角膜结膜及泪器病             2342                                      PO0327

　　Diagnosis and management of actinomycete keratitis.

　　Xiaotang Yin , Shiyun Luo, Ran Li, Zhiqun Wang , Shijing Deng, Xiuying Jin, Xuguang Sun

　　北京市眼科研究所 100005

　　Objective: To present the risk factors, clinical characteristics, laboratory results, and outcome of treatment in 5 patients with actinomycete keratitis.

　　METHODS: The clinical and microbiologic data of 5 culture-proven cases of actinomycete keratitis were analyzed. RESULTS: Of the 5 cases presented in this study, 4 cases were caused by Nocardia and one was by actinomycete with isolations identification. All were seen in males with a mean age of 57. A definite history of minor trauma was present in the four cases of Nocardia keratitis as a predominant risk factor, while the actinomycete keratitis was followed by the HSK with a 2- month – management of steroid. For Nocardia infection, patchy stromal infiltrates were seen in the 1/3 to 2/3 depth of stroma with wreath pattern of infiltration. The diagnosis of all cases was based on laboratory investigations including smear and culture. A combination of morphologic and chemotaxonomic methods was subjected to the genus and species identification.   A variable drug sensitivities were presented in nocardia isolates, while actinomycete is invariably sensitive to penicilin. Conclusion: Nocardia keratitis is mainly followed by a minor trauma, and is characteristic by a refractory corneal ulcer with a wreath pattern of infiltrate. It is identified predominantly by laboratory investigations. The drug sensitivity of nocardia isolates is variable.  Sulfonamides and amicasin are the first line drugs with levofloxacin and gentamicin as the second choice. For the late-stage keratitis, the drugs in combination with debridement and amnionic     transplantation could be an effective alternative.

　　CONCLUSION: Minor trauma is the main risk factor for farmers.  The diagnosis is made mainly based on laboratory investigations. Actinomycete isolates are not sensitive to the commonly used antibiotics. Tropical and systemically sensitive biotic are the initial choice, while debridement and amnionic  transplantation could be an effective alternative.

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