Cohen E J, Parlato C J, Arentsen J J, Genvert G I, Eagle R C, Wieland M R, Laibson P R
Am J Ophthalmol. 1987 May 15;103(5):615-25. doi: 10.1016/s0002-9394(14)74320-x.
We examined seven patients with Acanthamoeba keratitis. All patients had a history of soft contact lens use. Predisposing factors included use of homemade saline, hydrogen peroxide disinfection, a history of improper lens care, and swimming with contact lenses. Currently recommended medical therapy, including topical propamidine isethionate and dibromopropamidine isethionate, miconazole, Neosporin, corticosteroids, and systemic ketoconazole, was used in all patients. Five patients have undergone penetrating keratoplasty for progressive primary Acanthamoeba keratitis (four patients) or recurrent infection (one patient) after maximal medical therapy. Two patients who began medical therapy less than three weeks after the onset of symptoms have done well. Early diagnosis of Acanthamoeba keratitis appears critical for successful medical therapy. Penetrating keratoplasty continues to have a central role in the management of more advanced cases that are unresponsive, or only transiently responsive, to medical therapy.
我们检查了7例棘阿米巴角膜炎患者。所有患者均有使用软性隐形眼镜的病史。诱发因素包括使用自制生理盐水、过氧化氢消毒、镜片护理不当史以及戴隐形眼镜游泳。所有患者均采用了目前推荐的药物治疗，包括局部使用依西双脒腙和二溴丙脒、咪康唑、新霉素、皮质类固醇，以及全身使用酮康唑。5例患者因进行性原发性棘阿米巴角膜炎（4例患者）或在最大程度药物治疗后复发感染（1例患者）接受了穿透性角膜移植术。2例在症状出现后不到三周开始药物治疗的患者情况良好。棘阿米巴角膜炎的早期诊断对于成功的药物治疗似乎至关重要。穿透性角膜移植术在治疗对药物治疗无反应或仅短暂有反应的更晚期病例中仍起着核心作用。
