摘要
目的分析阿米巴性角膜炎患者的临床特征,实验室检查及治疗方法。设计回顾性病例系列。研究对象阿米巴性角膜炎患者20例(21眼)。方法所有患者均于裂隙灯显微镜下观察角膜病变,角膜溃疡区刮片及培养,7例患者行激光共焦显微镜检查。所有患者均给予0.04%洗必泰或0.04%聚六亚甲基双胍(PHMB)+0.5%新霉素滴眼,同时联合局部角膜溃疡清创;对多次刮片阿米巴仍阳性或基质致密浸润迁延的12例患者,3例行角膜板层切除术,9例行角膜板层切除+羊膜移植术;对于药物及清创治疗效果不佳,溃疡接近角膜缘的3例严重患者,行穿透性角膜移植术。主要指标视力、角膜刮片及培养、激光共焦显微镜下阿米巴包囊和滋养体观察结果。结果20例患者中,角膜外伤10例(50%),配戴角膜接触镜6例(30%),无明确危险因素4例(20%)。早期主要表现为上皮溃疡和角膜神经炎样改变,进展期为基质溃疡,环形浸润,可伴前房积脓。实验室检查:角膜刮片细胞学检查和阿米巴培养阳性率分别为95%(19/20)和70%(14/20)。7例患者在激光共焦显微镜下均发现阿米巴包囊,其中3例同时发现滋养体。平均随访时间5个月(19天～8个月),治疗后其中9例患者(10眼)视力≥0.1。结论阿米巴性角膜炎需根据患者病史和危险因素、临床表现以及实验室检查、共焦显微镜检查等进行综合诊断。角膜刮片的阳性率较高。角膜板层切除联合羊膜移植能有效控制感染,缩短患者病程。(眼科,2008,17:104-108)
Objective To review the clinical characteristics, treatment, and outcome of patients with acanthamoeba keratitis （AK）. Design Retrospective, noneomparative ease series. Participants 20 consecutive patients （21 eyes） with AK in Beijing Institute of Ophthalmology between Oct. 2005 and May 2007. Methods All the patients were observed with slit lamp, and performed corneal smear and culture. 7 patients were examined with laser confocal microscope. Treatment was instillation of 0.04% ehlorhexidine or 0.04% polyhexamethylene biguanide（PHMB）and 0.5% neomycin, combined with corneal lesion debridement. Surgical treatment included lamellar keratectomy, lamellar keratectomy combined with amniotic membrane transplantation and penetrating keratoplasty. Main Outcome Measures Smear and culture of cornea ulcer, laser eonfoeal microscope and visual acuity. Results Of the 20 patients with AK, 10 （50%） patients had a history of trauma, 3 （15%） wore overnight orthokeratology lenses, 3 （15%） used soft contact lenses and 4 （20%） had no definite risk factor. Manifestations of early phase were epithelial ulcer and radial neuritis and at advanced phase were cornea ulcer, stromal ring infiltrate and hypopyon. The diagnosis of all patients was based on the laboratory investigation. Smear and culture positive specimens were 19 of 20 （95%） and 14 of 20 （70%）. Acanthamoeba eysts or trophozoites were observed in the corneas of 7 patients with laser confoeal microscope. The mean time of follow-up was 150 days （range, 19-240 days）. The visual acuity was better or equal to 10/100 in 9 patients （10 eyes）. Conclusions Synthetic diagnosis and treatment of Aeanthamoeba keratitis is very important for prognosis. The positive rate of smear is higher than that of culture of organism. Lamellar kerateetomy combined with amniotic membrane transplantation provide corneal ulcer healing and reduce the duration of treatment.
出处
《眼科》
CAS
2008年第2期104-108,共5页
Ophthalmology in China
关键词
角膜炎
阿米巴/诊断
激光共焦显微镜
keratitis, acanthamoeba/diagnosis
laser eonfocal microscope
