棘阿米巴角膜炎6例治疗分析

目的总结6例因配戴角膜接触镜(CL)引起的棘阿米巴角膜炎的临床资料,并探讨其成功治疗经验。方法回顾性分析6例棘阿米巴角膜炎的临床资料和治疗经过。结果 6例患者(平均年龄25岁)均配戴CL(1例硬性CL,5例软性CL)。其中5例以角膜剧烈疼痛为主诉就诊。4例初次眼科检查时确诊假树枝状角膜炎,2例表现为放射状角膜神经炎和环状基质混浊。所有病例进行角膜刮片培养并确诊棘阿米巴感染。5例立即开始0.02%氯己定联合抗真菌滴眼液滴眼治疗,最终矫正视力获得不同程度的提高,范围为0.5～1.5。另外1例未能及时治疗,角膜炎症状恶化,视力下降为手动,施行穿透性角膜移植+白内障手术,术后矫正视力提高到0.6。结论棘阿米巴角膜炎病例早期阶段及时应用0.02%氯己定联合抗真菌药物滴眼可提高疗效,避免不必要手术,并产生相对较好的最终视力。

Successful treatment of six cases of Acanthamoeba keratitis

Objective To report the successful treatment of six cases of Acanthamoeba keratitis that developed in contact lenses(CL) users recently.Methods The medical records of six cases of Acanthamoeba keratitis were retrospectively analyzed.Results Six patients were CL wearers(one hard CL and five soft CL).In five cases,the patients complained very serious eye pain for their corneal condition from the first time in our hospital.The pseudo-dendritic corneal keratitis was admitted by four cases at the first ocular examination,and the radial corneal neuritis and corneal ring infiltration was found in two cases.All cases performed the corneal scraping culture and acanthamoeba was identified.The improvement of the final corrected visual acuity ranged from 0.5 to 1.5 in the five cases that had immediately begun treatment with 0.02% chlorhexidine(CHX) combined with antifungal eye drops.In the remaining case in which the treatment was delayed,the keratitis worsened and vision decreased to hand motion.Penetrating keratoplasty was performed and visual acuity improved to 0.6.Conclusion In cases of acanthamoeba keratitis,simultaneous instillation of 0.02% CHX and the antifungal eye drops at the early stage leads to relatively better vision.