眼弓形虫病11例临床分析  

Clinical analysis of 11 cases of ocular toxoplasmosis

作　　者：蒋婷婷 王克岩 邬海翔 常青 JIANG Tingting;WANG Keyan;WU Haixiang;CHANG Qing(Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China)

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：《中国眼耳鼻喉科杂志》2021年第6期419-424,共6页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：国家自然科学基金(81870670)。

摘　　要：目的探讨眼弓形虫病患者的临床表现、治疗情况及视力预后。方法回顾性病例研究。收集2013~2019年本院眼科确诊的11例眼弓形虫病患者的临床资料,分析临床表现及治疗预后。结果11例(12眼)患者中,男性4例、女性7例,双眼发病1例。年龄为13~68岁,平均(47.73±17.80)岁,随访时间为10个月~6年,平均(30.00±18.82)个月。2眼(16.7%)表现为神经视网膜炎,伴Kyrieleis动脉炎;1眼(8.3%)表现为视乳头血管炎;余9眼(75%)均表现为视网膜脉络膜炎。初始矫正视力(logMAR)为0.30~1.85,平均0.84±0.52;最终矫正视力(logMAR)为0~1.5,平均0.43±0.57。血清学检查,11例(100%)弓形虫IgG抗体滴度升高,2例(18.2%)伴IgM抗体滴度升高,所有患者Witmer Desmonts系数均>1。7眼(58.3%)出现眼部并发症:5眼眼压升高(41.7%),1眼继发黄斑裂孔伴视网膜脱离,1眼继发黄斑前膜。活动期患者口服驱虫药治疗,6例联合口服糖皮质激素。随访过程中,1眼复发(8.3%)。最终视力与初始视力(P<0.001)、黄斑中心凹受累情况(P<0.001)显著相关,与病程长短、病灶大小及活动性无显著相关。结论眼弓形虫病临床表现以玻璃体炎症伴视网膜脉络膜炎为主,易误诊。及时诊断、正规治疗可使病灶消退。视力预后与初始视力、黄斑中心凹受累情况相关。Objective To investigate the clinical manifestations,therapeutic effects and visual prognosis of ocular toxoplasmosis.Methods This was a retrospective study.The clinical data of 11 cases with ocular toxoplasmosis confirmed in the Eye&ENT Hospital,Fudan University from 2013 to 2019 were collected and studied retrospectively.The clinical characteristics and treatment outcomes of the patients were analyzed.Results Among the 11 patients(12 eyes),there were 4 males and 7 females.One patient was affected bilaterally.The ages ranged from 13 to 68 years,with an average age of 47.73±17.80 years.Treatment outcomes were followed for 10 months to 6 years,with an average of 30.00±18.82 months.Two eyes(16.7%)presented with neuroretinitis,accompanied by Kyrieleis arteritis,one eye(8.3%)presented with papillary vasculitis,and the remaining(75%)presented with retinochoroiditis.Baseline best corrected vision(logMAR)ranged from 0.3 to 1.85(0.84±0.52),and best corrected vision of last follow-up(logMAR)ranged from 0 to 1.5(0.43±0.57).Serological examination showed elevated IgG in 11 cases(100%)and elevated IgM in 2 cases(18.2%).Witmer Desmonts coefficient were positive(>1)in all patients.Ocular complications were observed in 7 eyes(58.3%)including elevated intraocular pressure(41.7%),secondary macular epiretinal membrane and retinal detachment.Patients with active lesions were treated with antibiotics and 6 patients were combined with oral corticosteroids.Recurrence occurred in one eye(8.3%)during the follow-up.Final visual acuity was significantly correlated with initial visual acuity(P<0.001)and macular fovea involvement(P<0.001),but not with duration of disease,size and activity of lesions.Conclusions The main presentations of ocular toxoplasmosis are vitritis combined with retinochoroiditis,which are often misdiagnosed.Timely diagnosis and standard treatment can make the lesion subside.The final visual acuity prognosis is related to the initial vision and macular fovea involvement.

关 键 词：眼弓形虫病 视网膜脉络膜炎 疾病特征 

分 类 号：R531.8[医药卫生—内科学]