[棘阿米巴角膜炎]

[Acanthamoeba keratitis].

作者信息

Bouheraoua N, Labbé A, Chaumeil C, Liang Q, Laroche L, Borderie V

机构信息

Service d'ophtalmologie 5, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Inserm, U968, UPMC Paris VI, UMR S 968, CNRS, UMR 7210, institut de la vision, 17, rue Moreau, 75012 Paris, France.

Inserm, U968, UPMC Paris VI, UMR S 968, CNRS, UMR 7210, institut de la vision, 17, rue Moreau, 75012 Paris, France; Service d'ophtalmologie 3, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, DHU View maintain, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.

出版信息

J Fr Ophtalmol. 2014 Oct;37(8):640-52. doi: 10.1016/j.jfo.2014.05.004. Epub 2014 Aug 29.

DOI:10.1016/j.jfo.2014.05.004

PMID:25169145

Abstract

Early diagnosis and appropriate therapy are key elements for a good prognosis in Acanthamoeba keratitis (AK). AK should be considered in any case of corneal trauma complicated by exposure to soil or contaminated water, and in all contact lens (CL) wearers. A presumptive diagnosis of AK can be made clinically and with in vivo confocal microscopy, although a definitive diagnosis requires identification of Acanthamoeba on direct scraping, histology, or identification of Acanthamoeba DNA by polymerase chain reaction (PCR). We use cysticidal drugs for treating AK because encysted forms are more resistant than trophozoites to treatment. The treatment protocol used a biguanide (PHMB 0.02% or chlorhexidine 0.02%) and a diamidine (propamidine 0.1% or hexamidine 0.1%). New diagnostic modalities and more specific topical anti-amoebic treatments would substantially benefit patients with AK.

摘要

早期诊断和适当治疗是棘阿米巴角膜炎（AK）获得良好预后的关键因素。对于任何因接触土壤或受污染水而并发角膜外伤的病例，以及所有隐形眼镜（CL）佩戴者，均应考虑AK的可能。临床上及通过活体共聚焦显微镜检查可作出AK的初步诊断，不过明确诊断需要通过直接刮片、组织学检查鉴定出棘阿米巴，或通过聚合酶链反应（PCR）鉴定出棘阿米巴DNA。我们使用杀包囊药物治疗AK，因为包囊形式比滋养体对治疗的耐受性更强。治疗方案采用一种双胍类药物（0.02%的聚六亚甲基双胍或0.02%的氯己定）和一种脒类药物（0.1%的丙脒腙或0.1%的己脒定）。新的诊断方法和更具特异性的局部抗阿米巴治疗将使AK患者显著受益。