Schaumberg D A, Snow K K, Dana M R
Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Cornea. 1998 Jan;17(1):3-10. doi: 10.1097/00003226-199801000-00001.
To review from a historical perspective the recent epidemic of Acanthamoeba keratitis and its association with the use of contact lenses and to provide a summary of recent techniques that have allowed earlier diagnosis and treatment.
The authors reviewed available literature on Acanthamoeba keratitis from 1973 to the present, with emphasis on the history of the epidemic and its association with contact lenses, identification of risk factors, preventive measures, and current diagnostic techniques. We also estimated the annual incidence of Acanthamoeba keratitis during 1985 through 1987 from available data.
Before the popularization of soft-contact-lens wear, Acanthamoeba keratitis was extremely rare; however, an epidemic began in the early 1980s, and the number of cases increased dramatically beginning in 1984. By 1985, the association of this infection with the use of contact lenses was firmly established, and in 1987, the infection was shown to occur more commonly among men, as well as in contact-lens wearers who failed to disinfect their lenses as frequently as recommended, swam while wearing lenses, or used homemade instead of commercially prepared saline solution. Adoption of "disposable" contact lenses in the late 1980s did not decrease the risk of Acanthamoeba keratitis, and concerns remain regarding the effectiveness of some contact-lens disinfectants; however, recent advances in diagnosis and treatment have improved the prognosis. The annual incidence during 1985 through 1987 was conservatively estimated at 1.65 to 2.01 cases per million contact-lens wearers. It is unclear whether the incidence is declining.
Acanthamoeba keratitis has now been recognized worldwide, and there are clear associations of this infection with improper contact-lens hygiene, particularly contact with water. Recent methods allow earlier diagnosis and thus improved outcomes. The epidemic provides a valuable lesson on how a new technology can be associated with unforeseen complications and exemplifies how rapid dissemination of epidemiologic information can aid in controlling an emergent epidemic.
从历史角度回顾近期棘阿米巴角膜炎的流行情况及其与隐形眼镜使用的关联，并总结有助于早期诊断和治疗的近期技术。
作者回顾了1973年至今有关棘阿米巴角膜炎的现有文献，重点关注该疾病的流行病史及其与隐形眼镜的关联、危险因素的识别、预防措施以及当前的诊断技术。我们还根据现有数据估算了1985年至1987年期间棘阿米巴角膜炎的年发病率。
在软性隐形眼镜普及之前，棘阿米巴角膜炎极为罕见；然而，20世纪80年代初开始出现流行，1984年起病例数急剧增加。到1985年，这种感染与隐形眼镜使用之间的关联得以确立，1987年发现该感染在男性以及未按推荐频率对镜片进行消毒、戴镜游泳或使用自制而非市售生理盐水溶液的隐形眼镜佩戴者中更为常见。20世纪80年代末采用“一次性”隐形眼镜并未降低棘阿米巴角膜炎的风险，并且对某些隐形眼镜消毒剂的有效性仍存在担忧；然而，近期诊断和治疗方面的进展改善了预后。1985年至1987年期间的年发病率保守估计为每百万隐形眼镜佩戴者1.65至2.01例。目前尚不清楚发病率是否在下降。
棘阿米巴角膜炎现已在全球范围内得到认识，这种感染与不当的隐形眼镜卫生习惯，尤其是与水接触，存在明确关联。近期方法可实现早期诊断，从而改善治疗结果。该流行病为新技术如何与不可预见的并发症相关联提供了宝贵教训，并例证了流行病学信息的快速传播如何有助于控制突发流行病。
