Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Cornea. 2009 Dec;28(10):1173-7. doi: 10.1097/ICO.0b013e318199fa41.
The purpose of this study was to report a case of contact lens-related Pythium insidiosum corneal ulcer.
The authors conducted an interventional case report. We report the clinical presentations, histopathologic findings, and treatments of a patient with P. insidiosum keratitis associated with contact lens wear.
A 22-year-old Thai woman presented to our clinic with a nonresponsive, progressive corneal ulcer of the left eye. Slit lamp examination showed a large central ulcer measuring 5.4 x 5.2 mm with underlying dense stromal infiltrates surrounded by subepithelial and superficial stromal opacity in a reticular pattern along with radial perineural-like infiltrates. Histopathologic examination revealed broad, branched, thin-walled nonparallel hyaline hyphae with rare septates consistent with P. insidiosum. The corneal culture confirmed the diagnosis. The infection recurred after multiple therapeutic penetrating keratoplasties. Enucleation was eventually performed to eradicate the infection. No definite report of contact lens-related P. insidiosum keratitis existed in the literature.
Pythium keratitis may present with central ulcer and radial keratoneuritis similar to acanthamoeba keratitis. Contact lens wear can be a risk factor for this infection. Increasing awareness, early diagnosis, and intervention may improve the prognosis.
本研究旨在报告一例与隐形眼镜相关的瓶霉属棘孢木霉角膜溃疡病例。
作者进行了一项介入性病例报告。我们报告了一位与隐形眼镜佩戴相关的棘孢木霉角膜炎患者的临床表现、组织病理学发现和治疗方法。
一位 22 岁的泰国女性因左眼进行性、无反应性角膜溃疡就诊于我院。裂隙灯检查显示中央大溃疡，大小为 5.4 x 5.2mm，底部有密集的基质浸润，周围有上皮下和浅层基质混浊呈网状，伴有放射状神经周围样浸润。组织病理学检查显示宽、分支、薄壁、无隔透明菌丝，罕见有隔，符合棘孢木霉。角膜培养证实了诊断。在多次治疗性穿透性角膜移植术后，感染复发。最终进行了眼球摘除以根除感染。文献中没有明确报道与隐形眼镜相关的棘孢木霉角膜炎。
棘孢木霉角膜炎可能表现为中央溃疡和放射状角膜神经炎，类似于棘阿米巴角膜炎。隐形眼镜佩戴可能是这种感染的危险因素。提高认识、早期诊断和干预可能会改善预后。
