Treatment of Acanthamoeba Keratitis Combined With Fungal Infection With Polyhexamethylene Biguanide

以Polyhexamethylene Biguanide 治療棘狀阿米巴角膜炎合併黴菌性感染

田世豪(Shih-Hao Tien) ； 許明木(Min-Muh Sheu)

《The Kaohsiung Journal of Medical Sciences》 15卷11期 (1999/11) Pp. 665-673

https://doi.org/10.6452/KJMS.199911.0665

摘要

從1996年7月至1997年3月間，我們診斷出三例棘狀阿米巴角膜潰瘍合併黴菌性感染。此三病例之診斷樣本取得分別經由角膜刮除，角膜層狀切除，以及前房探取術取得。診斷是經由抹片染色亦或病理報告結果而確定。此三例皆接受Polyhexamethylene Biguanide ( PHMB ) 0.02 %，Fluconazole，以及Anegyn 眼藥水治療。當感染被有效控制並無擴散時，我們為病患進行治療性角膜移植。術後同樣以上述藥水點眼，逐漸減少點藥次數並持續一至兩個月後，皆獲得良好結果。最後此三例之最佳矯正視力除第一例因移植角膜排斥為僅見眼前手動外，另兩例分別馮20 / 100 及20 / 20。此三例皆無回歸感染。我們認為依據抹片染色結果早期診斷並立即給予PHMB 和抗黴菌眼藥水，可有效治療棘狀阿米巴角膜潰瘍合併黴菌性感染。

並列摘要

From July 1996 to March 1997, three cases of Acanthamoeba keratitis combined with fungal infection were diagnosed and treated at our ophthalmic department. Specimens from all of these cases were obtained by cornea! scraping, keratectomy and anterior chamber paracentesis. The diagnosis was confirmed by either the results of smear test or pathology reports. All of these patients received aggressive treatment with polyhexamethylene biguanide (P11MB) 0.02 %, fluconazole, and anegyn eye drops. After the infection had been controlled without extension, therapeutic penetrating keratoplasty was performed on all of these patients despite the existence of infiltration beyond the edge of the graft. Postoperatively, eye drops were tapered gradually, and treatment was continued for 1 to 2 months. All three cases achieved good results and there was no recurrence of infection. Two cases had visual acuity of 20/100 and 20/20, while the other one perceived hand movement only due to later graft rejection. These cases suggest that early diagnosis and immediate use of P11MB and anti-fungal agents are effective in the treatment of Acanthamoeba keratitis combined with fungal infection.

並列關鍵字

Acanthamoeda keratitis ； keratomycosis ； polyhexamethylene biguanide