激光共焦显微镜在棘阿米巴角膜炎诊断及治疗中的初步临床研究

Diagnosis and treatment of acanthamoeba keratitis with confocal laser scaning microscope

目的应用激光共焦显微镜对棘阿米巴性角膜炎镜下特征进行研究，探讨其在该病诊断和治疗中的应用价值。方法应用激光共焦显微镜对拟诊为棘阿米巴性角膜炎患者9例（9只眼）进行观察，分析包囊的形态特点和分布特征；观察药物治疗过程中包囊、炎性细胞及树突细胞的变化情况；同时对每例行角膜刮片和培养，3例术眼行病理检查。结果9例激光共焦显微镜下包囊多于浅中基质层，圆形双壁，边境清晰。7例多见包囊的串珠样分布。角膜环形浸润患者，环形浸润处炎性细胞、树突细胞密度高于中央，包囊分布无明显差异。角膜中央基质浸润患者，病灶中央与周边包囊、炎性细胞及树突细胞密度无明显差异。角膜中央基质浸润患者镜下病灶区早期以树突细胞及炎性细胞为主。抗棘阿米巴药物治疗1个月后，树突细胞略有下降，炎性细胞及包囊密度下降显著，包囊散在分布。2个月后查见少量炎性细胞及树突细胞，包囊极少查见。4例角膜刮片阳性，6例培养阳性。3例病理阳性。结论激光共焦显微镜下棘阿米巴包囊多呈串珠样分布。观察药物治疗过程中包囊、炎性细胞和树突细胞的变化情况，可指导临床用药。

Objective To study the characteristics of the acanthamoeba keratitis, and to evaluate the value of confocal laser scanning microscope in the diagnosis and treatment. Methods The morphological characteristics and distribution were observed by confocal laser scanning microscope in 9 patients with acanthamoeba keratitis. The changes of acanthamoeba cysts, inflammatory cells and dendritic cells in the course of anti-acanthamoeba drug treatment were observed. Each patient had comeal scraping inspection and culture, 3 patients had corneal pathological examination. Results Typical acanthamoeba cysts of 9 eyes were found in the superficial stroma or in the stroma with circular double-wall and well defined. Cysts distributed bead-like structure in 7 eyes. The patient had corneal ring infiltrates with more inflammatory cells and dendritic cells in the ring infiltrates than the cen- tral, but had no significant difference in the distribution of the central cysts. The patient had central corneal infiltrates with the same distribution of cysts, inflammatory cells and dendritic cells, and the main were inflammatory cells and dendritic cells at the early stage. After 1 month anti-Acanthamoe- ba drugs, a slight decline in dendritic cells, density of inflammatory cells and cysts was significantly decreased. After 2 months only a small amount of dendritic cells and inflammatory cells, the cysts rarely were detected. The number of positive result in corneal scrapping; in culture and pathological examination were 4, 6 and 3. Conclusions The acanthamoeba cyst has a typical form of beaded distribution in the confocal laser scanning microscope. It will be a guide in the anti-acanthamoeba treatment with the changes of the acanthamoeba cysts, inflammatory cells and dendritic cells.