NEJM看图识病(230) 绿巨人的眼睛-棘阿米巴角膜炎

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A 41-year-old woman presented to the ophthalmology clinic with a 2-month history of intermittent pain, blurry vision, and sensitivity to light in her left eye. She wore monthly disposable soft contact lenses that she kept in her eyes while swimming and showering. The patient had difficulty keeping her left eye open during the physical examination, which revealed redness of the conjunctiva. The visual acuity was 20/20 in the right eye and 20/200 in the left eye. A large, ring-shaped infiltrate was present in the left eye, along with corneal haze and an overlying epithelial defect, which showed uptake of fluorescein dye. 

41岁女性因间歇性左眼疼痛、视物模糊、光过敏2月就诊眼科。患者平时戴月抛隐形眼镜，游泳及洗澡时也不摘下。

检查眼睛时患者无法保持左眼睁开状态，结膜充血。左眼视力明显下降。左眼可见一巨大环状浸润，伴角膜混浊及上皮缺损，缺损处荧光染色呈绿色状。

Cultures from corneal scrapings grew Acanthamoeba polyphaga.

角膜刮片培养出棘阿米巴

She received a diagnosis of acanthamoeba keratitis, a vision-threatening infection most commonly associated with contact lens wear. 

患者诊断为棘阿米巴滋养体角膜炎，一种有失明威胁的感染，常与不恰当配戴隐形眼镜相关。

The patient was treated with topical polihexanide and propamidine isethionate.

予外用羟乙磺酸丙氧苯脒，polihexanide 

Although the infection resolved, the vision in her left eye was not restored, owing to a dense, central corneal scar and cataract. 

经用药后感染缓解，视力未能恢复，角膜中央形成致密疤痕及白内障。

Twelve months after the initial presentation, the patient underwent deep anterior lamellar keratoplasty, which resulted in a postoperative visual acuity of 20/80 and no discomfort in her left eye.

12个月后，患者接受了深层前角膜成形术，视力有所恢复，左眼无遗留明显不适。