东南地区棘阿米巴角膜炎的特征及诊疗  

Clinical features, diagnosis and treatment of acanthamoeba keratitis in Southeast China

作　　者：胡建章[1] 杨娟[1] 张晶津[1] 韩晓丽[1] 朱学军[1] 徐国兴[1] 

机构地区：[1]福建医科大学附属第一医院眼科福建省眼科研究所,福州350005

出　　处：《中国实用眼科杂志》2013年第4期473-476,共4页Chinese Journal of Practical Ophthalmology

基　　金：福建省医学创新课题（2011-CXB-13）;山东省眼科学重点实验室一省部共建国家重点实验室培育基地开放课题（SDYK-KF-2010-8）;福建医科大学教授发展基金（js09009）

摘　　要：目的探讨东南地区棘阿米巴角膜炎的发病、临床表现、诊疗及其预后。方法对2007年7月至2011年6月在福建医科大学附属第一医院确诊的来自东南地区的47例棘阿米巴角膜炎进行临床分析，研究其发病诱因、诊断方法及临床特征，采用药物或结膜瓣遮盖术或穿透性角膜移植术进行治疗并观察疗效。结果47例确诊病例中，33例发病与角膜外伤有关，5例与角膜接触镜相关；41例经角膜刮片镜检确诊，17例合并真菌感染；临床主要表现及治疗：（1）29例表现为局部溃疡型，其中14例药物治愈，13例经结膜瓣遮盖治愈；（2）12例表现为基质环形浸润型，其中3例药物治愈，4例经结膜瓣遮盖治愈，3例行穿透性角膜移植术（PKP）；（3）6例表现为基质弥漫浸润型，仅50％的治愈率，且药物疗效尤其差。结论东南地区是棘阿米巴角膜炎的高发区，发病诱因以角膜外伤为主，角膜刮片镜检是早期诊断的有效方法，根据临床特征选择药物和／或手术治疗。Objective To study the onset, clinical features, diagnosis, treatment and prognosis of patients with acanthamoeba keratitis in Southeast China. Methods Forty-seven cases of acanthamoe- ba keratitis at the First Affiliated Hospital of Fujian Medical University between July 2007 and June 2011 were retrospectively reviewed. Predisposing factors, diagnosis, and clinical characteristics of the patients were analyzed. The patients were received medications or conjunctival flap covering or pene- trating keratoplasty （PKP）, and the therapeutic effect was studied. Results Out of 47 patients in this series, risk factors included corneal trauma （33/47） and contact lens wear （5/47）. Forty-one cases were confirmed by corneal scraping and microscopic examination, and 17 cases were complicated with fungal infection. Clinical characteristics presented： （1） Local ulcer （29/47）： 14 cases were cured by anti-amoeba drug therapy, and 13 patients were healing by conjunctival flap covering. （2） Ring in- filtration （12/47）： 3 cases were cured by anti-amoeba drug therapy, 4 cases were healing by conjunc- tival flap covering, and 3 patients were performed PKP. （3） Diffuse stroma infiltration （6/47）： healing rate was only 50%, especially failed to respond to anti-amoeba drug. Conclusions Southeast China is the high incidence area of acanthamoeba keratitis, and the main risk factor is corneal trauma. Scraping and microscopic examination is an effective method for early diagnosis. There was sig- nificance to chose drug therapy and/or operation based on the clinical characteristics.

关 键 词：棘阿米巴角膜炎 临床特征 诊疗 

分 类 号：R772.21[医药卫生—眼科]