Acanthamoeba keratitis: Risk factors and outcome
Acanthamoeba keratitis: Risk factors and outcome
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DOI：
10.1136/bjo.79.12.1078
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发表时间：
1995-12-01
影响因子：
4.1
通讯作者：
Easty, DL
中科院分区：
文献类型：
--
作者：
Illingworth, CD;Cook, SD;Easty, DL
目的/背景本研究旨在探讨棘阿米巴角膜炎的危险因素和预后。方法：对1985年至1995年2月在布里斯托尔眼科医院就诊的22例患者（23只眼）的治疗结果进行研究。还获得了有关隐形眼镜使用和消毒的细节。另外两名患者在布里斯托尔就诊，但主要在其他地方接受治疗，他们只接受了隐形眼镜相关信息的调查。结果：棘阿米巴角膜炎的发病率在20世纪90年代显著上升，1990年以前发病3例，1990年1月至1995年2月发病21例。自1994年1月以来已有11例患者出现。本系列患者均为隐形眼镜佩戴者，其中16例（67%）日常佩戴一次性隐形眼镜。22例患者有隐形眼镜消毒资料，其中11例（50%）使用含氯消毒剂。其他类型的消毒就不那么常见了。4例患者（18%）未使用消毒剂。在这一系列的研究过程中，平均诊断延迟明显下降，尽管77%的患者在首次出现时诊断为病毒性角膜炎，最常见的是单纯疱疹。除3例外，其余均用聚六亚甲基双胍和异硫代丙脒联合治疗。9/23眼（39%）行穿透性角膜移植术；所有这些眼睛的诊断都延迟了至少6周。治疗后，除一只眼外，其余眼的视力均达到6/9或以上，其中18只眼（78%）达到6/6或以上。结论：早期诊断棘阿米巴角膜炎可获得良好的视觉效果，经药物治疗可治愈。
Aims/Background-This study was initiated to investigate risk factors for and outcome of Acanthamoeba keratitis.Methods-Results of treatment were studied in 22 patients (23 eyes) presenting to Bristol Eye Hospital between 1985 and February 1995. Details related to the use and disinfection of contact lenses were also obtained. An additional two patients who were seen at Bristol but mainly treated elsewhere were surveyed for contact lens related information only.Results-The incidence of Acanthamoeba keratitis rose substantially in the 1990s: three patients presented before 1990, while the remaining 21 presented between January 1990 and February 1995. Eleven patients have presented since January 1994. All of the patients in this series were contact lens wearers, 16 (67%) using daily wear disposable contact lenses. Contact lens disinfection data were available in 22 patients of whom 11 (50%) were using chlorine disinfectant. Other types of disinfection were much less common. Four patients (18%) had not used any disinfectant. During the course of the series the average diagnostic delay has fallen markedly, although in 77% of patients a diagnosis of a viral keratitis, most commonly herpes simplex, was made on first presentation. All but three of the series were treated with a combination of poly-hexamethylene biguanide and propamidine isethionate. Penetrating keratoplasty was performed in 9/23 eyes (39%); in all of these eyes diagnosis was delayed for at least 6 weeks. All but one of the eyes in the series achieved a visual acuity of 6/9 or better after treatment, and 18 eyes (78%) saw 6/6 or better.Conclusions-Most patients with Acanthamoeba keratitis can now expect a good visual result and cure by medical therapy atone is favoured by early diagnosis.