Claerhout I, Kestelyn P
Department of Ophthalmology, University Hospital Ghent, Belgium.
Bull Soc Belge Ophtalmol. 1999;274:71-82.
Acanthamoeba keratitis is caused by protozoa and characterised by a protracted course. All patients presenting with a therapy-resistant keratitis, even non-contact lens wearers, should be examined for the presence of Acanthamoeba by means of specific cultures, histopathological stainings and--if necessary--a corneal biopsy. The combination of clinical signs, such as excessive pain, a radial keratoneuritis and in a later phase a stromal ring infiltrate, together with a suggestive history (contact lenses, polluted water) is an important factor for the early diagnosis. Because of improved clinical detection and earlier diagnosis, the infection can often be controlled with a combination therapy of polyhexamethylene biguanide or chlorhexidine with propamidine and neomycine. This results in a better visual prognosis and a decreased need for therapeutic keratoplasty.
棘阿米巴角膜炎由原生动物引起，病程迁延。所有出现治疗抵抗性角膜炎的患者，即使不佩戴隐形眼镜，也应通过特定培养、组织病理学染色以及必要时进行角膜活检来检查是否存在棘阿米巴。临床体征如剧痛、放射状角膜神经炎以及后期的基质环浸润，再加上提示性病史（隐形眼镜、污水接触史），这些因素结合起来是早期诊断的重要依据。由于临床检测手段的改进和早期诊断，通常可采用聚六亚甲基双胍或氯己定联合丙脒腙和新霉素的联合疗法来控制感染。这会带来更好的视力预后，并减少治疗性角膜移植术的需求。
