微孢子虫角膜炎临床诊治研究进展

Advances in clinical diagnosis and treatment of microsporidial keratitis

微孢子虫是一种单细胞、真核微生物, 可感染眼部, 引起微孢子虫角膜炎(MK)。MK一般表现为微孢子虫角结膜炎(MKC)或基质性角膜炎(MSK)。MKC通常可自愈, 但有时会进展为影响视力的MSK, 严重时可导致角膜穿孔。流行病学数据显示, MK在东南亚地区较为常见, 雨季发病率较高。诊断包括角膜刮片的微生物学检查、PCR及影像技术如前节光学相干层析成像术和活体共聚焦显微镜。治疗方式多样, MKC通常需要局部和全身药物治疗, 而MSK可能需要更密集的干预措施, 包括角膜移植。在中国, MK的病例报道较少见, 医生对其临床表现、诊断和治疗尚缺乏认识, 导致该病常被漏诊、误诊或过度治疗。本综述旨在总结MK的流行病学、病原学、临床表现、诊断和治疗, 为临床诊疗提供参考。

Microsporidia,a unicellular eukaryotic microorganism,poses a risk of infecting the eyes,precipitating microsporidia keratitis(MK).This condition typically manifests in two forms:microsporidian keratoconjunctivitis(MKC)or stromal keratitis(MSK).While MKC often resolves spontaneously,it can progress to MSK,a vision-threatening condition that,in severe instances,may lead to corneal perforation.Epidemiological studies reveal that MK is prevalent in Southeast Asia,particularly during the rainy season.Diagnosis encompasses a range of methods,including corneal scraping for microbiological analysis,PCR testing,and advanced imaging techniques such as AS-OCT and IVCM.Therapeutic approaches vary,with MKC typically managed through local and systemic drug therapy,while MSK may necessitate more aggressive interventions,including corneal transplantation.In China,MK case reports are scarce,and physicians still grapple with a lack of comprehensive understanding regarding its clinical presentation,diagnostic strategies,and treatment options.This deficit can lead to missed or misdiagnoses,as well as overtreatment.Consequently,this review endeavors to comprehensively outline the epidemiology,etiology,clinical features,diagnostic modalities,and therapeutic interventions for MK,thereby offering valuable insights and guidance for clinical practice.