本文選題：角膜炎 + 棘阿米巴�。� 參考：《廣西醫(yī)科大學》2012年碩士論文

【摘要】：目的：探討棘阿米巴性角膜炎的臨床特點、診治及預后。 設計：回顧性病例系列。 研究對象：5例（6眼）棘阿米巴性角膜炎患者。 方法：回顧性分析2008年11月至2011年4月間明確診斷的5例（6眼）棘阿米巴性角膜炎患者的發(fā)病誘因、臨床特點、實驗室檢查，診治及預后。 主要指標:發(fā)病誘因、臨床特點、診治及預后。 結果：5例確診病例中，其中3例發(fā)病前有“迷眼”——角膜擦傷史，另外兩列無明顯誘因，但是其中1例患者有梅毒，1例患者年輕時曾有同側眼潰瘍病病史；所有病例均通過角膜刮片鏡檢或細菌、真菌及棘阿米巴培養(yǎng)確診；3例表現為典型的基質環(huán)形浸潤，2例表現為角膜彌漫性炎癥浸潤，5例均有不同程度前房積膿；治療上主要采用聯合抗棘阿米巴藥物及手術治療，對于混合細菌或（和）真菌感染者聯合抗細菌真菌治療；2例經藥物治療治愈，其中1例繼發(fā)青光眼，2例我院行角膜穿透移植，其中1例角膜溶解穿孔最終摘除眼球，1例雖控制感染但因無法忍受青光眼行眼內容剜除術，1例經藥物治療好轉到外院行穿透性角膜移植治愈。 結論：棘阿米巴性角膜炎是嚴重的致盲性眼病，通過臨床及發(fā)病特點，借助角膜刮片細胞學及細菌學檢查可早期診斷。外傷引起的棘阿米巴性角膜炎易混合細菌或真菌感染，加強預防，綜合治療，，盡量做到早期診斷、早期治療是提高療效、減少并發(fā)癥和致盲的有效方法。
[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.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R772.21

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