SIFI Laboratory Sicily Italy), alone or in some cases combined with an oral imidazole itraconazole. Oral polyunsaturated fatty acid essential fatty acids are incontestable to enhance signs of ocular surface waterlessness and associated symptoms of ocular discomfort in Sjögren syndrome. Fluid-ventilated, gas porous scleral lenses are victorious in treating severe ocular surface diseases together with Sjögren syndrome. for several years, general corticosteroids are employed in a range of inflammatory conditions. because of restricted efficaciousness and high incidence of complications, they’re not wide employed in Sjögren syndrome. Topical corticosteroids are wide offered during a style of dosages, usually combined with antibiotics and preservatives, and will be helpful for short-run treatment of ocular surface inflammatory conditions. They’re sometimes offered in five, 10, or fifteen metric capacity unit dispensers or in 1/8 ounce ointment kind. Material & Methods: We present five cases of AK culture proved, its clinical diagnosis, treatment and evolution. Case No 1. Female 19 years old, living in Mexico City, contact lens user, she presented with visual acuity loss one week before attention in both eyes. She had received topical gatifloxacin 0.3% and netilmycin 0.3% with no specification of dose and time. At Cornea Department in this Hospital, slit lamp examination was performed: In OD corneal haze and mild keratitis were found; also epithelial edema and perineural infiltrate in temporal inferior quadrant (Figure 1). In OS conjunctiva hyperemia, central cornea stromal opacity and diffuse perineural infiltrate was observed (Figure 3). Patient was diagnosed as OS herpes simplex keratitis, oral Acyclovir was prescribed (400 mg/5 times a day), without clinical response. Sample of both corneas scraps, and both contact lens for bacterial, Fungal and Acanthamoeba was taken at the first medical consultation in the hospital. Laboratory report was Acanthamoeba spp growing in NNA agar covered with live E cloacae after 48hs, in both corneas and both contact lens samples, and culture was negative for bacteria in OS. Stenotrophomonas maltofilia in OD cornea, and contact lens samples. Acanthamoeba strain isolated form cornea sample in OD was identified as Acanthamoeba royreba. After laboratory results and AK diagnosis, topical netilmicin 0.3% eye drops (SIFI Sicily, Italy) and oral itraconazole (100 mg bid) were prescribed for booths eyes. The patient was attended 30 days after, at silt lamp examination were observed in OD epithelial edema and perineural infiltrate in temporal inferior quadrant, 30 days after she presented a little inflammatory ring and perineural infiltrate in the same site described before, 12 days after there was observed haze for paracentral corneal, and vascularization, total superficial epithelization of cornea surface in OD, and 6 weeks later she referred no pain, in the next visit the patient showed no ulcer in OD, inflammatory reaction and perineuritis diminished (Figure 2). In OS cornea, at this visit the patient showed no ulcer in OS cornea, an inflammatory reaction and perineuritis was diminished (Figure 4). The final visual acuity was 20/25 OD and 20/50 OS, perineural infiltrate on left eye continues but was diminished, 3 months later: final best corrected visual acuity 20/20 on both eyes, and haze on OD temporal cornea.