基质环形浸润性棘阿米巴角膜炎的治疗与分期初探

Acanthamoeba keratitis with ring-shaped stromal infiltration

目的探讨有角膜环形基质浸润病变的棘阿米巴角膜炎的临床分期、治疗及预后。方法对17例(17眼)有角膜环形基质浸润病变的棘阿米巴角膜炎或合并真菌感染病例作了回顾性研究,根据角膜环形基质浸润的病程、环宽、浸润深浅、色泽分为早期和晚期,然后分别给予相应的药物和手术治疗。结果早期者8眼,药物治愈5眼,手术成功2眼,手术失败1眼;晚期者9眼,药物治愈2眼,手术成功5眼,手术失败2眼。结论早期诊断、正确分期及应用有效的药物治疗和选择适当的术式是成功治疗有环形基质浸润病变的棘阿米巴角膜炎的关键。

Objective Acanthamoeba keratitis,a severe corneal infective disease,is often caused by free-living amoeba Acanthamoeba. Ring-shaped stromal infiltrate is one of the distinguished clinical characteristics in Acanthamoeba keratitis. This study was to discuss the clinical progress,treatment,and prognosis of Acanthamoeba keratitis with ring-shaped stromal infiltration. Methods Seventeen eyes of 17 cases of Acanthamoeba keratitis with or without fungal infection were studied retrospectively. According to the onset time,size,depth and color of the lesion, ring-shaped stromal infiltrates were divided into two stages ： early stage of lesion and late stage of one, and these lesions were managed by either medicine or surgery. Results In the early stage group （8 eyes） ,5 eyes got recovery by regents and 2 eyes by surgery,but 1 eye was not responded to the treatment. In the late stage group （9 eyes） , 2 eyes were recovered by pharmaceutical administration and the other 5 eyes by operation. No enough effectiveness was observed on the rest 2 eyes. Conclusion An early diagnosis,distinguishing stages correctly,administrating effective agents and selecting appropriate surgeries are crucial for the treatment of Acanthamoeba keratitis with ring-shaped stromal infiltration.