Monotherapy with PHMB 0.08% as ‘Switch Treatment’ in Complex Cases of Acanthamoeba Keratitis. Report of two Cases.

Αbstract Purpose: To describe the clinical outcomes of two patients with acanthamoeba keratitis (AK) following penetrating keratoplasty (PK), successfully managed with polyhexamethylene biguanide (PHMB) 0.08% monotherapy. Case Presentation: Both patients developed recurrent AK after PK, confirmed by microbiological testing and polymerase chain reaction (PCR). Standard dual therapy with PHMB 0.02% and Propamidine isethionate 0.1% was either ineffective or poorly tolerated due to ocular surface toxicity. Transition to PHMB 0.08% monotherapy resulted in marked clinical improvement, resolution of keratitis, and substantial visual recovery. At follow-up examination 9 months postoperatively for case 1 and 18 months postoperatively for case 2, both patients demonstrated clear corneal grafts with no signs of AK recurrence. Conclusion: PHMB 0.08% as switch monotherapy proved effective in managing recurrent AK after keratoplasty, achieving favorable anatomical and visual outcomes without recurrence during our follow-up period. These findings suggest that PHMB 0.08% monotherapy may serve as a viable alternative to conventional dual therapy, particularly in cases complicated by treatment intolerance or treatment failure. Further studies with larger cohorts and extended follow-up are warranted.