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。

Efficacy of vitrectomy through adjusted scleral incisions for ocular toxocariasis

Objective To explore the clinical effects of vitrectomy through adjusted scleral incisions on ocular toxocariasis. Design Retrospective case series. Participants 139 patients (139 eyes) with ocular toxocariasis who underwent vitrectomy with adjusted scleral incisions in Beijing Tongren Hospital between March 2012 to March 2018 and with a postoperative follow-up of at least 5 months were included. Methods The medical records of the patients including general information, results of preoperative ultrasonic bimicroscope (UBM) examination, surgical approaches, pre- and post-operative visual acuity and anatomical changes were retrospectively described. Postoperative visual acuity improvement was defined as two or more lines better than before；and postoperative visual acuity deterioration was defined as two or more lines worse than before；stable postoperative visual acuity was defined as changes no more than one lines. Main Outcome Measures Pre- and post-operative visual acuity, anatomical changes and complications. Results 46.0%（64/139 eyes） of the patients underwent vitrectomy combined with lensectomy. The follow-up-time was 29±9 months. At last follow-up, visual acuity improved in 85 eyes (85/121, 70.2%)，remained stable in 27 eyes (27/121，22.3%) and deterioration in 9 eyes (9/121，7.5%); 99 eyes (96/139, 69.1%) had tractional retinal detachment preoperatively, among which 65 eyes had retinal reattachment or partial retinal reattachment. Postoperative hypotony within 1 week and postoperative ocular hypertension after 1 month were most common complications. Conclusion Vitrectomy through adjusted scleral incisions assisted by preoperative UBM seems to be beneficial for the short-term prognosis of visual acuity and anatomic outcomes of ocular toxocariasis. Preoperative UBM seems to valuable in detecting the extent and range of peripheral vitreoretinal pathologies of ocular toxocariasis and assisting in selecting the optimum location of scleral incisions.