三级眼科医院棘阿米巴角膜炎的临床经验。

The clinical experience of Acanthamoeba keratitis at a tertiary care eye hospital.

机构信息

The Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.

出版信息

Cornea. 2010 Sep;29(9):1005-10. doi: 10.1097/ICO.0b013e3181cf9949.

DOI:10.1097/ICO.0b013e3181cf9949

PMID:20539211

Abstract

PURPOSE

In recent years, outbreaks of Acanthamoeba keratitis (AK) have been reported worldwide. The purpose of this study was to examine the clinical experience of AK at the Massachusetts Eye and Ear Infirmary.

METHODS

A retrospective case review was completed on patients with infectious keratitis whose corneal cultures were positive for Acanthamoeba between January 2000 and December 2008. The clinical characteristics and visual outcomes were examined in those patients with a follow-up period greater than 6 months.

RESULTS

Four cases were identified between January 2000 and December 2003, whereas 26 cases were identified between January 2004 and December 2008. Charts before 2004 were unavailable for review. A total of 15 cases between 2004 and 2008 had a follow-up period of greater than 6 months. In these cases, possible risk factors associated with AK included soft contact lens wear (12 of 15 cases), exposure to freshwater or saltwater sources (8 of 15 cases), chronic ocular surface disease (6 of 15 cases), ocular trauma (3 of 15 cases), and concomitant infectious keratitis (2 of 15 cases). Four cases were associated with the use of Advanced Medical Optics Complete MoisturePlus Multi-Purpose Solution. Many cases were recalcitrant to medical therapy alone, necessitating therapeutic penetrating keratoplasty in 8 of 15 cases.

CONCLUSIONS

The number of AK cases at the Massachusetts Eye and Ear Infirmary has increased since 2004. Contact lens wear and exposure to contaminated water sources were potential risk factors for AK. Clinicians should maintain a high clinical suspicion for AK in cases of atypical keratitis with known risk factors for AK.

摘要

目的

近年来，世界各地都有棘阿米巴角膜炎（AK）的爆发报告。本研究的目的是检查马萨诸塞眼耳医院 AK 的临床经验。

方法

对 2000 年 1 月至 2008 年 12 月期间，角膜培养阳性的感染性角膜炎患者进行了回顾性病例分析。对随访时间超过 6 个月的患者进行了临床特征和视力结果的检查。

结果

2000 年 1 月至 2003 年 12 月期间发现 4 例，2004 年 1 月至 2008 年 12 月期间发现 26 例。2004 年之前的图表无法进行回顾。2004 年至 2008 年期间共有 15 例患者的随访时间超过 6 个月。在这些病例中，与 AK 相关的可能危险因素包括软性隐形眼镜佩戴（15 例中的 12 例）、暴露于淡水或咸水来源（15 例中的 8 例）、慢性眼表面疾病（15 例中的 6 例）、眼外伤（15 例中的 3 例）和同时发生的感染性角膜炎（15 例中的 2 例）。有 4 例与使用 Advanced Medical Optics Complete MoisturePlus 多用途溶液有关。许多病例仅通过药物治疗难以治愈，因此需要进行 15 例中的 8 例穿透性角膜移植术。