{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T20:30:41Z","timestamp":1788985841191,"version":"build-2803163510"},"reference-count":48,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Ophthalmology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Polyhexamethylene biguanide (PHMB) 0.08% has received the orphan drug designation for management of Acanthamoeba keratitis (AK). This review aimed to evaluate the clinical efficacy and safety of PHMB, comparing outcomes across different concentrations (0.08% vs. 0.02%) using a dose-stratified meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Online databases were searched until February 2025 for studies on PHMB 0.02% or 0.08% as mono- or combination therapy. The primary outcome was clinical cure and secondary outcomes included conjunctival hyperemia and pain. Subgroup analyses were performed based on PHMB concentration. A random-effects model was applied; sensitivity analyses and publication bias assessments were conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The pooled proportion of cure across 17 studies (923 eyes) was 75.75% (95% CI: 64.56%\u201384.27%;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.0001; I\u00b2 = 85.2%). Subgroup analysis showed the highest cure rate with PHMB 0.08% monotherapy (87.04%; 95% CI: 77.54%\u201392.88%), followed by 0.02% monotherapy (79.27%; 95% CI: 65.29%\u201388.60%) and mixed 0.02% regimens (72.59%; 95% CI: 54.86%\u201385.23%). Conjunctival hyperemia was reported in 15.7%, and subgroup analysis by dose revealed highest prevalence in the 0.08% PHMB group (26.4%; 95% CI: 8.4%\u201349.2%). Pain was reported in 11.9% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009225), with no significant increase at higher concentrations. The pooled proportion of overall adverse events was 40.2% (95% CI 26.2%\u201355.0%;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.0001; I\u00b2\u2009=\u200981.4%). Findings were robust across sensitivity analyses, with no publication bias detected.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This dose-stratified meta-analysis found PHMB 0.08% monotherapy to have good efficacy and tolerability, supporting its use as a first-line empirical treatment and underscoring the need for standardized protocols and comparative trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11206721251407855","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T18:08:08Z","timestamp":1766426888000},"page":"421-433","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Efficacy and safety of polyhexamethylene biguanide for Acanthamoeba keratitis: Systematic review and proportional meta-analysis"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3358-2747","authenticated-orcid":false,"given":"Mamta","family":"Singh","sequence":"first","affiliation":[{"name":"All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noor","family":"Husain","sequence":"additional","affiliation":[{"name":"Indira Gandhi Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siddhartha","family":"Dutta","sequence":"additional","affiliation":[{"name":"All India Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bibhuti P","family":"Sinha","sequence":"additional","affiliation":[{"name":"RIO\/IGIMS, Indira Gandhi Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lalit","family":"Mohan","sequence":"additional","affiliation":[{"name":"Indira Gandhi Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harihar","family":"Dikshit","sequence":"additional","affiliation":[{"name":"Netaji Subhas Medical College and Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavana","family":"Sharma","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"e_1_3_2_2_2","first-page":"221","article-title":"Acanthamoeba polyphaga keratitis and Acenthamoeba uveitis associated with fatal meningoencephalitis","volume":"95","author":"Jones DB","year":"1975","unstructured":"Jones DB, Visvesvara GS, Robinson NM. 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