吊顶灯辅助下25G微创玻璃体切割手术治疗眼弓蛔虫病的疗效

目的:探讨吊顶灯辅助下25G微创玻璃体切割手术治疗眼弓蛔虫病(OT)的疗效,并分析术后并发症。方法:回顾性系列病例研究。选择2014年12月至2019年2月在徐州市立医院眼科确诊为OT的患者27例(27眼)。所有患者经过1~2个月的全身或局部皮质类固醇治疗后接受了25G微创玻璃体切割手术,避开周边病灶区放置灌注管和吊顶灯,切除玻璃体及牵拉条索,根据术中视网膜情况予激光光凝、气液交换、玻璃体腔填充空气或C3F8或硅油,部分联合晶状体摘除、环扎术。分析患者的临床特征、光学相干断层扫描(OCT)、眼底照相检查、治疗情况和术后并发症等,计算术后随访期内葡萄膜炎复发率和一次性视网膜解剖复位率。对手术前与末次随访最佳矫正视力(BCVA)进行 t检验分析。 结果:27例患者中周边部肉芽肿型11眼,后极部肉芽肿型11眼,眼内炎型5眼。伴视网膜前膜(ERM)23眼;伴牵拉性视网膜脱离(TRD)13眼,其中TRD合并ERM 11眼,单纯TRD 2眼。术后随访6~44(17.6±11.0)个月。术后早期低眼压4眼(15%),高眼压1眼(4%)。伴TRD的13眼中11眼经一次手术即实现解剖复位,一次性视网膜复位率为85%;伴ERM的23眼中术后复发2眼(9%);术后视网膜脱离2眼(7%),术后并发白内障3眼(11%)。27眼中有4眼(15%)于术后1~5个月炎症复发,其中1眼经再次手术后炎症消退,另外3眼予全身及局部皮质类固醇治疗2个月内炎症得到控制。术前及术后末次随访BCVA(logMAR)分别为1.46±0.66、1.13±0.66,术后视力较术前明显提高,差异有统计学意义( t=4.009, P<0.001)。 结论:吊顶灯辅助下25G微创玻璃体切割手术治疗眼弓蛔虫病可有效控制葡萄膜炎症,获得较满意的疗效。

Efficacy of 25G Minimally Invasive Vitrectomy Assisted by Chandelier Illumination in the Treatment of Ocular Toxocariasis

Objective: To investigate the efficacy of 25G minimally invasive vitrectomy assisted by chandelier illumination in the treatment of ocular toxocariasis (OT), and to analyze the postoperative complications. Methods: This was a retrospective case series study. Twenty-seven patients (27 eyes) who were diagnosed with ocular toxocariasis in Xuzhou Municipal Hospital from December 2014 to February 2019 were included in the study. All patients underwent 25G minimally invasive vitrectomy assisted by chandelier illumination after systemic and local corticosteroid treatment for 1-2 months. The perfusion tube and chandelier illumination were placed away from the peripheral lesions and the vitreous and drawstring were removed. Laser photocoagulation, gas-liquid exchange, or filling the vitreous cavity with air, C3F8 or silicone oil were performed during the operation according to the retinal condition. Some of the procedures were combined with lens extraction and/or scleral buckling. Clinical features, optical coherence tomography and fundus photography examinations were analyzed as well as treatment conditions and postoperative complications. The recurrence rate of uveitis and the one-time anatomical retinal reduction rate during the postoperative follow-up period were calculated. Data were analyzed by a t test. Results: Among the 27 patients, 11 eyes had peripheral granuloma, 11 eyes had posterior granuloma and 5 eyes had endophthalmitis. Thirteen eyes underwent vitrectomy for tractional retinal detachment (TRD), 23 eyes for epiretinal membrane (ERM), and 11 eyes for TRD combined with ERM. Postoperative followup was conducted for 6-44 months (17.6±11.0). Four eyes (15%) had low intraocular pressure in the early postoperative period and 1 eye (4%) had high intraocular pressure in the late postoperative period. Anatomical reduction was achieved in 11 of the 13 eyes with TRD after a single operation, and the onetime retinal reduction rate was 85%. ERM recurred in 2 of 23 eyes (9%). Retinal detachment occurred after surgery in 2 of 15 TRD eyes (15%), and 3 eyes had cataract after surgery (11%). In the 27 eyes, 4 eyes (15%) had recurrent inflammation 1-5 months after the operation. In one eye, inflammation disappeared after the second operation. In the other 3 eyes, the inflammation was controlled within 2 months after systemic and local corticosteroid treatment. The best corrected visual acuities (logMAR) preoperatively and at the last postoperative follow-up were 1.46±0.66 and 1.13±0.66. Postoperative visual acuity improved compared to preoperative visual acuity (t=4.009, P<0.001). Conclusions: 25G minimally invasive vitrectomy assisted by chandelier illumination can effectively control uveal inflammation and a relatively satisfactory curative effect can be achieved.