Acanthamoeba keratitis, a vision-threatening disease, is caused by a free-living amoeba of genus Acanthamoeba. Amoeba is widely distributed all around the world. Several cases of Acanthamoeba keratitis have been repor...Acanthamoeba keratitis, a vision-threatening disease, is caused by a free-living amoeba of genus Acanthamoeba. Amoeba is widely distributed all around the world. Several cases of Acanthamoeba keratitis have been reported from the Middle East and Iran as well. The infection is mainly caused by inappropriate use of contact lens;therefore, it is more common among lens wearers. The number of reported cases worldwide is increasing annually due to the increasing number of contact lens wearers for medical or cosmetic reasons. It is known that early diagnosis and treatment can reduce consequent damages, while the delay in these processes will deteriorate the vision. Nowadays contact lens wearing, surgery and use of corticosteroids are known to predispose to Acanthamoeba keratitis, and it was also believed that trauma was the main cause. Increasing public knowledge about Acanthamoeba infection, inquiring the history of patients, clinical signs and laboratory findings can be helpful to early diagnosis and better treatment. Regardless of the increasing knowledge of diagnosis and treatment, this disease is still a challenge. Considering the long curative time, and insufficient efficacy of available treatments, it seems that the prevention is more important than the treatment. This review aimed to explain Acanthamoeba keratitis in the Middle East and Iran from the aspects of epidemiology, diagnosis, and therapeutic treatment.展开更多
Background Fungal keratitis is a rare but serious corneal disease that may result in loss of vision. The poor prognosis might be due to limited treatment option. This study aimed to evaluate the clinical efficacy of 0...Background Fungal keratitis is a rare but serious corneal disease that may result in loss of vision. The poor prognosis might be due to limited treatment option. This study aimed to evaluate the clinical efficacy of 0.25% terbinafine eye drops comparing with 5% natamycin suspension on fungal keratitis. Methods A retrospective clinical trial was performed on 90 patients presenting with direct smear and/or culture positive fungal keratitis at Beijing Tongren Hospital, Beijing, China from January 2006 to May 2008. Corneal ulcers were categorized as mild or severe. Forty-five patients were treated with topical terbinafine and the next 45 cases received topical natamycin hourly. Results Filamentous fungi were found in corneal scrapings among all 90 cases. Fungal cultures were positive in 64 patients （71%）. Species of Fusarium and Aspergillus were the principal isolates. Forty （89%） patients showed favorable response to terbinafine, while forty-two （93%） patients exhibited favorable response to natamycin （P 〉0.05）. The mean course of treatment was significantly showed in the terbinafine treatment group than natamycin group （（26.5±11.2） days versus （19.3±6.4） days; P 〈0.05）. In terbinafine group, twenty patients with ulcers smaller than 4 mm had favorable outcome, while 20 of 25 patients with ulcers more than 4 mm in diameter had favorable response （P 〈0.05）. Twenty-seven patients with depth of infiltration less than half of stroma thickness had favorable response to terbinafine, while 13 of 18 patients with depth of infiltration more than half of stroma responded to terbinafine. This difference was statistically significant （P 〈0.05）. Conclusions Our findings suggest that topical terbinafine is an effective antifungal drug for the management of filamentous mycotic keratitis, particularly in cases with smaller and shallower ulcers. Its mean duration of treatment was longer than natamycin.展开更多
目的系统评价不同抗真菌药物治疗真菌性角膜炎(FK)的有效性及安全性。方法采用网状meta分析方法,检索PubMed、Cochrane Library、Embase、Web of Science共4个数据库,检索时限为建库至2023年3月16日。由2名研究者遵循纳入和排除标准筛...目的系统评价不同抗真菌药物治疗真菌性角膜炎(FK)的有效性及安全性。方法采用网状meta分析方法,检索PubMed、Cochrane Library、Embase、Web of Science共4个数据库,检索时限为建库至2023年3月16日。由2名研究者遵循纳入和排除标准筛选随机对照试验(RCT)研究文献,完成质量评估和信息提取。采用Review Manager 5.4偏移风险评估工具进行文献质量评估,采用Stata 14.0软件对不同抗真菌药物治疗FK的治愈率、治愈时间、治疗前后视力变化及安全性进行网状meta分析。结果最终纳入14项RCT研究,共1681例患者。网状meta分析显示,在治愈率方面,0.2%洗必泰滴眼液、5%那他霉素+伏立康唑(口服)较其他药物显示出更好的疗效,累计排序曲线下面积(SUCRA)为86.1%和63.3%,且1%伏立康唑滴眼液治愈率低于0.2%洗必泰滴眼液、5%那他霉素滴眼液+伏立康唑(口服)、0.05%洗必泰滴眼液、0.1%洗必泰滴眼液、5%那他霉素滴眼液+酮康唑(口服)、5%那他霉素滴眼液,差异均有统计学意义(均P<0.05);1%伏立康唑滴眼液、5%那他霉素+伏立康唑(口服)在治愈时间方面表现最好(SUCRA=66.9%、55.7%);5%那他霉素滴眼液、1%伏立康唑滴眼液和伏立康唑口服三联治疗在改善视力和安全性方面优于其他药物(SUCRA分别为74.8%、79.7%)。在安全性方面,5%那他霉素滴眼液优于1%伏立康唑滴眼液和0.2%洗必泰滴眼液,差异均有统计学意义(均P<0.05)。此外,此次分析可能存在潜在的发表偏倚。结论0.2%洗必泰滴眼液、1%伏立康唑滴眼液在FK治疗中具有较好的疗效,5%那他霉素滴眼液、1%伏立康唑滴眼液和伏立康唑口服三联治疗对FK患者具有较好的视力改善率及安全性。展开更多
文摘Acanthamoeba keratitis, a vision-threatening disease, is caused by a free-living amoeba of genus Acanthamoeba. Amoeba is widely distributed all around the world. Several cases of Acanthamoeba keratitis have been reported from the Middle East and Iran as well. The infection is mainly caused by inappropriate use of contact lens;therefore, it is more common among lens wearers. The number of reported cases worldwide is increasing annually due to the increasing number of contact lens wearers for medical or cosmetic reasons. It is known that early diagnosis and treatment can reduce consequent damages, while the delay in these processes will deteriorate the vision. Nowadays contact lens wearing, surgery and use of corticosteroids are known to predispose to Acanthamoeba keratitis, and it was also believed that trauma was the main cause. Increasing public knowledge about Acanthamoeba infection, inquiring the history of patients, clinical signs and laboratory findings can be helpful to early diagnosis and better treatment. Regardless of the increasing knowledge of diagnosis and treatment, this disease is still a challenge. Considering the long curative time, and insufficient efficacy of available treatments, it seems that the prevention is more important than the treatment. This review aimed to explain Acanthamoeba keratitis in the Middle East and Iran from the aspects of epidemiology, diagnosis, and therapeutic treatment.
文摘Background Fungal keratitis is a rare but serious corneal disease that may result in loss of vision. The poor prognosis might be due to limited treatment option. This study aimed to evaluate the clinical efficacy of 0.25% terbinafine eye drops comparing with 5% natamycin suspension on fungal keratitis. Methods A retrospective clinical trial was performed on 90 patients presenting with direct smear and/or culture positive fungal keratitis at Beijing Tongren Hospital, Beijing, China from January 2006 to May 2008. Corneal ulcers were categorized as mild or severe. Forty-five patients were treated with topical terbinafine and the next 45 cases received topical natamycin hourly. Results Filamentous fungi were found in corneal scrapings among all 90 cases. Fungal cultures were positive in 64 patients （71%）. Species of Fusarium and Aspergillus were the principal isolates. Forty （89%） patients showed favorable response to terbinafine, while forty-two （93%） patients exhibited favorable response to natamycin （P 〉0.05）. The mean course of treatment was significantly showed in the terbinafine treatment group than natamycin group （（26.5±11.2） days versus （19.3±6.4） days; P 〈0.05）. In terbinafine group, twenty patients with ulcers smaller than 4 mm had favorable outcome, while 20 of 25 patients with ulcers more than 4 mm in diameter had favorable response （P 〈0.05）. Twenty-seven patients with depth of infiltration less than half of stroma thickness had favorable response to terbinafine, while 13 of 18 patients with depth of infiltration more than half of stroma responded to terbinafine. This difference was statistically significant （P 〈0.05）. Conclusions Our findings suggest that topical terbinafine is an effective antifungal drug for the management of filamentous mycotic keratitis, particularly in cases with smaller and shallower ulcers. Its mean duration of treatment was longer than natamycin.
