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. Data are available upon request.

中文翻译：

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乌干达使用 0.2% 葡萄糖酸氯己定治疗顽固性真菌性角膜炎：一项试点研究

目的 真菌性角膜炎是一个主要的眼科公共卫生问题，特别是在低收入和中等收入国家。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% 氯己定滴眼液作为治疗顽固性真菌性角膜炎患者的额外治疗的结果。方法 这项研究是针对乌干达患有微生物性角膜炎的人群进行的一项大型队列研究。我们招募了顽固性真菌性角膜炎患者，局部使用 5% 游霉素后未见改善，并开始使用 0.2% 氯己定。随访计划为 3 个月和 1 年。主要结果指标是最终随访时的愈合情况、视力和疤痕大小。结果 本亚组研究共随访了 13 名患者。患者年龄为 27-73 岁（中位年龄 43 岁）。在所有病例中，通过对角膜刮擦样本进行显微镜检查来鉴定丝状真菌。分离的生物体包括曲霉属、镰刀菌属、念珠菌属、双极菌属和枝顶孢属。在最后一次随访时，9 名患者（75%）痊愈；三人的视力优于 6/18。3名患者因感染而失明。在其余 9 例中，角膜疤痕的变化范围为 4.6 至 9.4 毫米（中位值 6.6 毫米，IQR 5.9-8.0 毫米）；其中五人有浓密疤痕，三人有中度疤痕，一人有轻度疤痕。在随访期间，没有患者表现出洗必太中毒的迹象。结论 0.2% 洗必太被发现是一种有效的序贯辅助局部抗真菌药物，用于治疗对 5% 纳他霉素无反应的真菌性角膜炎病例，值得进一步评估。数据可根据要求提供。