The role of topical corticosteroids in the management of Acanthamoeba keratitis
The role of topical corticosteroids in the management of Acanthamoeba keratitis
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DOI：
10.1097/00003226-199705000-00004
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发表时间：
1997-05-01
期刊：
影响因子：
2.8
通讯作者：
Holland, EJ
中科院分区：
文献类型：
--
作者：
Park, DH;Palay, DA;Holland, EJ
目的.阐明外用皮质类固醇在阿米巴角膜炎治疗中的作用。方法：对38例阿米巴角膜炎患者的临床资料进行回顾性分析。结果：在单独药物治疗后，症状发作1个月内确诊的患者治愈的可能性增加（p = 0.02），视力达到20/60或更好（p < 0.01）。在任何时间接受局部皮质类固醇治疗的19例患者中，14例（73.7%）在单独抗阿米巴治疗后治愈，而5例（26.3%）患者因持续感染（n = 3）或穿孔（n = 2）需要穿透性角膜移植术。平均抗阿米巴治疗持续时间（不包括角膜移植术后的持续时间，如适用）为38.5周。17例患者中，13例（76.5%）接受抗阿米巴治疗，未使用局部皮质类固醇，药物治愈，而4例（23.5%）因持续感染（n = 2）或穿孔（n = 2）需要穿透性角膜移植术。平均抗阿米巴治疗时间为20周。虽然类固醇治疗组的平均抗阿米巴治疗持续时间显著长于非类固醇治疗组（p = 0.02），但两组药物治疗后的结局无显著差异。结论.局部皮质类固醇与阿米巴角膜炎患者的药物治疗失败率无关。相反，不良结局与诊断延迟显著相关。因此，在对镇痛药无反应的重度疼痛或重度角膜或前房炎症患者中谨慎使用皮质类固醇似乎是合理的。
Purpose. To clarify the role of topical corticosteroids in the management of Acanthamoeba keratitis. Methods, The records of 38 patients diagnosed with Acanthamoeba keratitis at three institutions were retrospectively reviewed. Results, After medical therapy alone, patients diagnosed within 1 month of symptom onset had an increased likelihood of being cured (p = 0.02) and attaining visual acuity of 20/60 or better (p < 0.01). Fourteen (73.7%) of 19 patients treated with topical corticosteroids at any time were cured after antiamoebal therapy alone, whereas five (26.3%) patients required penetrating keratoplasty for either persistent infection (n = 3) or perforation (n = 2). The mean antiamoebal therapy duration, excluding duration after keratoplasty if applicable, was 38.5 weeks. Thirteen (76.5%) of 17 patients treated with antiamoebal therapy without topical corticosteroids were medically cured, whereas four (23.5%) required penetrating keratoplasty for either persistent infection (n = 2) or perforation(n = 2). The mean antiamoebal therapy duration was 20 weeks. Although the mean antiamoebal therapy duration in the steroid-treated group was significantly longer than that in the non-steroid-treated group (p = 0.02), outcome after medical therapy between the groups was not significantly different. Conclusions. Topical corticosteroids were not associated with a higher rate of medical treatment failure in patients with Acanthamoeba keratitis. Rather, poor outcome was significantly related to diagnostic delays. Therefore prudent use of corticosteroids in selected patients with severe pain not responsive to analgesics or severe corneal or anterior chamber inflammation appears justified.