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A presentation to: Meeting name Date Medical interventions for acanthamoeba keratitis Majed Alkarashi, Kristina Lindsley, H Andrew Law, Shameema Sikder Issue 2, 2015 A presentation to: Meeting name Date

Table of Contents 01 Background 02 Types of studies 03 Key results 04 Tables (Risk of Bias/Forest Plots) 05 Conclusions 06 Acknowledgements

01: Background Acanthamoeba are microscopic, free-living, single-celled organisms They can infect the eye; causing Acanthamoeba keratitis (AK) AK has no formal guidelines or standards of care OBJECTIVE: To evaluate the relative effectiveness and safety of medical therapy for the treatment of AK

02: Types of studies Participants 56 eyes of 55 participants Interventions Comparison of two topical biguanides Chlorhexadine 0.02% VERSUS Polyhexamethalene biguanide

03: Key results “Resolution of infection, defined as control of ocular inflammation, relief of pain and photosensitivity, and recovery of vision, was 86% in the chlorhexidine group compared with 78% in the PHMB group” RR 1.10, 95% CI 0.84 to 1.42 “In the chlorhexidine group, 20 of 28 eyes (71%) had better visual acuity compared with 13 of 23 eyes (57%) in the PHMB group at final follow-up (RR 1.26, 95% CI 0.82 to 1.94).”

03: Key results (continued) “Five participants required therapeutic keratoplasty: 2 in the chlorhexidine group compared with 3 in the PHMB group” RR 0.55, 95% CI 0.10 to 3.00 “No serious adverse event related to drug toxicity was observed in the study.”

04: Tables

05: Conclusions “There is insufficient evidence to evaluate the relative effectiveness and safety of medical therapy for the treatment of AK.”

06: Acknowledgements Cochrane Eyes and Vision US Satellite, funded by the National Eye Institute, National Institutes of Health Cochrane Eyes and Vision Editorial Base, funded by the UK National Health Service Research and Development Programme Majed Alkarashi, Kristina Lindsley, H Andrew Law, Shameema Sikder Review citation Alkharashi M, Lindsley K, Law HA, Sikder S. Medical interventions for acanthamoeba keratitis. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD010792. DOI: 10.1002/14651858.CD010792.pub2.