棘阿米巴性角膜炎1例

棘阿米巴性角膜炎是一种罕见的原虫感染性角膜疾病 ,其愈后不良。随着角膜接触镜的广泛使用 ,其发病呈上升趋势。现将我院发现的 1例报告如下。1　临床资料患者 ,女 ,2 9岁 ,主诉左眼疼痛、畏光、流泪、视物模糊5 d,于 2 0 0 1年 9月来我院就诊。 5 d前 ,配戴浸泡半年的隐形眼镜 3h后 ,感左眼异物感、疼痛、畏光、流泪。自滴过期抗生素眼液后 ,无缓解。当地医院诊断为“左眼角膜炎 ,上皮剥脱”。局部滴抗生素眼液和球结膜下注射庆大霉素后 ,无明显改善 ,后就诊于我院。查 :左眼视力 0 .0 6 ,矫正 0 .3(- 8D) ,结膜水肿 ,混合充血 ,角膜中央…     

接触镜相关性棘阿米巴性角膜炎防治研究进展

棘阿米巴 (acantham oeba)是一种在自然界中广泛分布的自由生活原虫。棘阿米巴性角膜炎 (acanthamoeba kerati-tis,AK)最早于 1973年报道。1985年 ,证实 AK与配戴角膜接触镜 (contact lens,CL) ,特别是软性 CL(soft CL,SCL)密切相关 ,AK成为对 CL配戴安全的严重威胁。然而 ,CL相关性 AK(CL associated AK,CL AAK)是可以预防的。本文就近年来有关 CL AAK防治的国内外研究进展进行了简要综述。1　 CL AAK流行病学CL AAK最早报道见于 1984年。1989年 ,美国疾病控制中心 (CDC)的 Stehr- Green等对 2 0 8例 AK患者所做的流…     

棘阿米巴角膜炎误诊一例

棘阿米巴角膜炎误诊一例任广玲张文华武宇影罗时运患者男，３８岁，于１９９５年９月１２日左眼误入灰砂土，未加注意。两天后左眼红肿、疼痛、视力下降。曾在当地医院诊断为“角膜炎”，给予滴氯霉素、无环鸟苷眼液和涂红霉素眼膏，结膜下注射庆大霉素，口服抗生素及维生...     

棘阿米巴角膜炎研究的新进展

棘阿米巴角膜炎研究的新进展大连市第三医院眼科黄红深大连医科大学附属一院刘济琪棘阿米巴普遍存在于水土之中，但棘阿米巴角膜炎（Ａｃａｎｔｈａｍｏｅｂａｋｅｒａｔｉｔｉｓ）却是一少见而比较新认识的眼病。美国自１９７５年Ｊｏｎｅｓ等首次报告后，至今已日益有较...     

棘阿米巴角膜炎

棘阿米巴角膜炎系棘阿米巴属原虫感染引起的顽固性、进行性角膜炎，它常与戴角膜接触镜有关，近年来国外不断有所报道，我国近几年戴角膜接触镜的人数逐年增多，并发现由于戴角膜接触镜而引发的棘阿米巴角膜炎，因此引起眼科学界的广泛重视。本就棘阿米巴角膜炎的流行病学、临床表现、诊断、鉴别诊断、治疗、预后及预防作一综述。     

棘阿米巴角膜炎临床研究的进展

棘阿米巴角膜炎是严重致盲性眼病。近年来，由于隐形眼镜戴用者增多，棘阿米巴角膜炎诊断水平提高，其病例呈上升趋势。本文就棘阿米巴角膜炎的诊断与治疗的临床进展作一综述。     

棘阿米巴性角膜炎的临床特点及诊断

目的 分析、总结棘阿米巴性角膜炎的临床特点及各种病原学检查阳性率比较.方法 回顾分析2002年至2011年因棘阿米巴性角膜炎在山东省眼科研究所收集患者的临床资料.结果 10 a间因棘阿米巴性角膜炎在山东省眼科研究所治疗的患者共30例(30眼),均为单眼患病;其中男20眼,女10眼.所有患者(30眼)均因眼红、痛、视力下降就诊;其中28眼(93.3％)首次就诊我院时即诊为棘阿米巴性角膜炎,2眼(6.7％)误诊为病毒性角膜炎,1周后因治疗效果不佳,再次查找病原学病因才确诊为棘阿米巴角膜炎.所有患眼中,23眼(76.7％)有角膜环形基质浸润,5眼(16.7％)伴剧烈疼痛,4眼(13.3％)伴放射状角膜神经炎.所有患者均通过病原学诊断确诊为棘阿米巴性角膜炎,其中27眼(90.0％)经角膜刮片生理盐水湿片检查查见棘阿米巴包囊;17眼(56.7％)经角膜刮片棘阿米巴原虫培养阳性;行共焦显微镜检查的25眼中,22眼(88.0％)共焦显微镜下查见棘阿米巴包囊.结论 角膜环形基质浸润是棘阿米巴性角膜炎的特征性体征.根据病史、体征及相关病原学检查,绝大多数棘阿米巴性角膜炎患者能够及时确诊.相关病原学检查中,角膜溃疡灶刮片生理盐水湿片检查、共焦显微镜检查较棘阿米巴原虫培养阳性率高.     

共焦显微镜诊断棘阿米巴性角膜炎二例

共焦显微镜是利用特殊的光学装置,对角膜各个层面的组织与细胞形态进行活体观察的新型检查仪器,具有高分辨力与高对比度的特点。它的出现不仅为观察活体角膜组织细胞形态,而且为观察角膜内可能存在的某些病原微生物及病理成分提供了新的手段。我们自１９９７年１２月至１９９８年１１月采用共焦显微镜对２例棘阿米巴性角膜炎患者进行观察,为诊断及治疗提供了重要的参考依据,现报告如下。例１　患者男,３４岁。因稻壳溅伤左眼,红、痛２周,于１９９７年１２月２９日就诊首都医科大学附属北京同仁医院眼科。眼部检查：右眼视力１５,…     

棘阿米巴性角膜炎的手术治疗

目的：回顾性分析20例棘阿米巴性角膜溃疡行角膜移植术的疗效，确定其手术适应证及手术疗效。方法：20例患者中男性12例，女性8例，年龄13～46岁。病因为戴角膜塑型镜(OK镜)者10例，戴接触镜者6例，角膜外伤者4例。手术指征及手术方法：临床药物治疗无效，且角膜病变区逐渐扩大并加深，有穿孔危险者。20例患者中17例采用板层角膜移植术，3例因病变较深而行穿透角膜移植术。术后患者仍局部滴用抗阿米巴药物1～3个月。结果：20例患者角膜病变均得到控制。5例患者术后再次行穿透角膜移植术，术后裸眼视力为0．3～0．6。8例板层植片透明者视力为0．05～0．4。未行穿透角膜移植术者，由于板层植片大量新生血管长人，需再次行板层角膜移植术联合角膜缘干细胞移植术。结论：棘阿米巴性角膜溃疡药物治疗疗程长，难购药品，容易延误病情。对病变难以控制者，手术治疗为其有效的治疗方法。     

我国致病性自生生活阿米巴性角膜炎的研究进展

1992年金秀英等首次报道了我国棘阿米巴性角膜炎病例.十余年来,国内对这一致盲性角膜病的研究不断展开,研究范围涉及了病原学、生物学、虫株培养和保存方法、致病性和毒力、感染模型建立、病理学和免疫学、临床诊断及治疗等诸多方面.     

178例真菌性角膜炎的回顾性分析

目的 总结近年来厦门眼科中心的真菌性角膜炎住院患者流行病学及临床诊疗情况的变迁。方法回顾性调查2018年1月~2020年1月在我院拟诊为真菌性角膜炎的178例(178眼)患者的病例资料,将结果与2006年7月~2008年7月的研究结果进行对比分析。结果 患者男女比例约为1.6:1,平均年龄为(54.9±11.4)岁(23~78岁);疾病高发于秋冬季(9~12月、1月)及夏季农忙季节(7月)。101例(56.7%)有明确角膜外伤史,其中48例(27.0%)有明确植物性外伤史;排前2位的致病菌分别是曲霉(62例,34.8%)、镰刀菌(40例,22.5%);88例(49.4%)通过单纯药物治愈,90例(50.6%)通过药物联合手术治愈;眼球保存率达99.4%;153例(86.0%)患者经治疗视力得以提高或维持。结论 近年来厦门眼科中心的真菌性角膜炎住院患者平均发病年龄较前增高;多发于秋冬季(9~12月、1月)及夏季农忙时节(7月);多有明确角膜外伤史;致病菌属以曲霉、镰刀菌属为主,曲霉致病率升高成为第一位致病菌;联合手术治疗的比例、眼球保存率均较前提高;大部分患者经治疗可提高或维持原有视力。     

Steroid sensitive Acanthamoeba keratitis

A 44-year-old woman with proven Acanthamoeba keratitis was successfully treated medically with resultant 6/9 vision. During the treatment, repeated attempts to titrate the patient off topical corticosteroids resulted in recurrent flare-up of inflammatory keratitis from which Acanthamoeba could not be recultured. It is suggested that steroid administration during the course of Acanthamoeba keratitis may need to be withdrawn extremely slowly to avoid the recurrence of what appears to be an immunological corneal reaction.     

1054例化脓性角膜炎的回顾性分析

目的探讨化脓性角膜炎的病原学和临床特征。方法对1999年1月至2004年12月间于山东省眼科研究所、青岛眼科医院诊治的1054例化脓性角膜炎住院患者的人口学特征、症状持续时间、疾病危险因素、就诊前接受的治疗及实验室检查结果等资料进行回顾性分析。结果化脓性角膜炎中真菌性角膜炎所占比例最高（61．9％）,41～50岁的中年患者（27．3％）和农民（82．9％）最多见。角膜损伤是最常见的发病危险因素。氢氧化钾湿片直接镜检法诊断真菌性角膜炎的阳性率为88．7％,而革兰染色镜检法检查细菌性角膜炎的阳性率仅为43．4％。分离到的真菌中镰刀菌属占73．3％,其次为曲霉菌属（12．1％）。分离到的细菌病原谱中,以铜绿假单胞菌居多（35．7％）,其次为表皮葡萄球菌（22．5％）。结论真菌性角膜炎在严重的化脓性角膜炎中最常见且呈现逐年递增的趋势。氢氧化钾湿片直接镜检法是一种快速、简便及有效的真菌性角膜炎诊断工具。     

Acanthamoeba keratitis and contact lens wear

Acanthamoeba keratitis is a rare but serious complication of contact lens wear that may cause severe visual loss. The clinical picture is usually characterised by severe pain, sometimes disproportionate to the signs, with an early superficial keratitis that is often misdiagnosed as herpes simplex virus (HSV) keratitis. Advanced stages of the infection are usually characterised by central corneal epithelial loss and marked stromal opacification with subsequent loss of vision. In this paper, six cases of contact lens‐related Acanthamoeba keratitis that occurred in Australia and New Zealand over a three‐year period are described. Three of the patients were disposable soft lens wearers, two were hybrid lens wearers and one was a rigid gas permeable lens wearer. For all six cases, the risk factors for Acanthamoeba keratitis were contact lens wear with inappropriate or ineffective lens maintenance and exposure of the contact lenses to tap or other sources of water. All six patients responded well to medical therapy that involved topical use of appropriate therapeutic agents, most commonly polyhexamethylene biguanide and propamidine isethionate, although two of the patients also subsequently underwent deep lamellar keratoplasty due to residual corneal surface irregularity and stromal scarring. Despite the significant advances that have been made in the medical therapy of Acanthamoeba keratitis over the past 10 years, prevention remains the best treatment and patients who wear contact lenses must be thoroughly educated about the proper use and care of the lenses. In particular, exposure of the contact lenses to tap water or other sources of water should be avoided.     

Bilateral acanthamoeba keratitis and treatment strategy based on lesion depth

CASE REPORT: This report summarizes a case of bilateral acanthamoeba keratitis in an 18-year-old male contact-lens wearer. Early diagnosis is important and combination treatment is recommended, tailored to the depth of the lesions. COMMENTS: Treatment can be difficult, particularly since amoebic cysts are especially resistant. Surgery may be required for advanced cases. Suggestions for reducing corneal toxicity to antiamoebic therapy are included.     

Acanthamoeba keratitis cluster: an increase in Acanthamoeba keratitis in Australia

Background:  This study was undertaken in response to an increase in the number of patients treated for Acanthamoeba keratitis at a tertiary referral hospital in Brisbane, Australia. Incidence and patient characteristics were investigated over a 4-year period.
Methods:  A retrospective consecutive case series study was performed on patients with Acanthamoeba keratitis presenting to the Princess Alexandra Hospital between January 2003 and March 2007.
Results:  Nine cases of Acanthamoeba keratitis were identified over 12 months from March 2006 to March 2007 compared with four cases over the previous 37 months from January 2003 to February 2006. This was an increase from 0.07 cases per 1000 outpatient visits to 0.42 per 1000 ( P  = 0.003). Of the 13 cases, 11 patients used soft contact lenses of which two used monthly extended overnight wear silicone hydrogel lenses. Of the five patients who specified the type of contact lens solution they had used, three reported using AMO Complete Moistureplus Multipurpose solution, one reported using the AMO Complete Comfortplus Multipurpose solution and one was unsure which type of AMO Complete solution they were using.
Conclusions:  There has been a significant increase in incidence of cases of Acanthamoeba keratitis presenting to our institution. The type of contact lens solution and the use of silicon hydrogel lenses combined with extended overnight wear may play a role; however, the significance is unclear given the small numbers for analysis. Further study of incidence and patient characteristics is warranted to identify risk factors and causes for the rising incidence.     

Medical treatment for combined Fusarium and Acanthamoeba keratitis

Purpose: Acanthamoeba and fungal keratitis are rare ocular infections. We report cases of combined Fusarium and Acanthamoeba keratitis and the clinical course of medical treatment. Methods: We reviewed the medical records of patients treated for culture‐proven Acanthamoeba keratitis at a referral centre, during 2001?2006. Results: Eleven consecutive patients were treated for culture‐proven Acanthamoeba keratitis during the 5 years, two of whom had combined fungal infections. A 29‐year‐old man presented with ground‐glass corneal oedema and epitheliopathy caused by contact lens use. The other patient, a 7‐year‐old girl, had eye trauma that led to a feathery corneal infiltrate. Both cases were treated with topical 0.02% polyhexamethylene biguanide (PHMB), 0.1% propamidine, 1% clotrimazole and 5% natamycin. Therapeutic keratoplasty was not required in either case. Conclusions: Timely identification of the pathogen, with repeated culture and smear if necessary, as well as adequate dosage to prevent recurrence is highly recommended in order to preclude the need for therapeutic penetrating keratoplasty.     

棘阿米巴角膜炎的感染免疫及防治

棘阿米巴角膜炎是棘阿米巴属引起的角膜表面的感染。通常由粘附于软性接触镜的棘阿米巴滋养体所传递。当寄生虫粘附于角膜上皮细胞表面时可触发感染。后来的过程包括：寄生虫介导的细胞病理效应、诱导凋亡和通过产生各种蛋白酶入侵角膜基质层。滋养体也可浸润角膜神经，造成放射状角膜神经炎。棘阿米巴包囊即具有免疫原性又具有抗原性。然而，诱导针对棘阿米巴抗原的细胞介导的免疫应答对棘阿米巴角膜炎即无减轻作用又无预防效应。但是，普通粘膜免疫系统对于棘阿米巴角膜炎却具有显著的预防作用。其机制是通过IgA抗体阻断感染性滋养体与上皮层的结合。局部使用糖皮质激素对于缓解疼痛和减轻炎症反应具有显著效果，但可通过诱导静止包囊的脱包囊、增加滋养体的细胞病理效应以及麻痹初始免疫系统使疾病复燃。因此．糖皮质激素的使用是一把“双刃剑”。     

阿米巴角膜炎刮片细胞学特征

目的 探讨刮片细胞学检查诊断阿米巴角膜炎病原体形态特征.方法 实验研究.收集1991年5月至2007年12月期间,首都医科大学附属北京同仁医院、北京市眼科研究所眼微生物室诊断为阿米巴角膜炎的病例159例,对其实验室检查与临床资料进行分析.采用姬姆萨染色法和湿片检查法,对角膜刮片细胞进行观察并照相记录.结果 159例阿米巴角膜炎通过姬姆萨染色刮片细胞学检出阿米巴病原131例(82.4%),阿米巴培养阳性110例(69.2%).刮片细胞学检出率明显高于培养检出率.刮片细胞学检查可观察到典型的滋养体、包囊、包囊前期、空包囊等病原形态,对临床诊断有重要意义.刮片中水肿溶解的角膜上皮细胞、渗出细胞、丝状真菌的关节孢子或厚膜孢子、空泡、脂滴及药物结晶等需要与病原体相鉴别.通过湿片法主要观察滋养体的运动状态.结论 应用刮片细胞学检查法诊断阿米巴性角膜炎,观察到滋养体、包囊、包囊前期及空包囊典型特征对阿米巴性角膜炎有重要病原学诊断价值.