PDF(Pubmed)
Abstract：
OBJECTIVE: Acanthamoeba chorioretinitis is a rare manifestation of the parasitic infection, and reported cases often result in enucleation. Surgical removal of Acanthamoeba chorioretinitis has not been previously described. We report a surgical case of Acanthamoeba chorioretinitis spread from keratitis that ultimately resulted in a disease-free outcome.
METHODS: A healthy 80-year-old male with a history of keratoconus requiring a penetrating keratoplasty in the fellow eye presented with a severe corneal ulcer clinically consistent with Acanthamoeba keratitis. He ultimately required a penetrating keratoplasty and improved clinically until he developed vitritis on post-operative month 1 and was diagnosed with endophthalmitis. B-scan ultrasound demonstrated vitreous opacities and a large retinal mass that reduced in size following serial intravitreal injections of antibiotics, oral antibiotics, and a limited pars plana vitrectomy. He underwent a repeat pars plana vitrectomy 6 weeks later and a retinal mass in the mid-periphery with an associated tractional retinal detachment was noted. A localized retinectomy was performed around the lesion which was excised entirely, and silicone oil was instilled. Pathology of the lesion showed acute and chronic granulomatous necrotizing inflammation with the presence of several definitive amoebic organisms and numerous cells suspicious for amoebae. The patient was maintained on oral antibiotics by the Infectious Disease Service and was disease-free 1-year post-infection.
CONCLUSIONS: Acanthamoeba chorioretinitis is a rare, devastating disease and often leads to enucleation. We present a surgical case showing control of the infection utilizing a surgical retinectomy. Aggressive local therapy and a multidisciplinary approach with the Infectious Disease Service may lead to a successful outcome.
METHODS: A healthy 80-year-old male with a history of keratoconus requiring a penetrating keratoplasty in the fellow eye presented with a severe corneal ulcer clinically consistent with Acanthamoeba keratitis. He ultimately required a penetrating keratoplasty and improved clinically until he developed vitritis on post-operative month 1 and was diagnosed with endophthalmitis. B-scan ultrasound demonstrated vitreous opacities and a large retinal mass that reduced in size following serial intravitreal injections of antibiotics, oral antibiotics, and a limited pars plana vitrectomy. He underwent a repeat pars plana vitrectomy 6 weeks later and a retinal mass in the mid-periphery with an associated tractional retinal detachment was noted. A localized retinectomy was performed around the lesion which was excised entirely, and silicone oil was instilled. Pathology of the lesion showed acute and chronic granulomatous necrotizing inflammation with the presence of several definitive amoebic organisms and numerous cells suspicious for amoebae. The patient was maintained on oral antibiotics by the Infectious Disease Service and was disease-free 1-year post-infection.
CONCLUSIONS: Acanthamoeba chorioretinitis is a rare, devastating disease and often leads to enucleation. We present a surgical case showing control of the infection utilizing a surgical retinectomy. Aggressive local therapy and a multidisciplinary approach with the Infectious Disease Service may lead to a successful outcome.
摘要：
目的：棘阿米巴脉络膜视网膜炎是寄生虫感染的一种罕见表现，报告的病例通常会导致眼球摘除。先前尚未描述过棘阿米巴脉络膜视网膜炎的手术切除。我们报告了一例由角膜炎传播的棘阿米巴脉络膜视网膜炎的手术病例，最终导致无病结局。
方法：一名健康的80岁男性，有圆锥角膜病史，需要行穿透性角膜移植术，表现为严重的角膜溃疡，临床上符合棘阿米巴角膜炎。他最终需要进行穿透性角膜移植术，并在临床上有所改善，直到术后1个月出现玻璃体炎并被诊断为眼内炎。B扫描超声显示玻璃体混浊和大视网膜肿块，在连续玻璃体内注射抗生素后，口服抗生素,和有限的玻璃体切割术。6周后，他再次接受了平坦部玻璃体切除术，并注意到中周边有视网膜肿块，并伴有牵拉性视网膜脱离。在完全切除的病灶周围进行局部视网膜切除术，并滴入硅油。病变的病理显示急性和慢性肉芽肿性坏死性炎症，存在几种确定的阿米巴生物和许多可疑的变形虫细胞。该患者由传染病服务处维持口服抗生素，感染后1年无病。
结论：棘阿米巴脉络膜视网膜炎是一种罕见的，毁灭性的疾病，往往导致摘除。我们介绍了一个手术病例，显示通过手术视网膜切除术控制了感染。积极的局部治疗和传染病服务的多学科方法可能会导致成功的结果。
方法：一名健康的80岁男性，有圆锥角膜病史，需要行穿透性角膜移植术，表现为严重的角膜溃疡，临床上符合棘阿米巴角膜炎。他最终需要进行穿透性角膜移植术，并在临床上有所改善，直到术后1个月出现玻璃体炎并被诊断为眼内炎。B扫描超声显示玻璃体混浊和大视网膜肿块，在连续玻璃体内注射抗生素后，口服抗生素,和有限的玻璃体切割术。6周后，他再次接受了平坦部玻璃体切除术，并注意到中周边有视网膜肿块，并伴有牵拉性视网膜脱离。在完全切除的病灶周围进行局部视网膜切除术，并滴入硅油。病变的病理显示急性和慢性肉芽肿性坏死性炎症，存在几种确定的阿米巴生物和许多可疑的变形虫细胞。该患者由传染病服务处维持口服抗生素，感染后1年无病。
结论：棘阿米巴脉络膜视网膜炎是一种罕见的，毁灭性的疾病，往往导致摘除。我们介绍了一个手术病例，显示通过手术视网膜切除术控制了感染。积极的局部治疗和传染病服务的多学科方法可能会导致成功的结果。
