棘阿米巴性角膜炎误诊病例的回顾性研究

目的：回顾性分析棘阿米巴性角膜炎的临床特点及其误诊原因,方法：对269例临床诊断为单纯疱疹性角膜炎,细菌性角膜炎及不明原因感染性角膜炎患者的穿透性角膜移植术后组织理切片标本进行回顾性研究,寻找漏诊的棘阿米巴性角膜炎病例,并根据其临床资料,组织病理图特点进行分析。结果：重新复查的病理切片中,发现漏诊棘阿米巴性角膜炎5例,误诊单纯疱疹性角膜炎3例,真菌性角膜炎及化脓性角膜炎各1例,棘阿米巴角膜炎的主要症状为角膜基质内环状浸润及放射性神经痛,5例曾行穿透性角膜移植术治疗,其中2例复发后再次行穿透性角膜移植术仍未能控制感染,最终摘除眼球,结论：棘阿米巴性角膜炎仍是我国角膜病致盲的主要原因,确诊后即应采取积极治疗措施。

Retrospective analysis of misdiagnosed amoebic keratitis

Objective To analyze the clinical characteristic of amoebic keratitis and the cause of misdiagnosis retrospectively Methods Corneal pathological sections of 269 cases having been diagnosed as herpes simplex keratitis (HSK), bacterial keratitis and other microbial keratitis and then undergone penetrating keratoplasty (PKP) were reexamined to find the misdiagnosed cases of amoebic keratitis The clinical characteristic efficacy of treatment and cause of misdiagnosis were retrospectively analyzed according to case history and photographs Results Based on the pathological examination, 5 cases of amoebic keratitis were recognized which had been misdiagnosed, including HSK in 3 cases, fungal keratitis in 1 case and suppurative keratitis in 1 case previously The main clinical characteristics were severe radiating neuralgia and ring shaped stromal infiltrates After PKP, infection of 3 cases were controlled, 2 cases were recurrent and underwent eyeball enucleation eventually Conclusion The incidence of amoebic keratitis is not very low in China It is necessary to pay high attention to this kind of disease, and its early and definite diagnosis is very important for the prevention of serious results