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。     

眼弓蛔虫病

眼弓蛔虫病是由犬弓蛔虫的蚴侵入眼部各组织所引起,文献已有许多病例报告。一般认为是一种儿童病,但也可以有各年龄组患者。本病遍布全世界。诊断试验虽有多种,直到近年才获得一定的成就。治疗方面更有很多值得探讨。本文复习本病历史,介绍眼弓蛔虫病的目前情况、分布、病理生理、免疫病理学以及诊断和治疗。     

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.     

感染性葡萄膜炎的诊治观察

目的探讨感染性葡萄膜炎的临床特点及诊治疗效。方法回顾分析2011年8月至2016年9月在十堰市太和医院眼科诊断为感染性葡萄膜炎并接受住院治疗患者的病例资料。结果 18例(19只眼)感染性葡萄膜炎患者,其中急性视网膜坏死综合征8例、弓形虫性葡萄膜炎3例、弓蛔虫性葡萄膜炎1例、弓蛔虫合并弓形虫性葡萄膜炎1例及结核性葡萄膜炎5例。8例急性视网膜坏死综合征分别经过药物治疗或药物联合手术治疗,仅2例患者视力有轻度提高,余病情稳定,但视力无改善。1例弓形虫性葡萄膜炎因延误治疗导致视力降为光感/眼前,另外2例弓形虫性葡萄膜炎患者经过治疗后视力均得到了提高。1例弓蛔虫性葡萄膜炎经过药物治疗后行玻璃体手术,视力由0.5提高到0.6;1例弓蛔虫合并弓形虫性葡萄膜炎经过对症治疗后视力由0.1提高到0.15。结核性葡萄膜炎患者经过抗结核等对症治疗后病情稳定,视力均有不同程度的提高。结论弓形虫、弓蛔虫及结核性葡萄膜炎通常经过正确及时的治疗后,病情稳定,视力有改善。急性视网膜坏死综合征患者通常病情较重,预后相对较差。     

单眼牵引性视网膜脱离患儿房水与血清中犬弓蛔虫抗体的检测

目的　检测单眼牵引性视网膜脱离患儿房水与血清中犬弓蛔虫特异性IgG抗体,探究单眼牵引性视网膜脱离患儿眼弓蛔虫病的发病率。方法　选取2015-2017年就诊于上海新华医院眼科单眼牵引性视网膜脱离的患儿42例为研究对象（试验组）,另取20例确诊患者为阳性对照。收集血清及患侧房水样本,用ELISA试剂盒检测所有样本中犬弓蛔虫特异性IgG抗体。比较试验组与对照组抗体效价的差异,同时比较试验阳性组与阴性组临床资料的差异,并计算血清特异性抗体检测在诊断眼弓蛔虫病中的灵敏度及特异度。结果　42例患儿中有25例（59.5%）是由眼弓蛔虫病导致的牵引性视网膜脱离,25例患儿与另外17例相比,性别比例、年龄分布、临床表现均无特异性改变。表现为牵引性视网膜脱离的眼弓蛔虫病与阳性对照组相比,血清阳性率和房水效价值均无明显差异。血清检测诊断眼弓蛔虫病的灵敏度为76.0%,特异度为88.2%。结论　单眼牵引性视网膜脱离患儿中,眼弓蛔虫病所致的牵引性视网膜脱离患儿占59.5%,单从临床表现无法区分,房水特异性IgG抗体检测可确诊。     

棘阿米巴角膜炎

棘阿米巴角膜炎系棘阿米巴属原虫感染引起的顽固性、进行性角膜炎，它常与戴角膜接触镜有关，近年来国外不断有所报道，我国近几年戴角膜接触镜的人数逐年增多，并发现由于戴角膜接触镜而引发的棘阿米巴角膜炎，因此引起眼科学界的广泛重视。本文就棘阿米巴角膜炎的流行病学、临床表现、诊断、鉴别诊断、治疗、预后及预防作一综述。     

眼科免疫基础(二十) 蠕虫性虹膜炎

通常累及眼部的仅仅是盘尾丝虫属和犬弓蛔虫。绦虫中值得注意的是真蚴虫,由于弓蛔虫病主要寄生于网膜,故将在网膜病的章节讨论。盘尾丝虫病旋盘尾丝虫感染的眼部并发症较常见,且被蠕虫形式的微丝蚴所导致,可分别引起前、后葡萄膜炎,却很少累及全葡萄膜。慢性虹膜睫状体炎是盘尾丝虫性角膜结合膜炎的一种相当常见的并发症(Quere et al 1964),并且与前房中微丝蚴的存在有关,微丝蚴进入房水的方式和通道未明,但有人提出直接穿透角膜(Rodger 1960),或选择性的血性播散(Anderson et al 1974),虹膜和睫状体     

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。     

眼弓蛔虫病诊断与鉴别诊断的临床研究

目的探讨眼弓蛔虫病(OT)诊断与鉴别诊断的方法。 方法收集2016年11月至2021年2月就诊于西安市人民医院(西安市第四医院)眼科，曾在外院误诊的OT患者11例(11只眼)进行研究。其中，男性7例(7只眼)，女性4例(4只眼)；年龄4~47岁，平均年龄(21.4±13.8)岁。采集患者病史，收集临床表现，就诊过程，影像学检查结果，眼内液检测结果。年龄和眼压以 ±s描述。职业、居住地、猫狗接触史、主诉、既往病史、视力、眼部表现、影像学检查结果、眼内液检测结果、诊断及鉴别诊断采用例数(眼数)和百分比进行描述。随访6个月，观察临床诊断是否有修正。 结果11例均为单眼患病。其中，18岁以下者6例(6只眼)，占54.55%(6/11)；18岁以上者5例(5只眼)，占45.45%(5/11)。有玻璃体混浊者11例(11只眼)，占100.00%(11/11)；玻璃体机化分层者7例(7只眼)，占63.64%(7/11)；玻璃体增殖及牵拉性视网膜脱离者4例(4只眼)，占36.36%(4/11)。超声生物显微镜(UBM)检查显示前部玻璃体混浊者4例(4只眼)，占36.36%(4/11)；睫状体后有异常高回声者3例(3只眼)，占27.27%(3/11)，提示周边肉芽肿形成。B型超声检查玻璃体可见异常回声者9例(9只眼)，占81.82%(9/11)。其中，表现为特异性的条索状或带状分层回声者5例(5只眼)，占45.45%(5/11)；表现为点团状回声者4例(4只眼)，占36.36%(4/11)。B型超声显示有牵拉性视网膜脱离者6例(6只眼)，占54.55%(6/11)。荧光素眼底血管造影(FFA)显示视盘着染、荧光素渗漏及视网膜血管显著渗漏者6例(6只眼)，占54.55%(6/11)。其中，表现出视网膜毛细血管"羊齿蕨样"渗漏者3例(3只眼)，占27.27%(3/11)。光学相干断层扫描(OCT)检查结果显示显著黄斑水肿者3例(3只眼)，占27.27%(3/11)。首诊外院误诊为非感染性葡萄膜炎者4例(4只眼)，占36.36%(4/11)；陈旧性视网膜脱离者2例(2只眼)，占18.18%(2/11)；永存原始玻璃体增生症者2例(2只眼)，占18.18%(2/11)；视网膜母细胞瘤者1例(1只眼)，占9.09%(1/11)；黄斑水肿者1例(1只眼)，占9.09%(1/9)；Coat′s病伴新生血管型青光眼者1例(1只眼)，占9.09%(1/11)。眼内液弓蛔虫免疫球蛋白(Ig)G均远高于3U者7例(7只眼)，占63.64%(7/11)。11例(11只眼)OT分型为典型者9例(9只眼)，占81.82%(9/11)。其中，后极部肉芽肿型2例(2只眼)，占18.18%(2/11)；周边肉芽肿型4例(4只眼)，占36.36%(4/11)；眼内炎型3例(3只眼)，占27.27%(3/11)。OT分型为非典型者2例(2只眼)，占18.18%(2/11)。随访6个月以上，临床诊断无修正。 结论OT多为单眼发病，儿童和成人均可患病。OT临床表现复杂多样，可有后极部和(或)周边肉芽肿、眼内炎及玻璃体视网膜增殖等典型表现，B型超声和UBM检查可辅助诊断。也可仅表现为全葡萄膜炎或中间葡萄膜炎，伴黄斑水肿和视网膜毛细血管"羊齿蕨样"渗漏等非典型改变。眼内液弓蛔虫抗体检测对OT诊断具有重要价值。     

棘阿米巴角膜炎

棘阿米巴角膜炎系棘阿米巴属原虫感染引起的顽固性、进行性角膜炎，它常与戴角膜接触镜有关，近年来国外不断有所报道，我国近几年戴角膜接触镜的人数逐年增多，并发现由于戴角膜接触镜而引发的棘阿米巴角膜炎，因此引起眼科学界的广泛重视。本就棘阿米巴角膜炎的流行病学、临床表现、诊断、鉴别诊断、治疗、预后及预防作一综述。     

Ocular toxocariasis in adults.

Human infection by toxocara larvae has been thought to be predominantly a disease of young children, but the percentage of the population with antibodies to this nematode worm has recently been shown to increase with age. Although a definite diagnosis of ocular toxocariasis can be made only by identifying the larva histologically, the evidence in three cases presenting with recent uniocular loss of vision strongly suggests that adults may also be affected. The lesions noted on ophthalmoscopy closely resembled toxocaral granulomata in children. Toxocaral fluorescent antibody tests were positive in each case.     

Ocular toxocariasis. Value of local immunodiagnosis

Toxocara canis is a nematode that may be involved in human ocular toxocariasis. Specific immunotesting is of importance but may be negative as toxocara antigens may localize exclusively in vitreous humor. We report here the case of one patient with optic disc toxocariasis granuloma negative for toxocara canis immunodiagnostic on serum. Clinical diagnosis was confirmed by toxocara canis specific enzyme-linked immunosorbent assay (ELISA) on aqueous humor showing elevated titers of antibodies. Systemic steroids associated to specific treatment of toxocariasis were initiated. Follow-up displayed regression of uveitis but development of vitreous bands leading to posterior retinal detachment. Toxocara posterior granuloma is of poor visual prognosis. Moreover, diagnosis may be of late setting, as clinical features are often unrecognized and specific immunodiagnostic on serum negative. Specific immunotesting on aqueous humor is of particular importance to rule out severe clinical differential diagnosis such as retinoblastoma in children. Ultrasound biomicroscopy (UBM) seems to be specific and sensitive in patients with a presumed diagnosis of peripheral toxocariasis. Granuloma surgery appears to yield good clinical results and allows histological confirmation of the diagnosis.     

Diagnóstico de toxocariasis ocular mediante la demostración de anticuerpos en el humor vítreo

Objectives

To demonstrate the production of the local toxocara antibodies in the vitreous of patients with negative serology.

Clinical features of ocular toxocariasis in Japan

Purpose: To characterize the clinical features of ocular toxocariasis and to describe the unique aspects of the disease in Japan. Methods: Thirty-six cases diagnosed as ocular toxocariasis at the uveitis clinic of Tokyo Medical University Hospital were analyzed retrospectively. Results: Thirty-six cases comprised 34 adults (average age: 39 ± 10 years) and two nine-year-old boys. All cases were classified into two clinical types: posterior pole type (13 cases) and peripheral type (23 cases). Visual acuity was maintained over 20/20 in 50% and less than 20/200 in 14% of the cases. The peripheral type had worse outcomes than the posterior pole type in all of the endpoints examined: final visual outcome, frequency of ocular complications, and effectiveness of vitreous surgery. Antibody titers in intraocular fluids led to a diagnosis of ocular toxocariasis in eight seronegative cases of 33 cases examined for antibodies in both serum and intraocular fluid samples. Conclusions: The peripheral type had a worse prognosis than the posterior pole type. However, in general, ocular toxocariasis resulted in fair visual outcomes. The antibody titer in intraocular fluid was helpful in the diagnosis.     

Unusual presentation of ocular toxocariasis in friends.

Two cases of presumed ocular toxocariasis are reported in 19-year-old college students. One presented with an acute exudative intraocular inflammation, with marked peripheral eosinophilia, while the other had only minimal inflammatory changes of the disc and vitreous. Both had elevated Toxocara antibody titers by the enzyme-linked immunosorbent assay (ELISA) method. The simultaneous occurrence of ocular toxocariasis in friends and the early presentation and detection of their ocular lesions make these 2 cases interesting. The presence of positive laboratory data with only minimal clinical disease in one of the cases suggests that ocular toxocariasis may be more common than is usually appreciated.     

Treatment of ocular toxocariasis with albendezole: A case report

BackgroundToxocara canis is a parasite that can infect the eye and create a significant inflammatory response that can be detrimental to the patient's vision. Its clinical presentation can mimic other causes of uveitis, and its diagnosis and treatment can be challenging. Prompt and accurate diagnosis of ocular toxocariasis is essential to prevent permanent visual loss.Case ReportA 7-year-old Hispanic boy presented to the clinic with complaints of reduced visual acuity in the left eye. After a careful evaluation of his ocular health, he had ocular toxocariasis diagnosed and confirmed by enzyme-linked immunosorbent assay testing. Treatment with the anthelmintic, albendazole, and oral steroids was initiated. There was initial improvement of the vitritis with significant vitreous debris. However, 2 years later, reactivation occurred, and a vitrectomy was required. This case report reviews the management of a patient with active ocular toxocariasis, including clinical findings and treatment options.ConclusionsThe differential diagnosis of ocular toxocariasis and review of the available treatments are presented.     

Okuläre Toxokariasis

Ocular toxocariasis represents an organ manifestation of the systemic infection with the Nematode larva Toxocara canis. The infection can provoke very different changes in the eye. Especially posterior uveitis, vitreous body infiltrates, epiretinal membranes and suberetinal granulomas can occur. The diagnosis of these changes can be difficult due to the variety of the symptoms and on the other side by the absence of characteristic specific changes. Moreover unclear findings can occur when only serological examinations are performed. In unclear cases the antibody-detection by means of ELISA from the vitreous body fluid can be useful. The examination of vitreous body material can prove toxocara infection when no systemic signs of infection are present and no antibodies are detectable in the serum. Besides the systemic anti-helminthic therapy with Albendazol the pars plana vitrectomy is a substantial therapeutic option in ocular toxocariasis when vitreo-retinal complications are present. A well timed adequate therapy can stabilize the visual acuity in many cases.     

Ocular toxocariasis. A review

This review is an update on the subject of ocular toxocariasis. An introductory section is designed to familiarize the clinician with the epidemiology, characteristics of the organism, the life cycle in dogs and the systemic human disease known as visceral larval migrans (VLM). The more comprehensive second section considers the historical aspects of the ocular involvement, the clinical variations of ocular toxocariasis, pathology, differential diagnosis, diagnostic approaches, and treatment. Emphasis is placed upon new diagnostic techniques such as the enzyme-linked immunosorbant assay (ELISA) and cytologic diagnosis of intraocular aspirates. Newer therapeutic techniques such as vitrectomy are also considered. The review includes 200 references on systemic and ocular toxocariasis.     

Ocular toxoplasmosis and toxocariasis in childhood

Toxoplasmosis and toxocariasis are parasitic infections that are transmitted by cats and dogs, respectively, to humans, and which may induce posterior uveitis already in childhood. Toxoplasmosis presents as a congenitally or postnatally contracted infection whereas toxocariasis is always an acquired disease. The typical ocular sign of toxoplasmosis is retinochoroiditis, occurring as an active lesion, in most instances, associated with an inactive pigmented scar. In contrast, toxocariasis leads to a choroidal granuloma secondarily involving the retina or an endophthalmitis-like picture. Although toxoplasmosis represents the most common cause of posterior uveitis, there are uncertainties regarding the timing and specificity of the diagnosis, namely in atypical cases and those at risk of permanent severe loss of function. Antiparasitic treatment should be tailored to the severity of the inflammation and the risk of visual function loss. Concomitant steroids may be used to control the sequelae of unspecific inflammation, but should be used with caution and must be combined with an antimicrobial regimen. Because it is a rare disorder, one may not be familiar with the clinical presentation and suggested therapy for ocular toxocariasis. With this survey we, therefore, wish to provide a current, practice-oriented overview on the infection, ocular manifestations, diagnosis and treatment of ocular toxoplasmosis and toxocariasis in childhood.     

Ultrasound biomicroscopy findings in peripheral vitreoretinal toxocariasis

PURPOSE: To describe the morphologic alterations in ultrasound biomicroscopy (UBM) present in peripheral vitreoretinal toxocariasis. METHODS: An observational prospective study of case series. Fifteen eyes of 15 patients with clinical and laboratory diagnosis of peripheral vitreoretinal toxocariasis were enrolled. The patients were submitted to UBM examination of the region corresponding to the pars plana of the affected eye. RESULTS: The most common morphologic alterations found by UBM in patients with peripheral vitreoretinal toxocariasis were as follows: vitreal membranes (13 cases), toxocara granuloma (11 cases), and pseudocysts (8 cases). Other less frequent findings were thickening of the ciliary body (6 cases), cystic formation (2 cases), peripheral retinal detachment (2 cases), rectification of the iris root (1 case), and posterior synechiae (1 case). CONCLUSIONS: UBM allows detection of well-defined morphologic alterations associated with peripheral vitreoretinal toxocariasis, being useful to reinforce the clinical diagnosis.