Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC.
Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2022 Mar 1;85(3):381-387. doi: 10.1097/JCMA.0000000000000676.
Acanthamoeba keratitis (AK) is a vision-threatening disease, usually associated with contact lens (CL) wear. As overnight orthokeratology (OOK) is increasingly used to control myopia, we have found incidence of OOK-associated AK is increasing. This study aimed to investigate the clinical presentation and visual outcomes of OOK-associated AK.
Demographic characteristics, clinical features, and treatment outcomes were collected by reviewing the medical charts of CL-associated AK patients (n = 35) diagnosed at Taipei Veterans General Hospital from 2001 to 2016. Cases were OOK-associated AK patients (n = 13), and controls were all other CL-associated AK patients (n = 22). Student t tests and chi-square tests were used to compare cases and controls. Linear regression analyses were used to identify factors associated with the final visual outcome in CL-associated AK.
OOK-associated AK accounted for half of all CL-associated AK after 2010. OOK-associated AK patients and other CL-associated patients had similar best-corrected logarithm of the minimum angle of resolution visual acuity (BCLVA) before treatment (1.10 ± 0.75 vs 1.13 ± 0.76, p = 0.893), but OOK-associated AK patients were younger (17.15 ± 3.21 vs 26.36 ± 12.81 years, p = 0.004), had less severe disease (ring infiltration, 0% vs 31.82%, p = 0.023), and had better post-treatment BCLVA (0.06 ± 0.15 vs 0.51 ± 0.95, p = 0.041). Multiple linear regression analysis showed that better BCLVA after treatment in CL-associated AK was associated with initial presentation without ring infiltration (p = 0.002) but not with OOK use itself (p = 0.793). Twenty-six of 35 CL-associated AK patients had final BCLVA equal to or better than 0.10 (Snellen visual acuity of 6/7.5). All 13 OOK-associated AK cases were treated with chlorhexidine 0.02% ± voriconazole 1% ± oral voriconazole, and 12 of these patients had final BCLVA equal to or better than 0.10.
Most CL-associated AK patients had satisfactory visual outcomes. Half of AK at our hospital is OOK-associated since 2010. Early diagnosis and correct treatment may be the reason why OOK-associated AK patients had better vision prognosis.
棘阿米巴角膜炎（AK）是一种威胁视力的疾病，通常与隐形眼镜（CL）佩戴有关。随着过夜角膜塑形术（OOK）越来越多地用于控制近视，我们发现 OOK 相关 AK 的发病率正在增加。本研究旨在探讨 OOK 相关 AK 的临床特征和视力结果。
通过回顾 2001 年至 2016 年在台北荣民总医院诊断的 CL 相关 AK 患者（n = 35）的病历，收集人口统计学特征、临床特征和治疗结果。病例为 OOK 相关 AK 患者（n = 13），对照组为所有其他 CL 相关 AK 患者（n = 22）。使用学生 t 检验和卡方检验比较病例和对照组。使用线性回归分析确定与 CL 相关 AK 最终视力相关的因素。
2010 年后，OOK 相关 AK 占所有 CL 相关 AK 的一半。OOK 相关 AK 患者和其他 CL 相关患者在治疗前的最佳矫正视力对数最小角分辨率（BCLVA）相似（1.10 ± 0.75 与 1.13 ± 0.76，p = 0.893），但 OOK 相关 AK 患者更年轻（17.15 ± 3.21 与 26.36 ± 12.81 岁，p = 0.004），疾病程度较轻（环状浸润，0% 与 31.82%，p = 0.023），治疗后 BCLVA 更好（0.06 ± 0.15 与 0.51 ± 0.95，p = 0.041）。多线性回归分析显示，CL 相关 AK 治疗后更好的 BCLVA 与初始无环状浸润表现相关（p = 0.002），但与 OOK 使用本身无关（p = 0.793）。35 例 CL 相关 AK 患者中有 26 例最终 BCLVA 等于或优于 0.10（Snellen 视力 6/7.5）。所有 13 例 OOK 相关 AK 病例均接受了洗必泰 0.02% ± 伏立康唑 1% ± 口服伏立康唑治疗，其中 12 例患者最终 BCLVA 等于或优于 0.10。
大多数 CL 相关 AK 患者的视力预后良好。自 2010 年以来，我院 AK 的一半是 OOK 相关的。早期诊断和正确治疗可能是 OOK 相关 AK 患者视力预后较好的原因。
