眼弓蛔虫病临床特征及治疗预后分析

Clinical characteristics and treatment prognosis of ocular toxocariasis

目的观察眼弓蛔虫病(OT)患者的临床特征和治疗预后。方法回顾性临床研究。2018年3月至2021年9月于郑州大学第一附属医院眼科检查确诊的OT患者40例40只眼纳入研究。所有患眼均行最佳矫正视力(BCVA)、扫描激光检眼镜(SLO)检查。同时行彩色多普勒超声血流成像(CDFI)、荧光素眼底血管造影(FFA)、光相干断层扫描(OCT)检查分别为25、26、26只眼。40例患者中,男性23例(57.5%,23/40),女性17例(42.5%,17/40);均为单眼发病。年龄<18岁者30例(75.0%,30/40),年龄(9.60±0.60)岁;≥18岁者10例(25.0%,10/40),年龄(34.60±4.52)岁。长住农村地区33例(82.5%,33/40);有犬、猫接触史27例(67.5%,27/40)。40只眼中,周边肉芽肿型(周边型)、后极部肉芽肿型(后极型)、类似眼内炎的玻璃体混浊型(混浊型)、混合型,分别为18(45.0%,18/40)、11(27.5%,11/40)、6(15.0%,6/40)、5(12.5%,5/40)只眼。所有患者明确诊断后均接受药物和(或)手术治疗。周边型、后极型、混合型28只眼,给予手术、药物治疗分别为17、11只眼;混浊型5只眼,仅给予药物治疗。40例患者中,33例患者参与随访;治疗后随访时间(18.78±9.44)个月。观察患眼BCVA改善情况。治疗前后不同BCVA眼数比较行χ^(2)或Fisher's检验。结果首诊时,患眼BCVA光感~0.6,其中BCVA<0.1、0.1~0.3、>0.3者分别为20、13、7只眼。晶状体后玻璃体前界膜增厚24只眼(60.0%,24/40),玻璃体分层样混浊27只眼(67.5%,27/40),周边部/后极部肉芽肿22只眼(55.0%,22/40)。行CDFI检查的25只眼中,玻璃体可见特征性分层样或弥漫性混浊14只眼(56.0%,14/25)。行FFA检查的26只眼中,视网膜毛细血管“羊齿蕨样”渗漏15只眼(57.7%,15/26),病灶处片状无灌注区。行OCT检查的26只眼中,视网膜前膜、黄斑囊样水肿、玻璃体视网膜牵拉分别为8(30.8%,8/26)、5(19.2%,5/26)、2(7.7%,2/26)只眼。末次随访时,与治疗前比较,混浊型5只眼BCVA提高,差异有统计学意义(P<0.05)。周边型、后极型、混合型28只眼中,行手术治疗的17只眼,BCVA提高,差异有统计学意义(χ^(2)=6.258,P<0.05);仅行药物治疗的11只眼,BCVA不变,差异无统计学意义(χ^(2)=0.594,P>0.05)。结论OT患者以儿童多见;视网膜肉芽肿、晶状体后灰白色增生膜或玻璃体分层样混浊具体一定特征性;OT主要通过糖皮质激素类药物和玻璃体切割手术进行治疗。

Objective To observe the clinical characteristics and treatment prognosis of patients with ocular toxocariasis(OT).Methods A retrospective clinical trial.From March 2018 to September 2021,40 eyes of 40 OT patients diagnosed by ophthalmic examination in the First Affiliated Hospital of Zhengzhou University were included in the study.All patients underwent best corrected visual acuity(BCVA)and scanning laser ophthalmoscope(SLO)examination.Color Doppler ultrasound flow imaging(CDFI),fluorescein fundus angiography(FFA)and optical coherence tomography(OCT)were performed in 25,26 and 26 eyes,respectively.Among the 40 patients,there were 23 males(57.5%,23/40)and 17 females(42.5%,17/40).All patients were monocular.Thirty patients(75.0%,30/40)were younger than 18 years old,with the mean age of(9.60±0.60)years.Ten patients(25.0%,10/40)were great than or equal to 18 years old,with the mean age of(34.60±4.52)years.Thirty-three patients(82.5%,33/40)lived in rural areas for a long time.There were 27 patients(67.5%,27/40)with a history of contact with dogs and cats.In 40 eyes,peripheral granuloma(peripheral type),posterior pole granuloma(posterior pole type),vitreous opacity similar to endophthalmitis(turbid type)and hybrid type were 18(45.0%,18/40),11(27.5%,11/40),6(15.0%,6/40)ang 5(12.5%,5/40),respectively.All patients were treated with drugs and/or surgery after definite diagnosis.There were 28 eyes of peripheral type,posterior pole type and hybrid type,17 eyes were treated with surgery and 11 eyes with drug treatment,respectively.Five eyes with turbid type were only treated with drugs.In 40 patients,33 patients participated in follow-up.The follow-up time after treatment was(18.78±9.44)months.The improvement of BCVA was observed.The number of eyes with different BCVA before and after treatment was compared byχ2 test or Fisher's test.Results At the first visit,the BCVA ranged from light perception to 0.6,including 20 eyes with BCVA<0.1,13 eyes with BCVA 0.1-0.3,and 7 eyes with BCVA>0.3.The posterior vitreous anterior limiting membrane was thickened in 24 eyes(60.0%,24/40).There were 27 eyes(67.5%,27/40)with lamellar vitreous opacity and 22 eyes(55.0%,22/40)with peripheral/posterior pole granulomas.Among 25 eyes examined by CDFI,14 eyes(56.0%,14/25)showed characteristic stratified or diffuse opacity in vitreous body.Of the 26 eyes examined by FFA,15 eyes(57.7%,15/26)had"fern-like"leakage of retinal capillaries,and the lesion had a patchy non-perfused area.In 26 eyes examined by OCT,epiretinal membrane,cystoid macular edema and vitreoretinal traction were 8(30.8%,8/26),5(19.2%,5/26)and 2(7.7%,2/26)eyes,respectively.At the last follow-up,compared with before treatment,the BCVA of 5 eyes with turbid type increased,and the difference was statistically significant(P<0.05).In 28 eyes with peripheral type,posterior pole type and hybrid type,17 eyes with surgical treatment improved BCVA,and the difference was statistically significant(χ2=6.258,P<0.05).In 11 eyes only treated with drugs,BCVA remained unchanged,and the difference was not statistically significant(χ2=0.594,P>0.05).Conclusions OT patients are mostly children;retinal granulomas,gray-white hyperplastic membrane behind lens or vitreous stratified opacity are specific characteristics.OT is mainly treated by glucocorticoid drugs and vitrectomy.