Matsumoto Yukihiro, Dogru Murat, Sato Enrique Adan, Katono Yasuhiro, Uchino Yuichi, Shimmura Shigeto, Tsubota Kazuo
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
Mol Vis. 2007 Jul 25;13:1319-26.
To evaluate the role of in vivo laser scanning confocal microscopy (Heidelberg Retina Tomograph II, Rostock Cornea Module, HRTII-RCM) in the management of Acanthamoeba keratitis (AK).
Four eyes of four patients with AK seen at Keio University Hospital at the Department of Ophthalmology were studied in this single-center, prospective, interventional case series. All patients were routinely examined by slit-lamp microscopy including corneal fluorescein staining. Best corrected visual acuity (BCVA) was also measured before and after the treatment for AK. Both the scraped corneal epithelium and soft contact lens (SCL) storage solution in each patient's SCL case were cultured. Patient corneas were examined regularly using the HRTII-RCM before treatment and after commencement of medications including azoles, echinocandins, and chlorhexidine.
All patients had various degrees of conjunctival injection, corneal edema, stromal opacity with radial keratoneuritis with slit-lamp examination. Cultures for AK were positive in three out of four cases by corneal scraping. Contact lens storage solutions were also positive in three of four cases. HRTII-RCM examination could detect Acanthamoeba cysts or trophozoites in all eyes before corneal scraping. No organisms were detectable in any of the cases in any of the corneal layers four to six weeks after treatment. The BCVA improved with treatment in three of four eyes.
HRTII-RCM could effectively demonstrate cysts and trophozoites and the nature of the inflammatory process in AK. In vivo laser scanning confocal microscopy employing HRTII-RCM could provide an end-point for treatment, saving the patient from additional invasive diagnostic procedures and unneeded exposure to long term topical or systemic medications.
评估活体激光扫描共聚焦显微镜（海德堡视网膜断层扫描仪II，罗斯托克角膜模块，HRTII-RCM）在棘阿米巴角膜炎（AK）治疗中的作用。
在这项单中心、前瞻性、干预性病例系列研究中，对庆应义塾大学医院眼科就诊的4例AK患者的4只眼睛进行了研究。所有患者均常规接受裂隙灯显微镜检查，包括角膜荧光素染色。在AK治疗前后还测量了最佳矫正视力（BCVA）。对每位患者软性角膜接触镜（SCL）病例中的刮取角膜上皮和SCL储存液进行培养。在治疗前以及开始使用包括唑类、棘白菌素和氯己定在内的药物治疗后，定期使用HRTII-RCM对患者角膜进行检查。
裂隙灯检查显示，所有患者均有不同程度的结膜充血、角膜水肿、基质混浊伴放射状角膜神经炎。4例中有3例通过角膜刮片培养出AK。4例中有3例的隐形眼镜储存液培养也呈阳性。在角膜刮片前，HRTII-RCM检查可在所有眼中检测到棘阿米巴囊肿或滋养体。治疗后四至六周，在任何角膜层的任何病例中均未检测到病原体。4只眼中有3只眼的BCVA随治疗而改善。
HRTII-RCM能够有效显示AK中的囊肿和滋养体以及炎症过程的性质。采用HRTII-RCM的活体激光扫描共聚焦显微镜可为治疗提供一个终点，使患者避免额外的侵入性诊断程序以及不必要地长期接触局部或全身药物。
