Serratia Marcescens Corneal Ulcer-Complications of Orthokeratology-A Case Report

Serratia marcescens角膜潰瘍－○rtho-K引起之併發症―病例報告

鄺冬梅(Tung-Mei Kuang) ； 陳克華(Ko-Hwa Chen) ； 葉則祥(Tse-Hsiang Yeh) ； 吳志翹(Chih-Chiau Wu) ； 李淑美(Shui-Mei Lee) ； 許紋銘(Wen-Ming Hsu) ； 劉榮宏(Jorn-Hon Liu)

《中華民國眼科醫學會雜誌》 39卷3期 (2000/09) Pp. 282-285

https://doi.org/10.30048/ACTASOS.200009.0010

摘要

Orthokeratology (Ortho-K)被認為可以治療近視，希望病人最終可以每天或隔天晚上戴一到二小時之維持鏡片，則可擁有整天良好的裸視視力。但是Ortho-K之效果不確定，而且有較高的感染機率，值得我們注意。
本文報告一例接受Ortho-K治療之九歲小孩，每晚戴上治療鏡片至隔天早上。暑假期間他從美國回來台灣時，突然覺得右眼疼痛，因此到診所求助，醫師給予抗生素治療，但是病情惡化，因此轉介至本院作進一步診治。初診時右眼視力為十公分處可辨手動，左眼視力為零點伍。右眼結膜紅腫，角膜中心處有潰瘍。前房蓄膿。住院後病人接受了細菌培養以及隱形眼鏡保存液培養等檢查。病人接受右眼每小時一次Ciloxan以及一天三次1% Atropine的治療。由於個人因素，病人於住院一天後要求出院，改為門診追蹤。出院後兩天病人仍有角膜破皮及浸潤的情形。隱形眼鏡保存液培養為Serratia marcescens，一週後角膜結疤情況穩定，病人於是回美國求學。

並列摘要

Orthokeratology is the technique of using rigid contact lenses to cause progressive flattening of the cornea to induce reduction in myopia and astigmatism. It is hoped that, ultimately, lens wearing time can be reduced to the minimum required to attain good functional vision throughout the day. However, orthokeratology suffers from lack of predictability and poses patients at great risk of infection.
A 9-year old boy was under orthokeratology protocol for 6 months in USA. He was wearing hard contact lens overnight on daily basis. Painful right eye was noted when he came back to Taiwan for his summer vacation. His visual acuity was HM/10cm, CD and 6/12, OS on his first visit to our hospital. The conjunctiva of his right eye was severely congested and corneal edema with abscess on the center was noted. Corneal debridement, conjunctival swab, corneal scraping and cultures were performed. Contact lens storing solution was also sent for culture. Ciloxan, q1h OD day and night, 1% atropine tid CD were given. Culture of contact lens storing solution revealed Serratia marcescens which was sensitive to Ciloxan. Central scarring of cornea was noted. He was then returned to USA under stable condition. Patients who receive orthokeratology therapy must be followed carefully and instructed to contact their ophthalmologists whenever problems occur.

並列關鍵字

Orthokeratology ； Serratia marcescens ； corneal ulcer ； complications