Donoso Rodrigo, Mura Juan José, López Mauricio
Servicio de Oftalmología, Hospital del Salvador, Santiago-Chile.
Rev Med Chil. 2002 Apr;130(4):396-401.
The diagnosis of acanthamoeba keratitis has increased since 1985 due to the massive use of contact lenses and a better knowledge of the disease by ophthalmologists. The use of biassociated therapy has resulted in a better prognosis and lower complication rate.
To report patients with acanthamoeba keratitis treated with the association of propamidine (Brolene) and polyhexamethylbiguanide (PHMB) 0.02%.
Retrospective analysis of 27 patients (31 eyes) with acanthamoeba keratitis (bilateral in four cases), diagnosed by culture, biopsy or characteristic clinical features.
Ninety six percent of patients used rigid contact lenses. Acanthamoeba cultures were positive in 71% of cases. The delay in the diagnosis was between 1 and 5 months. Early treatment was possible in 29% of patients. Infection was irradicated in all cases with the biassociated therapy. A tectonic keratoplasty to treat a trophic perforation was done in eight eyes. No patient required therapeutic keratoplasty to resolve the infection. Visual acuity at the end of follow up was better than 20/40 in nine patients and in eight it was in the range of count fingers or less.
In patients with the clinical picture of acanthamoeba keratitis, early or late antiamoebic treatment is warranted even in the absence of positive cultures. The visual results of the treatment are highly dependent on the precocity of treatment. Prevention is imperative and is based on a strict contact lens hygiene.
自1985年以来，由于隐形眼镜的大量使用以及眼科医生对该疾病的进一步了解，棘阿米巴角膜炎的诊断病例有所增加。联合治疗的应用带来了更好的预后和更低的并发症发生率。
报告使用丙脒腙（Brolene）和0.02%聚己基双胍（PHMB）联合治疗的棘阿米巴角膜炎患者。
对27例（31只眼）棘阿米巴角膜炎患者（4例为双眼患病）进行回顾性分析，通过培养、活检或特征性临床特征进行诊断。
96%的患者使用硬性隐形眼镜。71%的病例棘阿米巴培养呈阳性。诊断延迟时间为1至5个月。29%的患者得以早期治疗。联合治疗使所有病例的感染均得到根除。8只眼进行了治疗营养性穿孔的结构性角膜移植术。没有患者需要进行治疗性角膜移植术来控制感染。随访结束时，9例患者的视力优于20/40，8例患者的视力为指数或更差。
对于有棘阿米巴角膜炎临床表现的患者，即使培养结果为阴性，也应尽早或及时进行抗阿米巴治疗。治疗的视觉效果高度依赖于治疗的及时性。预防至关重要，应基于严格的隐形眼镜卫生习惯。
