Wang I J, Hong J P, Hu F R
Department of Ophthalmology, National Taiwan University Hospital, Taipei, ROC.
J Formos Med Assoc. 1997 Nov;96(11):895-900.
We retrospectively reviewed 11 patients with culture-proven Acanthamoeba keratitis who presented at the National Taiwan University Hospital between 1989 and 1996. We assessed predisposing factors, initial diagnosis, clinical presentation, treatment, and outcome. A history of contact lens-wear, poor contact lens hygiene, intractable eye pain, and ring infiltrates in the cornea were the most prominent characteristics and clinical manifestations. Acanthamoeba keratitis was often misdiagnosed, with herpetic keratitis (7/11) being the most common initial diagnosis from referring hospitals. These patients were usually treated on the basis of the inaccurate diagnosis for more than 1 month (range 1-8 mo) before referral. All patients ultimately received penetrating keratoplasty because of poor response to delayed medical treatment. We suggest that inadequate contact lens hygiene may be important in Acanthamoeba keratitis. This condition is often misdiagnosed and, as early diagnosis is a major factor for successful medical treatment in such patients, awareness in clinical practice is critical.
我们回顾性研究了1989年至1996年间在台湾大学医院就诊的11例经培养证实的棘阿米巴角膜炎患者。我们评估了诱发因素、初始诊断、临床表现、治疗及预后。戴隐形眼镜史、不良的隐形眼镜卫生习惯、顽固性眼痛以及角膜环形浸润是最突出的特征和临床表现。棘阿米巴角膜炎常被误诊，转诊医院最常见的初始诊断为疱疹性角膜炎（7/11）。这些患者在转诊前通常基于不准确的诊断接受了1个多月（范围1 - 8个月）的治疗。由于对延迟治疗反应不佳，所有患者最终均接受了穿透性角膜移植术。我们认为不良的隐形眼镜卫生习惯可能在棘阿米巴角膜炎中起重要作用。这种疾病常被误诊，而且由于早期诊断是此类患者成功药物治疗的主要因素，临床实践中的认识至关重要。
