40例眼弓蛔虫病患者首诊临床特征分析  

Clinical characteristics of ocular toxocariasis patients on the first attendance

作　　者：李肖春[1] 常青[1] 江睿[1] 黄欣[1] 张艳琼[1] 陈倩[1] 颜赛梅[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中华眼底病杂志》2016年第1期40-43,共4页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金（81371041）

摘　　要：目的观察眼弓蛔虫病（0T）患者首诊时的临床特征。方法临床及实验室检查确诊的OT患者40例40只眼纳入研究。其中，男性29例29只眼，女性11例11只眼。平均年龄（12．12±10．42）岁。发现临床症状至首诊时间为0．2～72．0个月。能配合检查的患者均行眼压、裂隙灯显微镜联合＋90D前置镜、眼B型超声、光相干断层扫描检查。行视力检查39例39只眼；超声生物显微镜（UBM）检查29例29只眼。周边肉芽肿型、后极部肉芽肿型、眼内炎型、混合型分别为21、13、1、5只眼。回顾分析就诊原因、首诊时最佳矫正视力（BCVA）、临床表现特征。结果40例患者中，因瞳孔区白色反光就诊4例；斜视2例；体检发现异常5例；视力下降29例；外院诊断为视网膜母细胞瘤、Coats病、白内障、虹膜睫状体炎、视网膜脱离分别为1、1、2、2、2例。首诊时临床诊断OT15只眼，占37．5％。患眼BCVA无光感～0．7。晶状体混浊19只眼，视网膜脱离23只眼。B型超声检查，周边眼底前增厚或周边眼球壁前中强回声12只眼；后极部增厚18只眼。UBM检查结果提示睫状体平坦部中强回声伴增厚23只眼；周边视网膜脱离12只眼。25例血清学抗体检测结果阳性患者中IgE升高17例，占68．0％。结论牵拉性视网膜脱离、玻璃体混浊、晶状体混浊是OT患者首诊时常见临床表现；晶状体后灰白增生膜或机化条索、B型超声或UBM检查提示周边部中强回声团具有一定特征性。Objective To investigate the clinical characteristics of 40 patients with ocular toxocariasis （OT） on the first attendance. Methods A total of 40 consecutive patients who were clinically and serologically diagnosed with OT were retrospectively reviewed. Results The mean age of patients was （ 12. 12 ~ 10.42） years. There were 29 males and 11 females. 29 cases presented with decreased vision, 4 children with leukocoria, 2 cases with strabismus and 5 cases was found abnormal during regular eye examination. Initially 8 eyes （20%） were misdiagnosed as retinoblastoma （1 eye）, Coatt s disease （1 eye）, cataract （2 eyes）, iridocyclitis （2 eyes） and retinal detachment （2 eyes）. 23 eyes had retinal detachment, 19 eyes had cataract. OT was the initial diagnosis for 15 patients （37.5%）. The best corrected visual acuity （BCVA） were NLP to 0.7. Ultrasound biomicroscopy （UBM） were performed in 29 eyes, and identified peripheral granulomas in 23 eyes and adjacent tractional retinal detachment in 12 eyes. We also identified 17 cases （68.0%） with elevated IgE level among 25 patients with positive serological antibody test. Conclusions Tractional retinal detachment, vitreous opacities and cataract are the common clinical findings at the first attendance of OT patients. The adjunctive test of serum total IgE level may be helpful for the diagnosis. The application of UBM and specific IgG detection in serum and intraocular fluid, can also improve the diagnosis.

关 键 词：弓蛔虫病/诊断 弓蛔虫病/并发症 视网膜疾病/诊断 视网膜疾病/病因学 

分 类 号：R774.1[医药卫生—眼科] R779.7[医药卫生—临床医学]