Por Yong Ming, Mehta Jodhbir S, Chua Jocelyn L L, Koh Tse-Hsien, Khor Wei Boon, Fong Allan C Y, Lim Jimmy W K, Heng Wee Jin, Loh Raymond S K, Lim Li, Tan Donald T H
Singapore National Eye Centre, Singapore, Republic of Singapore.
Am J Ophthalmol. 2009 Jul;148(1):7-12.e2. doi: 10.1016/j.ajo.2009.02.030. Epub 2009 Apr 29.
To describe an outbreak of Acanthamoeba keratitis (AK) cases among contact lens wearers.
Retrospective cohort study.
Patients with AK were included. Relevant demographic and clinical data were obtained from case records, and patients were interviewed using a standardized questionnaire. Contact lens practices, including type of contact lens and solution used, were noted. In addition, clinical features at presentation, management, and clinical outcomes were recorded.
Forty-two patients (affecting 43 eyes) treated between 2000 and 2007 were included. Diagnosis was made by microbiologic culture in 35 cases and by microbiologic and histologic analysis in 2 cases, whereas the remainder were diagnosed based on clinical features and response to treatment. There was a gradual increase in cases since 2005, with a sharp increase in 2007, when 8 local patients were treated. Of 30 patients where contact lens solution data were available, 18 reported using a Complete brand Multipurpose solution (Advanced Medical Optics, Santa Ana, California, USA) before the infection. Among resident cases treated since February 2006, 7 (63%) of 11 patients used a Complete brand solution. Suboptimal hygiene practices were found in all patients interviewed. Fifteen patients required corneal grafting, with 11 undergoing therapeutic deep lamellar keratoplasty (DLK), 2 undergoing optical penetrating keratoplasty (PK), 1 undergoing optical DLK, and 1 undergoing therapeutic PK. The remainder were treated successfully medically with combination antiamebic therapy. The average duration of therapy was 116.2 days (range, 15 to 283 days). Of patients with radial keratoneuritis with or without epithelial disease, 83.3% achieved final vision of 20/40 or better, whereas this was achieved in 41.7% of those with ring infiltrate. Twenty-five percent of patients with ring infiltrate had final visual acuity of counting fingers or worse, whereas no patient with keratoneuritis and epithelial disease had final vision worse than counting fingers.
There was an increase in the number of contact lens users with AK seen in the major eye departments of Singapore. Most of our patients also reported using a Complete brand Multipurpose solution before infection, and this parallels a similar outbreak in the United States. Increasing severity of infection was associated with worse visual outcome.
描述隐形眼镜佩戴者中棘阿米巴角膜炎（AK）病例的一次暴发。
回顾性队列研究。
纳入AK患者。从病例记录中获取相关人口统计学和临床数据，并使用标准化问卷对患者进行访谈。记录隐形眼镜使用习惯，包括所使用的隐形眼镜类型和护理液。此外，记录就诊时的临床特征、治疗情况及临床结局。
纳入2000年至2007年间接受治疗的42例患者（累及43只眼）。35例通过微生物培养确诊，2例通过微生物学和组织学分析确诊，其余根据临床特征及治疗反应确诊。自2005年起病例逐渐增多，2007年急剧增加，当年有8例本地患者接受治疗。在可获取隐形眼镜护理液数据的30例患者中，18例报告在感染前使用了Complete品牌的多功能护理液（美国加利福尼亚州圣安娜市的Advanced Medical Optics公司生产）。在2006年2月以来接受治疗的常住病例中，11例患者中有7例（63%）使用了Complete品牌护理液。在所有接受访谈的患者中均发现卫生习惯欠佳。15例患者需要进行角膜移植，其中接受治疗性深层板层角膜移植术（DLK）的有11例，接受光学穿透性角膜移植术（PK）的有2例，接受光学DLK的有1例，接受治疗性PK的有1例。其余患者通过联合抗阿米巴治疗成功治愈。平均治疗时间为116.2天（范围15至283天）。有或无上皮病变的放射性角膜神经炎患者中，83.3%最终视力达到20/40或更好，而环形浸润患者中这一比例为41.7%。环形浸润患者中有25%最终视力为指数或更差，而放射性角膜神经炎合并上皮病变的患者中没有最终视力差于指数的情况。
新加坡主要眼科部门中隐形眼镜使用者发生AK的病例数有所增加。我们的大多数患者还报告在感染前使用了Complete品牌的多功能护理液，这与美国的一次类似暴发情况相似。感染严重程度增加与视力预后较差相关。
