【摘要】 目的分析角膜创伤致棘阿米巴感染的角膜炎临床特征、治疗及预后。方法对20例(20眼)棘阿米巴性角膜炎的危险因素、临床表现、实验室检查、治疗及其结果进行回顾性分析。结果20例中,学生12例,农民6例。危险因素中包括戴角膜接触镜12例和角膜创伤6例。主要的临床表现为角膜溃疡、弥漫性基质浸润和环形溃疡。实验室检查:角膜刮片细胞学检查和棘阿米巴培养阳性率分别为95.00%(19/20)和60.00%(12/20),其中4眼在共焦显微镜检查下查见包囊。0.02%洗必泰,0.5%新霉素,0.4%甲硝唑滴眼液联合治疗,同时结合1%洗必泰局部烧灼和角膜清创。平均疗程为70天(18~150天)。19例溃疡愈合,形成角膜薄翳或白斑。其中7眼的最佳矫正视力≥0.5。结论棘阿米巴性角膜炎的早期诊断至关重要,联合应用抗棘阿米巴药物、局部清创术和烧灼术为目前治疗的最佳选择。更多还原

【Abstract】 Objective To review the clinical characteristics,treatment and outcome of patients with acanthamoeba keratitis.?Methods(Retrospective analysis) of medical records from 20 consecutive patients with acanthamoeba keratitis between December 1997 and March 2003.Risk factors,clinical manifestations,laboratory investigations,management and outcomes of these patients were analyzed.?Results Out of 20 patients presented in this series,12 patients were students and 6 farmers.Risk factors included the contact lens wear(12/20) and trauma(6/20).Corneal ulceration,diffuse stromal infiltration and ring infiltration were the main clinical manifestations.The diagnosis of all patients was based on the laboratory investigation.Smear and culture positive specimens were 95%(19/20) and 60% (12/20),respectively.Images of cysts were demonstrated with the confocal microscopy in 4 patients.Management was combined topical chlorhexidine 0.02%,neomycin 0.5%,metronidazole 0.4%,and/or cauterization of corneal lesions with chlorhexidine 1%,and corneal debridement.The mean duration of therapy was 70 days(range,18-150 clays).19 patients resulted in healing with scar formation.The best corrected visual acuity was better or equal to 0.5 in 7 eyes.Conclusions The early diagnosis of acanthamoeba keratitis is the key challenge in practice.The combined management with anti-acanthamoeba agents,cauterization and debridement may be best choice for acanthamoeba keratitis.更多还原