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題 名 | Acanthamoeba Keratitis Presenting as Dendritic Keratitis in a Soft Contact Lens Wearer=隱形眼鏡配戴者感染以樹枝狀角膜炎為表現之棘狀阿米巴角膜炎 |
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作 者 | 楊曄; 黃朝銘; 蔡瑞芳; | 書刊名 | 長庚醫學 |
卷 期 | 25:3 2002.03[民91.03] |
頁 次 | 頁201-206 |
分類號 | 416.711 |
關鍵詞 | 棘狀阿米巴角膜炎; 類固醇; 樹枝狀角膜炎; Acanthamoeba keratitis; Corticosteroid; Dendritic keratitis; Metronidazole; |
語 文 | 英文(English) |
中文摘要 | 棘狀阿米巴角膜炎是一種罕見但可以造成嚴重視力影響之角膜感染。一位37歲女性軟式隱形眼鏡配戴者主訴左眼劇烈疼痛,與表徵不成正比。裂隙燈檢查可見樹枝狀角膜炎、放射狀角膜神經炎及細微之角膜內皮沉積物。經由鋪滿大腸桿菌之非營養性培養皿培養出許多棘狀阿米巴原蟲。病患住院治療包括使用局部的neomycin-polymyxin B及metronidazole(0.5%)眼藥水、口服ketoconazole及後期口服類固醇後,角膜感染獲得了良好的控制。在經過21個月之追蹤後,未見有復發之跡象,而病患之最佳矯正視力可以達到0.9。棘狀阿米巴角膜炎可以有類似泡疹感染之樹枝狀角膜炎表現,並可能因此延誤治療。早期診斷及適當治療是恢復視力及避免最終需要角膜全層移植術的最關鍵方法。 |
英文摘要 | Acanthamoeba keratitis is a rare cause of corneal infection in Taiwan, which can result in devastating visual outcomes. A 37-year-old woman, who wore soft contact lenses, suffered from severe pain in her left eye. Biomicroscopy revealed dendritic keratitis, radial keratoneuritis, and fine keratic precipitates on her cornea. Culture, using non-nutrient agar plate seceded with Escherichia coli, resulted in heavy growth of Acanthamoeba. The inpatient treatment, including topical neomycin-polymyxin B and metronidazole (0.5%) eyedrops, oral ketoconazole, and then oral prednisolone, successfully controlled the corneal infection. The best-corrected visual acuity was 0.9 without any evidence of recurrence of infection after 21 months of follow up. Acanthamoeba keratitis can present as dendritic keratitis, which mimics herpes simplex infection, thus, delays appropriate treatment. Early diagnosis and indicious treatment are essential for restoring the vision and avoiding the subsequent need of penetrating keratoplasy. |
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