Murdoch D, Gray T B, Cursons R, Parr D
Eye Department, Auckland Hospital, New Zealand.
Aust N Z J Ophthalmol. 1998 Aug;26(3):231-6. doi: 10.1111/j.1442-9071.1998.tb01317.x.
Acanthamoeba keratitis is an uncommon corneal infection that can run a protracted course with, at times, serious visual results. Eighty-five per cent of cases occur in soft contact lens wearers. The first New Zealand case occurred in 1990 and only seven cases have been identified in New Zealand to the end of 1996.
We surveyed the ophthalmologists looking after these seven cases of acanthamoeba keratitis as to time to diagnosis, treatment and outcome.
New Zealand has a low incidence of this disease. All cases were soft contact lens wearers with defective care in every instance. After an initial two late-diagnosed cases, the time to diagnosis for four of the five other cases has been within 2 weeks. Medical treatment has varied over this series, but since the introduction of the cationic antiseptics polyhexamethylene biguanide (PHMB) and chlorhexidine in 1992, the last five cases were all treated with PHMB. One case diagnosed within 2 weeks ran a devastating course, despite intensive PHMB, and a second case remained culture positive after 1 year of PHMB and the late addition of chlorhexidine. Debridement, 0.1% PHMB and hexamidine eventually settled this eye.
For treatment PHMB, hexamidine rather than propamidine and surgical debridement are favoured. While all Acanthamoeba isolates show good in vitro sensitivity to PHMB, the in vivo response is not always proportionate. A bacterial endosymbiont may have been a factor in the favourable outcome of one protracted case.
棘阿米巴角膜炎是一种罕见的角膜感染疾病，病程可能迁延不愈，有时会导致严重的视力损害。85%的病例发生在软性隐形眼镜佩戴者中。新西兰首例病例于1990年出现，截至1996年底，新西兰仅确诊7例。
我们就这7例棘阿米巴角膜炎病例的诊断时间、治疗方法及治疗结果对负责诊治的眼科医生进行了调查。
新西兰该病发病率较低。所有病例均为软性隐形眼镜佩戴者，且每次护理均存在缺陷。最初有2例诊断较晚，之后5例中的4例诊断时间在2周内。在这一系列病例中，治疗方法各不相同，但自1992年引入阳离子防腐剂聚六亚甲基双胍（PHMB）和氯己定以来，最后5例均采用PHMB治疗。1例在2周内确诊的病例，尽管接受了强化的PHMB治疗，病情仍严重恶化；另1例在接受PHMB治疗1年后培养仍呈阳性，后期加用氯己定后才转阴。清创术、0.1%的PHMB和己脒最终使该眼病情得到缓解。
在治疗方面，PHMB、己脒优于丙脒，手术清创也较为常用。虽然所有棘阿米巴分离株在体外对PHMB均表现出良好的敏感性，但体内反应并不总是与之成正比。一种细菌内共生体可能是1例迁延性病例取得良好治疗效果的一个因素。
