Tien S H, Sheu M M
Department of Ophthalmology, Kaohsiung Medical University, Taiwan, Republic of China.
Kaohsiung J Med Sci. 1999 Nov;15(11):665-73.
From July 1996 to March 1997, three cases of Acanthamoeba keratitis combined with fungal infection were diagnosed and treated at our ophthalmic department. Specimens from all of these cases were obtained by corneal scraping, keratectomy and anterior chamber paracentesis. The diagnosis was confirmed by either the results of smear test or pathology reports. All of these patients received aggressive treatment with polyhexamethylene biguanide (PHMB) 0.02%, fluconazole, and anegyn eye drops. After the infection had been controlled without extension, therapeutic penetrating keratoplasty was performed on all of these patients despite the existence of infiltration beyond the edge of the graft. Postoperatively, eye drops were tapered gradually, and treatment was continued for 1 to 2 months. All three cases achieved good results and there was no recurrence of infection. Two cases had visual acuity of 20/100 and 20/20, while the other one perceived hand movement only due to later graft rejection. These cases suggest that early diagnosis and immediate use of PHMB and anti-fungal agents are effective in the treatment of Acanthamoeba keratitis combined with fungal infection.
1996年7月至1997年3月，我院眼科诊断并治疗了3例棘阿米巴角膜炎合并真菌感染的病例。所有这些病例的标本均通过角膜刮片、角膜切除术和前房穿刺术获取。通过涂片检查结果或病理报告确诊。所有这些患者均接受了0.02%聚六亚甲基双胍（PHMB）、氟康唑和阿内吉滴眼液的积极治疗。在感染得到控制且无扩散后，尽管移植边缘存在浸润，所有这些患者均接受了治疗性穿透性角膜移植术。术后，滴眼液逐渐减量，并持续治疗1至2个月。所有3例均取得良好效果，且无感染复发。2例视力为20/100和20/20，而另一例因后期移植排斥反应仅能感知手动。这些病例表明，早期诊断并立即使用PHMB和抗真菌药物对治疗棘阿米巴角膜炎合并真菌感染有效。
