2008 OMIG, Abstract 20

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A prospective, randomized, double-masked, placebo-controlled trail of topical Polyhexamethylene biguanide (0.02%) in patients with Microsporidial keratoconjunctivitis.
Savitri Sharma, Srikant K Sahu, Sujata Kar, Shyam S Nayak
L V Prassad Eye Institute, Bhubaneswar – 751024, Orissa, India

Purpose: To report the results of a prospective, randomized, double-masked, placebo controlled trail of polyhexamethylene biguanide in the treatment of microsporidial keratoconjunctivitis.
Methods: Seventy-six patients were enrolled in the study between July 2007 and August 2008.  Inclusion criteria consisted of patients presenting with symptoms and slit-lamp biomicroscopic features suggestive of keratoconjunctivitis and corneal scrapings positive for microsporidial spores in smear examination.  The patients were randomized to receive either hydroxypropyle methylcellulose (placebo) or 0.02% polyhexamethylene biguanide (PHMB) IN THE AFFECTED EYE SIX TIMES A DAY.  They were examined on day 3 and then weekly (up to two months) until resolution of lesions with recording of slit lamp findings at each visit.  Outcome measures included complete resolution, partial resolution or worsening of the corneal lesions.
Results: All patients showed multiple coarse, diffuse, punctuate, raised epithelial lesions with or without sub-epithelial infiltrates in the cornea and conjunctival congestion.  Mean age of the patients was 36.5 ± 14 (10 to 80) years and the duration of symptoms ranged from 1 to 25 (mean 7.95 ± 4.4) days.  Equal proportion of patients had healed corneal scars in both the groups [Placebo (n=41)-62.8%, PHMB (n=35)-63.4%].  Worsening (removed from study and treated with PHMB) of the lesions was seen in 4 and 1 patient respectively in placebo and PHMB group and the difference was not significant.  Mean number of days taken to achieve healing between the groups was also no significant [Placebo-9.96(6.58) vs PHMB-7.95(3.06)].
Conclusions: This study confirms the self limiting nature of microsporidial keeratoconjunctivitis and suggests that antimicrobial agents have little role to play in the outcome of the disease.

Financial Support: Hyderabad Eye Research Foundation, Hyderabad.