Illingworth C D, Cook S D, Karabatsas C H, Easty D L
Department of Ophthalmology, Bristol Eye Hospital, Bristol.
Br J Ophthalmol. 1995 Dec;79(12):1078-82. doi: 10.1136/bjo.79.12.1078.
AIMS/BACKGROUND: This study was initiated to investigate risk factors for and outcome of Acanthamoeba keratitis.
Results of treatment were studied in 22 patients (23 eyes) presenting to Bristol Eye Hospital between 1985 and February 1995. Details related to the use and disinfection of contact lenses were also obtained. An additional two patients who were seen at Bristol but mainly treated elsewhere were surveyed for contact lens related information only.
The incidence of Acanthamoeba keratitis rose substantially in the 1990s: three patients presented before 1990, while the remaining 21 presented between January 1990 and February 1995. Eleven patients have presented since january 1994. All of the patients in this series were contact lens wearers, 16 (67%) using daily wear disposable contact lenses. Contact lens disinfection data were available in 22 patients of whom 11 (50%) were using chlorine disinfectant. Other types of disinfection were much less common. Four patients (18%) had not used any disinfectant. During the course of the series the average diagnostic delay has fallen markedly, although in 77% of patients a diagnosis of a viral keratitis, most commonly herpes simplex, was made on first presentation. All but three of the series were treated with a combination of polyhexamethylene biguanide and propamidine isethionate. Penetrating keratoplasty was performed in 9/23 eyes (39%); in all of these eyes diagnosis was delayed for at least 6 weeks. All but one of the eyes in the series achieved a visual acuity of 6/9 or better after treatment, and 18 eyes (78%) saw 6/6 or better.
Most patients with Acanthamoeba keratitis can now expect a good visual result and cure by medical therapy alone is favoured by early diagnosis.
目的/背景：开展本研究以调查棘阿米巴角膜炎的危险因素及治疗结果。
对1985年至1995年2月间在布里斯托尔眼科医院就诊的22例患者（23只眼）的治疗结果进行研究。还获取了与隐形眼镜使用和消毒相关的详细信息。另外两名在布里斯托尔就诊但主要在其他地方接受治疗的患者仅接受了与隐形眼镜相关信息的调查。
20世纪90年代棘阿米巴角膜炎的发病率大幅上升：1990年前有3例患者就诊，其余21例在1990年1月至1995年2月间就诊。自1994年1月以来有11例患者就诊。本系列所有患者均为隐形眼镜佩戴者，16例（67%）使用日抛型隐形眼镜。22例患者有隐形眼镜消毒数据，其中11例（50%）使用氯消毒剂。其他类型的消毒则少见得多。4例患者（18%）未使用任何消毒剂。在本系列研究过程中，平均诊断延迟时间显著缩短，尽管77%的患者初诊时被诊断为病毒性角膜炎，最常见的是单纯疱疹病毒性角膜炎。本系列除3例患者外均接受了聚六亚甲基双胍和依西酸丙脒的联合治疗。9只眼（39%）接受了穿透性角膜移植术；所有这些眼的诊断均延迟至少6周。本系列除1只眼外其余所有眼治疗后视力均达到6/9或更好，18只眼（78%）视力达到6/6或更好。
大多数棘阿米巴角膜炎患者现在有望获得良好的视力结果，早期诊断有利于仅通过药物治疗治愈。
