Akantamyobny keratit — the inflammatory disease of a cornea caused to protozoa — akantameby. This type of a keratit is characteristic of the people using contact correction. Arises at the wrong care of lenses. Is it is long the current disease, is more often from the failure. Patients show complaints to severe pain in eyes, a photophobia, decrease in visual acuity. Pathology is diagnosed by means of a method of a biomikroskopiiya, a pakhimetriya, a keratometriya and microbiological researches. Treatment is conservative, by means of eye drops; in hard cases surgical intervention is necessary.
Akantamyobny keratit - it is chronic, the proceeding infectious disease of a cornea caused by a sort Acanthamoeba amoeba and which is shown severe damages of eyes is long. In works on ophthalmology it is for the first time described in 1974. Considering big progress in development of branch of the contact lenses (CL) for the last decades, many people began to use them as the correction method giving excellent sight. Against the background of it also the complications connected with the wrong care of C began to arise more often. Akantamyobny keratit remains to the most serious of them. Meets at men more often, than at women. The age of developing of a disease fluctuates from 20 to 40 years. Meets in the developed countries the frequency of 1,5-2 cases at 1 million users of contact lenses.
Reasons of an akantamyobny keratit
Activators — free living amoebas of the sorts Acanthamoeba (A. culherisom, A. castellanii, A. polyphaga and A. astronyxis) and Hartmanelta. Live in the soil, standing reservoirs, swimming pools, sewer pipes, in tap water. The amoeba exists in the form of two forms – trofozoit (an active form) and cisthat (inactive). In a tsistny form it is capable it is long to keep viability, it is steady against temperature drops, radiation, the chlorinated water in pools. Under favorable conditions cisthat is capable to turn into the trofozoita producing various enzymes which help an amoeba to get into body tissues of the person.
Normal the person has steady resistance to introduction tsist of an amoeba in an organism. Infection comes at the slightest injuries in a cornea, a thicket from carrying C. Damage of eyes develops after bathing in the polluted reservoir or the pool, when washing C tap water. The activator takes root into cornea fabrics, causing inflammatory reaction and starting the subsequent changes.
Also treat risk factors of development of an akantamyobny keratit a syndrome of "a dry eye" (plaintive liquid is necessary for maintenance of local immunity in eyes, at a shortcoming there is an easing to influence of various microbic agents); diabetes (leads to the smaller resilience of an organism to infections); earlier undergone surgeries in the eyes (long restoration of integrity of a protective layer of a cornea).
Classification of an akantamyobny keratit
Depending on changes in a cornea allocate 4 stages of an akantamyobny keratit.
1st stage: superficial epitelialny keratit. On a cornea in the central or paracentral area there is a roundish site of limited epitelialny hypostasis.
2nd stage: Superficial epitelialny dot keratit. Intensity of turbidity increases. Infiltration of a cornea is more expressed, small speakers whitish or grayish epitelialny small knots appear. There are noticeable nervous trunks in Strom of a cornea (radial keratonevrit). There is a considerable pain syndrome.
3rd stage: Stromalny ring keratit. The consuming of an akantamyobama of an epitelialny cover of a cornea is followed by inflammatory reaction in blankets of its stroma. Turbidity of a cornea accrues and extends due to infiltration and hypostasis of a stroma. Keratit gets a ring-shaped form. Easy Irit is observed.
4th stage: Ulcer akantamebny keratit. Destruction of a stroma of a cornea accrues and the superficial ulcer of a cornea is formed more often; arise Irit, iridotsiklit, a hypopeony, it is rare - sklerit, it is frequent - secondary glaucoma, a cataract. The cornea perforation is possible.
Symptoms of an akantamyobny keratit
Akantamyobny keratit can be shown both on one eye, and on both at once. The long chronic course of a disease is characteristic. In initial stages of an akantamyobny keratit of the patient shows complaints to unpleasant feelings under an upper eyelid, feeling of a foreign matter, slight irritation of an eye, small decrease in visual acuity.
In process of progressing of a disease visual acuity continues to decrease, considerable reddening of an eyeball joins, there are periodic eye pains. The inflammation of a cornea is followed blefarospazmy, dacryagogue and a photophobia. In final stages of a disease of the patient constant most severe pains in eyeballs disturb, visual acuity is sharply reduced to a svetooshchushcheniye, or sight completely is absent. From complications of an akantamyobny keratit note development of an iridotsiklit, sklerit, secondary glaucoma and the most terrible complication – a perforation (perforation) of a cornea.
Diagnostics of an akantamyobny keratit
For diagnostics of an akantamyobny keratit the main method is the eye biomicroscopy which is carried out by means of a slot-hole lamp. The ophthalmologist visually determines depth of damage of a cornea (at initial stages dot epitelialny erosion are defined, swelled an epithelium; at the started stages of an akantamyobny keratit folds of a destsementovy cover are visualized, swelled cornea stroma, formation of an ulcer).
At specification of the diagnosis of an akantamyobny keratit use additional methods of diagnostics, such as pakhimetriya (measurement of thickness of a cornea), keratometriya (measurement of curvature of a cornea), microbiological researches (coloring or crops of scrape from a cornea on special nutrient medium).
Treatment of an akantamyobny keratit
Akantamyobny keratit rather hard gives in to treatment. Conservative therapy consists of local application of eye drops, treatment duration not less than 6 weeks. The following groups of medicines are at the same time used: antiseptics (, ), antifungal (, ), antibacterial (, ), corticosteroids. At a pain syndrome inside appoint analgetics. Instillations of midriatik, and also medicines of an artificial tear are applied. At aggravation a state connect intravenous administration of antifungal medicines.
Resort to surgical techniques when developing an ulcer of a cornea. Use methods of a medical and tectonic keratoplasty autoskleralny rags, a layer-by-layer superficial keratoplasty with application of a conjunctival rag, through keratoplasty.
Prevention of an akantamyobny keratit
Prevention of an akantamyobny keratit comes down to the correct care of contact lenses. Use of special solutions is necessary for their storage and leaving, observance of terms of carrying, it is ideal to use one-day lenses. Before removal or putting on of C more careful washing of hands is required. It is recommended not to take a hot bath with C, it is desirable to remove them before acceptance of a shower or visit of a sauna. It is necessary to give rest to eyes at night, to delete C before withdrawal to a dream. Doctors recommend to change a case for lenses each 3 months. Visit of the ophthalmologist is obligatory point of prevention of an akantamyobny keratit, it is necessary to do it time in 4-5 months, regardless of existence of complaints.