Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ open ophthalmology
Abstract
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.
Description
Keywords
Chlorhexidine gluconate, Treatment, Recalcitrant fungal keratitis, Pilot study
Citation
Arunga S, Mbarak T, Ebong A, et al. Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study. BMJ Open Ophthalmology 2021;6:e000698. doi:10.1136/ bmjophth-2020-000698