Abstract：
OBJECTIVE: The purpose of this paper is to report the increasing incidence of contact-lens related Acanthamoeba keratitis (AK) in a tertiary ophthalmology department in Umbria, central Italy.
METHODS: Observational and retrospective case series were carried out. A total of nine eyes with a diagnosis of AK were examined. All patients underwent a full slit lamp examination, in vivo confocal microscopy (IVCM) and corneal scraping. The IVCM was repeated at one and two-week and at one, three and six-month intervals. Samples of domestic tap water were also examined for PCR analysis. Patients were treated with levofloxacin0,5%, Polyhexamethylene biguanide 0.02%, and Propamidine Isetionate0,1%.
RESULTS: All patients were contact lens wearers. The average patient age was 27.75 (range 18-45), with three men and five women. The main clinical features were ciliary congestion, diffuse epitheliopathy with punctuated keratitis, multiple, small sub-epithelial, greyish, corneal infiltrates with epithelial defect, pseudodendritic corneal lesions, perineural infiltrates, corneal stromal cellularity, and stromal infiltrates. IVCM was indicative of Acanthamoeba in seven out of the nine eyes. All the positive IVCM images were section images showing double walled, bright-spot cysts with a clear chain-like arrangement of five or more cysts identified in three of the patients. PCR analysis of the water was negative in all cases.
CONCLUSIONS: Although PCR is the most common method used, the increased incidence of AK could mainly be related to a proper IVCM interpretation. A broad-spectrum antibiotic, such as levofloxacin might play a role in the early treatment of AK reducing the virulence of the amoeba.
METHODS: Observational and retrospective case series were carried out. A total of nine eyes with a diagnosis of AK were examined. All patients underwent a full slit lamp examination, in vivo confocal microscopy (IVCM) and corneal scraping. The IVCM was repeated at one and two-week and at one, three and six-month intervals. Samples of domestic tap water were also examined for PCR analysis. Patients were treated with levofloxacin0,5%, Polyhexamethylene biguanide 0.02%, and Propamidine Isetionate0,1%.
RESULTS: All patients were contact lens wearers. The average patient age was 27.75 (range 18-45), with three men and five women. The main clinical features were ciliary congestion, diffuse epitheliopathy with punctuated keratitis, multiple, small sub-epithelial, greyish, corneal infiltrates with epithelial defect, pseudodendritic corneal lesions, perineural infiltrates, corneal stromal cellularity, and stromal infiltrates. IVCM was indicative of Acanthamoeba in seven out of the nine eyes. All the positive IVCM images were section images showing double walled, bright-spot cysts with a clear chain-like arrangement of five or more cysts identified in three of the patients. PCR analysis of the water was negative in all cases.
CONCLUSIONS: Although PCR is the most common method used, the increased incidence of AK could mainly be related to a proper IVCM interpretation. A broad-spectrum antibiotic, such as levofloxacin might play a role in the early treatment of AK reducing the virulence of the amoeba.
摘要：
目的：本文的目的是报告与接触镜相关的棘阿米巴角膜炎（AK）在翁布里亚的三级眼科中的发病率增加，意大利中部。
方法：进行观察性和回顾性病例系列。检查了总共9只诊断为AK的眼睛。所有患者都接受了全裂隙灯检查,体内共聚焦显微镜（IVCM）和角膜刮擦。IVCM在一周和两周以及一周重复，三个月和六个月的间隔。还检查了家用自来水的样品用于PCR分析。患者接受左氧氟沙星治疗0.5%，聚六亚甲基双胍0.02%,和丙脒浓度0.1％。
结果：所有患者均为隐形眼镜配戴者。患者平均年龄为27.75（范围18-45），三个男人和五个女人。主要临床特征为睫状充血,弥漫性上皮病伴点状角膜炎，多个,小上皮下，灰色,角膜浸润伴上皮缺损，假树突状角膜病变，神经周浸润,角膜基质细胞，和基质浸润。IVCM表明9只眼睛中有7只存在棘阿米巴。所有阳性IVCM图像都是显示双壁的切片图像，亮点囊肿，在三名患者中发现五个或更多囊肿呈清晰的链状排列。在所有情况下，水的PCR分析均为阴性。
结论：尽管PCR是最常用的方法，AK发病率的增加可能主要与正确的IVCM解释有关.广谱抗生素,如左氧氟沙星可能在AK的早期治疗中发挥作用，降低阿米巴的毒力。
方法：进行观察性和回顾性病例系列。检查了总共9只诊断为AK的眼睛。所有患者都接受了全裂隙灯检查,体内共聚焦显微镜（IVCM）和角膜刮擦。IVCM在一周和两周以及一周重复，三个月和六个月的间隔。还检查了家用自来水的样品用于PCR分析。患者接受左氧氟沙星治疗0.5%，聚六亚甲基双胍0.02%,和丙脒浓度0.1％。
结果：所有患者均为隐形眼镜配戴者。患者平均年龄为27.75（范围18-45），三个男人和五个女人。主要临床特征为睫状充血,弥漫性上皮病伴点状角膜炎，多个,小上皮下，灰色,角膜浸润伴上皮缺损，假树突状角膜病变，神经周浸润,角膜基质细胞，和基质浸润。IVCM表明9只眼睛中有7只存在棘阿米巴。所有阳性IVCM图像都是显示双壁的切片图像，亮点囊肿，在三名患者中发现五个或更多囊肿呈清晰的链状排列。在所有情况下，水的PCR分析均为阴性。
结论：尽管PCR是最常用的方法，AK发病率的增加可能主要与正确的IVCM解释有关.广谱抗生素,如左氧氟沙星可能在AK的早期治疗中发挥作用，降低阿米巴的毒力。
