Davis R M, Schroeder R P, Rowsey J J, Jensen H G, Tripathi R C
Department of Ophthalmology, Dean A. McGee Eye Institute, University of Oklahoma, Oklahoma City.
Arch Ophthalmol. 1987 Nov;105(11):1524-7. doi: 10.1001/archopht.1987.01060110070034.
Two cases of Acanthamoeba keratitis and infectious crystalline keratopathy, occurring simultaneously, are presented. Three and 12 months after initiating topical corticosteroid therapy in cases 1 and 2, respectively, alpha-hemolytic Streptococcus viridans was cultured from each cornea. Topical corticosteroid therapy was initiated for the treatment of an annular stromal opacity, presumably secondary to herpes simplex keratitis. Acanthamoeba was identified in culture following penetrating keratoplasty in case 1, and Acanthamoeba polyphaga, Acanthamoeba rhysodes, and Acanthamoeba castellanii were identified using indirect fluorescent antibody staining in case 2. Histopathologic examination and electron microscopy demonstrated sheets of cocci within stromal lamellae characteristic of infectious crystalline keratopathy and double-walled encysted organisms typical of Acanthamoeba. These case reports alert one to the possibility of developing bacterial keratitis, such as infectious crystalline keratopathy, following the use of topical corticosteroids for the treatment of Acanthamoeba keratitis.
本文报告了两例同时发生棘阿米巴角膜炎和感染性结晶状角膜病变的病例。病例1和病例2分别在开始局部使用皮质类固醇治疗3个月和12个月后，从每个角膜培养出草绿色链球菌。局部皮质类固醇治疗开始用于治疗疑似继发于单纯疱疹性角膜炎的环形基质混浊。病例1在穿透性角膜移植术后的培养物中鉴定出棘阿米巴，病例2使用间接荧光抗体染色鉴定出多食棘阿米巴、里斯棘阿米巴和卡氏棘阿米巴。组织病理学检查和电子显微镜显示，基质板层内有片状球菌，这是感染性结晶状角膜病变的特征，还有典型的棘阿米巴双壁包囊生物。这些病例报告提醒人们，在使用局部皮质类固醇治疗棘阿米巴角膜炎后，有发生细菌性角膜炎（如感染性结晶状角膜病变）的可能性。
