国际眼科纵览 ›› 2026, Vol. 50 ›› Issue (1): 22-28.doi: 10.3760/cma.i.cn115500-20251203-26104

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微孢子虫角膜炎的病原学、危险因素与诊断治疗

蒋涵宇  姜洋  李莹  孙旭光   

  1. 1 中国医学科学院北京协和医院眼科,北京 100730;2 中国医学科学院北京协和医学院临床医学专业(八年制),北京 100730;3 首都医科大学附属北京同仁医院 北京同仁眼科中心 眼科学与视觉科学北京市重点实验室,北京 100730
  • 收稿日期:2025-12-03 出版日期:2026-02-22 发布日期:2026-02-22
  • 通讯作者: 孙旭光,Email: sunxg1955@163.com

Microsporidial keratitis: pathogenesis, risk factors, diagnosis, and treatment

Jiang Hanyu1,2, Jiang Yang1, Li Ying1, and Sun Xuguang   

  1. 1Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China; 2Eight-Year Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; 3 Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100730, China
  • Received:2025-12-03 Online:2026-02-22 Published:2026-02-22
  • Contact: Sun Xuguang, Email: sunxg1955@163.com

摘要: 微孢子虫角膜炎是由微孢子虫感染引起的一种感染性角膜病变。其临床表现缺乏特异性,常与Thygeson浅层点状角膜炎、病毒性或真菌性角膜炎等混淆,误诊、漏诊率较高。该病在免疫功能正常与免疫抑制人群中均可发生,主要危险因素包括泥土或污水接触、饲养宠物、佩戴隐形眼镜及局部使用糖皮质激素等。本病主要分为两种类型:具有自限性倾向、预后良好的微孢子虫角结膜炎,以及病情顽固、常需角膜移植手术、预后较差的微孢子虫角膜基质炎。诊断主要依靠角膜刮片染色、聚合酶链式反应等实验室检查。治疗可试用局部氟喹诺酮类药物,微孢子虫角膜基质炎对传统抗感染药物反应差,烟曲霉素滴眼液可能成为有潜力的新疗法。提高对该病的认识、实现早期诊断与合理治疗,对改善患者预后具有重要意义。

关键词: 微孢子虫, 微孢子虫角结膜炎, 微孢子虫角膜基质炎

Abstract: Microsporidial keratitis is an infectious corneal disease caused by microsporidial infection. Its clinical manifestations are non-specific and often resemble conditions such as Thygeson's superficial punctate keratitis, viral keratitis, or fungal keratitis, leading to high rates of misdiagnosis and underdiagnosis. The disease can occur in both immunocompetent and immunocompromised individuals. Major risk factors include exposure to soil or contaminated water, pet ownership, contact lens wear, and the use of topical corticosteroids.Based on clinical features, the disease is primarily classified into two types: microsporidial keratoconjunctivitis, which tends to be self-limiting with a favorable prognosis, and microsporidial stromal keratitis, which is more refractory, often requires corneal transplantation surgery, and carries a poorer prognosis. Diagnosis relies mainly on laboratory tests such as corneal scraping stains and polymerase chain reaction (PCR). Regarding treatment, topical fluoroquinolones may be tried for microsporidial keratoconjunctivitis, while microsporidial stromal keratitis responds poorly to traditional anti-infective agents. Topical fumagillin eye drops could represent a promising new therapeutic approach. Enhancing awareness of this disease, achieving early diagnosis, and implementing appropriate treatment are crucial for improving patient outcomes.

Key words: Microsporidia, Microsporidial keratoconjunctivitis, Microsporidial stromal keratitis