共焦显微镜在棘阿米巴性角膜炎临床诊断中的应用  

Clinical diagnosis of Acanthamoeba keratitis with confocal microscopy

作　　者：李航[1] 王立[1] 邹留河[1] 孙旭光[1] 

机构地区：[1]首都医科大学附属北京同仁眼科中心,北京100730

出　　处：《眼科》2003年第6期336-338,共4页Ophthalmology in China

摘　　要：目的 :评价共焦显微镜 (confocalmicroscopy)在棘阿米巴性角膜炎 (acanthamoebakeratitis)临床诊断 ,尤其是早期诊断中的应用价值。方法 :对临床拟诊为棘阿米巴性角膜炎患者 2 3例进行共焦显微镜检查 ,并同时行角膜涂片及棘阿米巴原虫培养检查 ,对两种检查方法的结果进行比较。结果 :2 3例患者中 ,13例共焦显微镜检查可见棘阿米巴包囊和 /或神经炎表现 ,综合各项检查结果及临床表现 ,18例确诊为棘阿米巴性角膜炎 ,共焦显微镜的阳性率为 5 6 5 %。在 5例表现为上皮性及浅基质病变的早期角膜炎患者 ,共焦显微镜检查 3例 (6 0 % )为阳性 ,刮片、培养各 1例 (2 0 % )为阳性。结论 :共焦显微镜检查是一种无创、快速和有效的活体检查手段 ,在棘阿米巴性角膜炎的诊断中 ,如同时结合实验室刮片及培养和患者临床情况可起到重要的辅助诊断作用 ,尤其是在棘阿米巴角膜炎的早期诊断中 。Objective:To illustrate the value of confocal microscopy in the diagnosis,especially the early diagnosis,of Acanthamoeba keratitis.Methods:In vivo confocal microscopy was performed on 23 patients with suspected Acanthamoeba keratitis.The results were compared to those of smears and cultures.Results:Acanthamoeba cycsts were imaged in 13 of 23 patients,while Acanthamoeba keratitis was diagnosed in 18 patients based on clinical signs and all the methods of examination.The positive rate of confocal microscopy was 56 5%.Of the 5 patient presented with epithelial defect and anterior stroma infiltration,3 cases(60%) were positive with in vivo microscopy and 1 case (20%) was positive with corneal scrapes or culture respectively.Conclusion:Confocal microscopy is a rapid,effective and noninvasive imaging technique,and it is helpful in the diagnosis of Acanthamoeba keratitis combined with the lab investigation and clinical features,especially in the early diagnosis of Acanthamoeba keratitis.

关 键 词：共焦显微镜 角膜炎 棘阿米巴/诊断 

分 类 号：R772.21[医药卫生—眼科]