Department of Ophthalmology, Süleyman Demirel University Faculty of Medicine, 32260, Isparta, Turkey.
BMC Complement Med Ther. 2023 Jan 2;23(1):124. doi: 10.1186/s12906-022-03613-1.
The medicinal leech therapy (MLT) is a kind of complementary treatment method used for various diseases. The leeches (Hirudo medicinalis) have been used for more than 2500 years by surgeons. The substances presenting in the saliva of leeches have anti-inflammatory, anticoagulant, platelet inhibitory, thrombin regulatory, analgesic, extracellular matrix degradative and antimicrobial effects. The method is cheap, easy to apply, effective and its mechanisms of action have been clarified for specific diseases. Infection particularly Aeromonas infection is the most common complication of MLT.
In this case report, a keratitis case developing after leech therapy applied for the periocular and facial eczematous dermatitis lesions will be presented. The patient referred to our hospital with decreased vision, ocular pain, stinging, redness and lacrimation complaints. A large corneal epithelial defect with irregular margins, dying by fluorescein, involving more than inferior half of cornea and conjunctival hyperemia were seen in the right eye. No agent was determined in microbiological investigation, as the patient had used topical moxifloxacin eye drop which was commenced in another clinic before applying to us. The patient was treated with fortified vancomycin and ceftazidime, before using besifloxacin with the diagnosis of bacterial keratitis. Three weeks later epithelial defect improved completely leaving an opacity and neovascularization.
MLT should be performed by certified physicians with sterile medicinal leeches and precautious antibiotics should be used before MLT for prevention against potential infections.
医用蛭疗法（MLT）是一种用于多种疾病的补充治疗方法。自外科医生使用以来，医用水蛭（Hirudo medicinalis）已经使用了超过 2500 年。水蛭唾液中的物质具有抗炎、抗凝、血小板抑制、凝血酶调节、镇痛、细胞外基质降解和抗菌作用。该方法价格低廉、易于实施、有效，其作用机制已明确适用于特定疾病。感染，特别是气单胞菌感染，是 MLT 最常见的并发症。
本病例报告介绍了一例因眼周和面部湿疹性皮炎病变接受蛭疗后发生角膜炎的病例。患者因视力下降、眼部疼痛、刺痛、眼红和流泪就诊。右眼可见大的角膜上皮缺损，边缘不规则，荧光素染色染色，累及角膜下 1/2 以上和结膜充血。由于患者在来我院就诊前在另一家诊所开始使用局部莫西沙星滴眼液，微生物学检查未确定病原体。患者被诊断为细菌性角膜炎，接受了强化万古霉素和头孢他啶治疗，随后使用贝西沙星治疗。3 周后，上皮缺损完全愈合，遗留混浊和新生血管。
应由持牌医生使用无菌医用蛭进行 MLT，并在 MLT 前谨慎使用抗生素，以预防潜在感染。
