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棘狀阿米巴角膜炎的治療經驗－壹病例報告
Management of Acanthamoeba Keratitis-Report of a Case
摘要
我們藉由病理切片診斷了一例棘狀阿米巴角膜潰瘍的病例。病人雖因延遲診斷呈現嚴重角膜潰瘍穿孔；經治療性角膜移植及以0.5%Flagyl(Metronidazole)及Statrol治療；效果反應良好。0.5%Metronidazole合併Statrol是目前台灣現有有效抗阿米巴的藥物，我們提出用藥的臨床經驗以供參考；並強調必須密集而長期的使用，且注意慢慢地減少劑量。檢驗方面，我們建議使用10%KOH覆蓋角膜取樣，以幫助早期診斷棘狀阿米巴角膜炎。
關鍵字
無資料並列摘要
A thirty-two year-old male patient, without any history of contact lens wearing, presented with ring-formed corneal infiltration. Repeated cultures and smears were negative. He developed progressive corneal ulceration despite empirical antibiotic, antifungal and antiviral therapies. Therapeutic penetrating keratoplasty was then performed for subsequent cornea perforation. Initial pathology report was non-diagnostic. Twenty days postoperatively, arcuate-shaped infiltration was discovered inside the donor-recipient junction with characteristic uninvolvement of recipient cornea. Review of the excised cornea button revealed cyst form of Acanthamoeba. We instituted a combination of topical 0.5% metronidazole (Flagyl), neomycin-polymyxin B (statrol) every one hour alternatively and oral ketaconazole. After the infection came under control, topical corticosteroid was added as adjuvant therapy. The keratitis subsided markedly with our regimen within three weeks. However, it recurred and rapidly progressed due to rapid tapering of medication. The patient underwent another penetrating keratoplasty for corneal perforation one month later. Postoperatively, there was no further evidence of recurrence under the prolonged and intensive medication. The only complication was mild cataract. 0.5% Flagyl, avilable in our country, is an effective antiamoebic drug; moreover, its prolonged use and slow tapering could not be overemphasized. In addition, we suggest the use of 10% KOH wet mount of corneal ulcer scraping as a method for early diagnosis.