Awwad Shady T, Petroll W Matthew, McCulley James P, Cavanagh H Dwight
Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9057, USA.
Eye Contact Lens. 2007 Jan;33(1):1-8. doi: 10.1097/ICL.0b013e31802b64c1.
Acanthamoeba keratitis is a potentially blinding microbial disease that has been increasing in incidence during the past two decades. Prognosis of this serious disease had been dismal, but improvement in diagnosis, a better understanding of the natural course of the disease, and recent introduction of multiple and effective therapeutic agents have resulted in improvement of visual outcomes.
A review of literature pertaining to Acanthamoeba keratitis.
Contact lens wear and exposure to contaminated water sources remain the most important risk factors; however, in vivo confocal microscopy and improved biomicroscopic screening have proven instrumental in accurate early diagnosis. Complications of Acanthamoeba keratitis include dacryoadenitis, corneal melting and scarring, severe secondary glaucoma, cataract, and chronic anterior segment inflammation that can rarely lead to reactive blinding retinal ischemia. Combination chemotherapeutic agents have been shown to be more effective than monotherapy, whereas rehabilitative surgery such as penetrating keratoplasty is best performed on a quiet eye free of ocular inflammation and with no residual amoebae.
Increased suspicion by clinicians for Acanthamoeba and confocal microscopy have allowed more rapid and accurate diagnosis; treatment with multiple antiamoeba drugs is essential to disease resolution. Provided there are no residual amoebae after treatment, penetrating keratoplasty has been successful in visual rehabilitation. Secondary glaucoma occurs frequently and may require drainage procedures for control of intraocular pressure. Posterior complications are rare but may lead to ischemic retinitis.
棘阿米巴角膜炎是一种有潜在致盲风险的微生物性疾病，在过去二十年中发病率不断上升。这种严重疾病的预后曾经很糟糕，但诊断方法的改进、对疾病自然病程的更好理解以及近期多种有效治疗药物的引入，已使视力预后得到改善。
对有关棘阿米巴角膜炎的文献进行综述。
佩戴隐形眼镜和接触受污染水源仍然是最重要的危险因素；然而，活体共聚焦显微镜检查和改进的生物显微镜筛查已被证明有助于准确的早期诊断。棘阿米巴角膜炎的并发症包括泪腺炎、角膜溶解和瘢痕形成、严重的继发性青光眼、白内障以及慢性眼前段炎症，后者极少会导致反应性致盲性视网膜缺血。联合化疗药物已被证明比单一疗法更有效，而穿透性角膜移植等修复性手术最好在没有眼部炎症且无残留阿米巴的安静眼上进行。
临床医生对棘阿米巴的怀疑增加以及共聚焦显微镜检查使得诊断更加快速和准确；使用多种抗阿米巴药物治疗对于疾病的解决至关重要。如果治疗后没有残留阿米巴，穿透性角膜移植术已成功用于视力康复。继发性青光眼经常发生，可能需要进行引流手术来控制眼压。后部并发症很少见，但可能导致缺血性视网膜炎。
