眼弓蛔虫病的诊治进展

眼弓蛔虫病(OT)是因蛔虫科线虫感染眼组织而引起的一种眼寄生虫病,常由犬弓蛔虫或猫弓蛔虫引起。易感人群多与自己的卫生状况、接触猫犬的频率、食用被弓蛔虫幼卵污染的食物或水源有关。目前在全球范围内的报道多见于儿童,但是近几年也陆续有成人感染的病例被报道,可能因目前对其诊断、治疗和预防还缺乏系统的归纳和总结有关。本文通过查阅国内外相关文献,将OT的四种临床表现、先进的无创诊断技术、实验室免疫学检查进行梳理和补充,同时本文介绍了OT近几年的治疗进展,如驱虫药和激素的联合使用,玻璃体腔内注射与玻璃体手术的应用等。希望引起临床医生对本病的重视,提高OT早期诊断的准确性,保护患者视力。     

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。     

眼弓蛔虫病

眼弓蛔虫病主要由犬弓蛔虫、猫弓蛔虫的2期蛔蚴移行至眼部引起。患者多为儿童,常单眼发病。临床主要分为周边肉芽肿型、后极部肉芽肿型、慢性眼内炎型、混合型。活检发现弓蛔虫蛔蚴是诊断眼弓蛔虫病的有力依据,目前主要依靠影像学和免疫学特别是酶联免疫吸附测定法（ELISA）检测血清或眼内液中弓蛔虫特异性抗体进行间接诊断。治疗以减轻炎症反应和防止增生膜形成为主,早期行玻璃体切割手术对诊断和治疗有重要意义。     

眼弓首线虫病一例

眼弓首线虫病(Ocular Toxocriasis)亦称"眼弓蛔虫病",是由犬科动物常见的肠道寄生虫犬弓首线虫侵入人体导致的眼部感染性炎症[1].临床较为少见.现将我们最近诊治的1例报道如下.     

眼弓蛔虫病患者眼内液与血清犬弓蛔虫特异性IgG抗体检测

目的 评价眼内液犬弓蛔虫特异性IgG抗体检测在眼弓蛔虫病诊断中的作用.方法 临床确诊为眼弓蛔虫病的50例患者(眼弓蛔虫病组)、就诊于耳鼻喉科的152例患者(血清对照组)及就诊于眼科的70例其他病患者(眼内液对照组)纳入研究.眼弓蛔虫病组收集房水样本28份,玻璃体液样本22份,血清样本50份;血清对照组收集血清样本152份;眼内液对照组收集房水样本46份,玻璃体液样本24份.采用酶联免疫吸附试验检测所有受检者眼内液及血清中犬弓蛔虫特异性IgG抗体的阳性率.同时对眼弓蛔虫病组患者的血清及眼内液样本进行配对检测,对比分析两者之间的犬弓蛔虫特异性IgG水平的差异.结果 眼弓蛔虫病组血清犬弓蛔虫特异性IgG阳性率为68.00％,U值为20.42±17.01;眼内液犬弓蛔虫特异性IgG阳性率为88.00％,U值为25.72±23.04.血清对照组血清犬弓蛔虫特异性IgG阳性率为2.63％,U值为2.37±2.71;眼弓蛔虫病组患者血清特异性IgG水平较血清对照组明显偏高,差异有统计学意义(Z=8.962,P=0.000).眼内液对照组未见眼内液犬弓蛔虫特异性IgG阳性者,U值为0.69±0.34;眼弓蛔虫病组患者眼内液特异性IgG水平较眼内液对照组明显偏高,差异有统计学意义(Z=8.120,P=0.000).眼弓蛔虫病组50例患者中,血清及眼内液犬弓蛔虫特异性IgG均为阳性者28例,占56.00％;血清犬弓蛔虫特异性IgG阳性,而眼内液犬弓蛔虫特异性IgG阴性者6例,占12.00％;血清犬弓蛔虫特异性IgG阴性,而眼内液犬弓蛔虫特异性IgG阳性者16例,占32.00％.血清与眼内液犬弓蛔虫特异性IgG阳性率比较,差异有统计学意义(x2=4.720,P=0.028).眼弓蛔虫病组患者的血清及眼内液样本配对检测结果显示,32例患者的眼内液犬弓蛔虫特异性IgG水平高于血清样本,占64.00％.结论 眼内液犬弓蛔虫特异性IgG抗体检测相对于血清具有更高的检出率.眼内液与血清犬弓蛔虫特异性IgG抗体的共同检测可能具有更好的诊断价值.     

巩膜切口位置调整下玻璃体切除术治疗眼弓蛔虫病的效果

目的 观察巩膜切口位置调整后玻璃体切除术治疗眼弓蛔虫的临床效果。设计 回顾性病例系列。研究对象 2012年3月至2018年3月北京同仁医院眼科因眼弓蛔虫病行巩膜切口位置调整下玻璃体切除术、随诊≥5个月的患者139例（139眼）。方法 回顾性分析患者病历资料,描述其一般情况,术前行UBM检查,根据术前UBM检查结果或双目间接检眼镜检查结果进行巩膜切口位置调整。描述手术前后视力及局部解剖变化和手术并发症。术后最佳矫正视力较术前提高≥2行者定为视力改善,下降≥2行为视力下降,提高或下降≤1行定为视力稳定。主要指标 手术前后视力和局部解剖变化及手术并发症。结果 139眼眼弓蛔虫患者64眼（46.0%）联合晶状体切除术。平均随访（29±9）个月。末次随访时视力较术前改善者70.2%（85/121）,视力稳定者22.3%（27/121）,视力下降者7.5%（9/121）;69.1%（96/139）的患者术前合并牵拉性视网膜脱离,其中65眼术后视网膜脱离复位或改善;术后1周内22.3%低眼压（31/139）和1个月后13.7％高眼压（19/139）。 结论 巩膜切口位置调整下玻璃体切除术有助于改善眼弓蛔虫病患者视功能和眼局部解剖预后;术前UBM检查可明确周边玻璃体视网膜病变的位置和范围而引导巩膜切口位置调整。     

后葡萄膜炎的临床鉴别诊断

后葡萄膜炎的类型繁多,脉络膜和视网膜的炎症相互影响许多免疫性,感染性炎症和恶性肿瘤坏均可导致脉络膜和视网的病理性损伤,从而使后葡萄膜的临床诊断变得更加复杂。综合相关文献资料,对病因,病史,眼前后段体征以及全身性疾病相关体征的描述和讨论,为不同类型的临床鉴别诊提供参考依据。     

眼弓蛔虫病临床特征及治疗预后分析

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...     

儿童眼犬弓蛔虫病并发白内障1例

资料患儿男性,5岁。因被家长发现右眼瞳孔发白1个月余,于2013年6月17日来我院眼科门诊就诊。患儿3个月前右眼不慎被拉链击中,当即觉眼红、眼痛,后自行缓解,未就医。眼部检查:右眼视力光感(LP)/相似文献   

彩色多普勒血流显像在儿童眼弓蛔虫病诊断中的应用

目的观察儿童眼弓蛔虫病(OT)的彩色多普勒血流显像(CDFI)特征。方法回顾性临床研究。2014年7月至2020年6月于首都医科大学附属北京同仁医院眼科经临床和实验室检测确诊的OT患者61例61只眼纳入研究。其中, 男性45例45只眼, 女性16例16只眼(男∶女=2.81∶1);年龄(6.93±2.50)岁。右眼、左眼分别为29、32只眼。患者双眼均行二维超声、CDFI检查。采用二维超声估测患眼及对侧健康眼眼轴长度(AL), 其中采用光学生物测量仪和(或)A型超声测量AL者52例。超声检查后1周内行玻璃体视网膜手术。应用二维超声观察玻璃体内混浊形态、与眼球壁相连情况、是否发生玻璃体后脱离及视网膜脱离。应用血流显像功能观察病理膜上是否存在血流信号, 统计不同形态玻璃体混浊及牵拉性视网膜脱离的检出率;分析眼内增生性病变所在位置。患眼与对侧健康眼AL比较行配对t检验。对CDFI检查及玻璃体视网膜手术中所见增生性病变位置行Kappa一致性检验。结果所有患眼均存在不同程度玻璃体混浊。其中, 混浊呈典型"圣诞树样"23只眼(37.7%, 23/61);团状及条状回声27只眼(44.3%, 27/...     

The diagnostic significance of immuno-diffusion test in atypical ocular toxocariasis

A case of atypical intra-ocular Toxocara infestation in a 53 year-old Japanese male is described. Characteristic long, linear, subretinal tracts resembling a coiled circle were observed at the posterior pole and in the equatorial region of the fundus. These subretinal coiled tracks may be caused by larval appearance and migration in the subretinal space of the fundus. Immuno-diffusion tests which may aid the diagnosis of ocular Toxocariasis and the implications of infestation are discussed.     

Progress in the diagnosis of ocular sarcoidosis

Sarcoidosis is a multisystem granulomatous inflammation that affects multiple organ systems. The spectrum of extraocular and ocular involvement is wide and may precede systemic involvement. The diagnosis of ocular sarcoidosis relies on a combination of clinical findings, laboratory investigations, and radiographic findings. These include but are not limited to serum angiotensin-converting enzyme (ACE), lysozyme, plain-film radiographs of the chest, computed tomography (CT) scans of the chest, pulmonary function testing, bronchoalveolar lavage, and retinal imaging among others. In this review, we highlight current and evolving systemic investigations and approaches to ophthalmic imaging when considering the diagnosis of ocular sarcoidosis.     

Clinical course of ocular Behçet's disease in siblings

PURPOSE: Familial occurrence has been reported in approximately 8% of Turkish patients with Behçet's disease. Our aim was to compare the clinical course of ocular Behçet's disease among siblings. METHODS: We retrospectively studied five pairs of siblings with ocular involvement of Behçet's disease. No other family member of these siblings had any symptom of Behçet's disease. RESULTS: The siblings comprised three sister-brother pairs, one sister-sister pair, and one brother-brother pair. There was a 5–10-year difference between the age at onset of ocular disease among siblings. Three of the five pairs (two sister-brother, one brother-brother) had a dissimilar course of disease activity. Female siblings had an earlier age at onset and tended to have a worse prognosis than their brothers. CONCLUSIONS: It is generally acknowledged that male sex is associated with a worse prognosis. In this study, however, we observed that, among siblings with a dissimilar course, female patients were more severely affected than male patients. Poor ocular prognosis in a patient does not indicate aggressive treatment in his/her sibling. We believe that each sibling should be managed on an individual basis.     

Differential diagnosis between retinoblastoma and ocular toxocariasis

We studied the sensitivity for Toxocara Canis (ELISA technique) in 5 cases of retinoblastoma confirmed by anatomopathological examination. Some presented with a positive reaction in serum and/or in aqueous. Now that surgical technique are available that permit to functionally save eyes affected by toxocariasis, we felt that a safe and reliable differential diagnosis between toxocariasis and retinoblastoma is of major importance. A positive ELISA test even in the aqueous fluid does'nt seem reliable enough for that purpose. We concluded to the necessity to include in preoperative tests some more invasive techniques such as aqueous tap for dosage of lactico-dehydrogenases or vitreous biopsy for cytological examination, at least for the most difficult cases with a positive ELISA test.     

Ocular toxocariasis: A presumed case of peripheral granuloma

We report a case of peripheral Toxocara granuloma in a young boy of 17. Of the 3 forms of ocular toxocariasis, macular granuloma, endophthalmitis and peripheral granuloma, the latter is the least common and is characterized by the retention of relatively good vision.A differential diagnosis was performed between an intraocular foreign body encapsulated in fibroglial tissue, toxoplasmic retinochoroiditis, retinoblastoma, intermediate uveitis and toxocariasis.Fluorescein angiography showed not only some neovascularizations at the level of the peripheral granuloma but also manifestations of inflammatory reactions at the level of the posterior pole, i.e. diffuse leakages from retinal capillaries and parietal staining of some venous segments.Among the various laboratory tests, the most significant are eosinophilia, IgE concentration and detection of specific antibodies in serum as well as in aqueous humour.     

ELISA for diagnosis of ocular toxocariasis.

The enzyme-linked immunosorbed assay test was positive in 37 of 41 patients (90%) suspected of having clinical Toxocara infections. The antigen used in this test is prepared from the Toxocara egg and is felt to be extremely specific in making the diagnosis. The prevalence of Toxocara infection is much greater than previously believed. It is hoped that this test will help the surgeon fell more secure in not enucleating eyes containing masses suggestive of Toxocara infection.     

眼内液检查在儿童葡萄膜炎诊断中的应用

目的 探讨眼内液检查在儿童葡萄膜炎诊断中的应用.方法 回顾分析18 例接受前房或玻璃体液检查的儿童葡萄膜炎的临床特征,并结合眼内液检查作出最后诊断.对患者进行了最佳矫正视力、眼压、B超、超声生物显微镜、间接眼底镜以及RetCam数字视网膜照相机检查.对疑为犬弓蛔虫病例做血清和眼内液酶联免疫吸附测定（enzyme-linked immunosorbent assay, ELISA）.结果 最终诊断为眼犬弓蛔虫病的患者有12 例,中间葡萄膜炎的5 例.眼犬弓蛔虫病多单眼发病,玻璃体条索和视网膜肉芽肿是其典型表现,眼内液和（或）血清ELISA 呈阳性,细胞学检查58.3%（7/12）可见嗜酸性细胞.中间葡萄膜炎双眼发病多见,常发生虹膜后粘连、白内障等并发症.结论 犬弓蛔虫病在本地区并不少见,诊断性玻璃体手术切除混浊玻璃体后能更清楚地了解眼底情况,取得眼内液做ELISA和病理检查能最终明确诊断;同时行玻璃体手术也是本病的有效治疗方法.