Lin Hsin-Chiung, Hsiao Ching-Hsi, Ma David Hui-Kang, Yeh Lung-Kun, Tan Hsin-Yuan, Lin Meng-Yin, Huang Samuel Chao-Ming
Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan.
Acta Ophthalmol. 2009 Mar;87(2):199-203. doi: 10.1111/j.1755-3768.2008.01192.x. Epub 2008 May 27.
Acanthamoeba and fungal keratitis are rare ocular infections. We report cases of combined Fusarium and Acanthamoeba keratitis and the clinical course of medical treatment.
We reviewed the medical records of patients treated for culture-proven Acanthamoeba keratitis at a referral centre, during 2001-2006.
Eleven consecutive patients were treated for culture-proven Acanthamoeba keratitis during the 5 years, two of whom had combined fungal infections. A 29-year-old man presented with ground-glass corneal oedema and epitheliopathy caused by contact lens use. The other patient, a 7-year-old girl, had eye trauma that led to a feathery corneal infiltrate. Both cases were treated with topical 0.02% polyhexamethylene biguanide (PHMB), 0.1% propamidine, 1% clotrimazole and 5% natamycin. Therapeutic keratoplasty was not required in either case.
Timely identification of the pathogen, with repeated culture and smear if necessary, as well as adequate dosage to prevent recurrence is highly recommended in order to preclude the need for therapeutic penetrating keratoplasty.
棘阿米巴角膜炎和真菌性角膜炎是罕见的眼部感染。我们报告了镰刀菌和棘阿米巴混合性角膜炎病例以及药物治疗的临床过程。
我们回顾了2001年至2006年期间在一家转诊中心接受经培养证实的棘阿米巴角膜炎治疗的患者的病历。
在这5年中，连续有11例患者接受了经培养证实的棘阿米巴角膜炎治疗，其中2例合并真菌感染。一名29岁男性因佩戴隐形眼镜出现毛玻璃样角膜水肿和上皮病变。另一名患者是一名7岁女孩，眼部外伤导致羽毛状角膜浸润。两例均采用局部应用0.02%聚六亚甲基双胍（PHMB）、0.1%丙脒、1%克霉唑和5%那他霉素治疗。两例均无需进行治疗性角膜移植术。
为避免进行治疗性穿透性角膜移植术，强烈建议及时识别病原体，必要时重复培养和涂片检查，并给予足够剂量以预防复发。
