广西棘阿米巴性角膜炎5例临床分析

发布时间：2018-05-17 01:22

本文选题：角膜炎 + 棘阿米巴　；参考：《广西医科大学》2012年硕士论文

【摘要】：目的：探讨棘阿米巴性角膜炎的临床特点、诊治及预后。设计：回顾性病例系列。研究对象：5例（6眼）棘阿米巴性角膜炎患者。方法：回顾性分析2008年11月至2011年4月间明确诊断的5例（6眼）棘阿米巴性角膜炎患者的发病诱因、临床特点、实验室检查，诊治及预后。主要指标:发病诱因、临床特点、诊治及预后。结果：5例确诊病例中，其中3例发病前有“迷眼”——角膜擦伤史，另外两列无明显诱因，但是其中1例患者有梅毒，1例患者年轻时曾有同侧眼溃疡病病史；所有病例均通过角膜刮片镜检或细菌、真菌及棘阿米巴培养确诊；3例表现为典型的基质环形浸润，2例表现为角膜弥漫性炎症浸润，5例均有不同程度前房积脓；治疗上主要采用联合抗棘阿米巴药物及手术治疗，对于混合细菌或（和）真菌感染者联合抗细菌真菌治疗；2例经药物治疗治愈，其中1例继发青光眼，2例我院行角膜穿透移植，其中1例角膜溶解穿孔最终摘除眼球，1例虽控制感染但因无法忍受青光眼行眼内容剜除术，1例经药物治疗好转到外院行穿透性角膜移植治愈。结论：棘阿米巴性角膜炎是严重的致盲性眼病，通过临床及发病特点，借助角膜刮片细胞学及细菌学检查可早期诊断。外伤引起的棘阿米巴性角膜炎易混合细菌或真菌感染，加强预防，综合治疗，，尽量做到早期诊断、早期治疗是提高疗效、减少并发症和致盲的有效方法。
[Abstract]:Objective: to investigate the clinical features, diagnosis, treatment and prognosis of Acanthoamoeba keratitis. Design: retrospective case series. Participants five cases of amoebic keratitis with Acanthoamoeba (6 eyes) were studied. Methods: five cases of Acanthoamoeba keratitis diagnosed between November 2008 and April 2011 were analyzed retrospectively. The predisposing factors, clinical features, laboratory examination, diagnosis, treatment and prognosis were analyzed. Main outcome measures: pathogenesis, clinical features, diagnosis, treatment and prognosis. Results of the 5 confirmed cases, 3 had a history of "lost eye" -cornea scraping before onset, the other two had no obvious inducement, but one patient had syphilis and one patient had a history of ipsilateral ulcerative disease when he was young. All the cases were examined by corneal scraping or bacteria, and 3 cases were diagnosed as typical stromal circular infiltration by fungi and Acanthamoeba culture. 2 cases showed diffuse inflammatory infiltration of cornea. 5 cases had different degrees of anterior chamber pus. Two cases of mixed bacterial or / and fungal infections were cured by drug therapy. One case of secondary glaucoma and 2 cases of secondary glaucoma underwent penetrating keratoplasty in our hospital. One case of corneal perforation was eventually extirpated and 1 case was cured by penetrating keratoplasty because of the control of infection but the enucleation of the eye content because of the intolerable glaucoma. One case was improved by drug therapy to be cured by penetrating keratoplasty. Conclusion: Acanthamoeba keratitis is a serious blinding ophthalmopathy. It can be diagnosed early by means of corneal scraper cytology and bacteriological examination. Acanthamoeba keratitis caused by trauma is easy to mix bacterial or fungal infection, strengthen prevention, comprehensive treatment, try to achieve early diagnosis, early treatment is an effective way to improve the efficacy, reduce complications and blindness.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R772.21

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