玻璃体切割手术联合地塞米松缓释剂玻璃体腔植入治疗儿童眼弓蛔虫病临床观察  

Clinical observation of dexamethasone sustained release intraocular implantation combined with vitrectomy in pediatric ocular toxocariasis

作　　者：刘敬花 李松峰 邓光达 李亮 麻婧 原铭贞 卢海 Liu Jinghua;Li Songfeng;Deng Guangda;Li Liang;Ma Jing;Yuan Mingzhen;Lu Hai(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Ophthalmology and Visual Sciences Key Laboratory,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院,北京同仁眼科中心,北京市眼科学与视觉科学重点实验室,北京100730

出　　处：《中华眼底病杂志》2022年第7期562-567,共6页Chinese Journal of Ocular Fundus Diseases

基　　金：2021年度院自然科研培育基金(2021-YJJ-ZR-010)。

摘　　要：目的观察玻璃体切割手术(PPV)联合0.7 mg地塞米松缓释剂Ozurdex玻璃体腔植入治疗儿童眼弓蛔虫病(OT)的疗效及并发症。方法回顾性临床研究。2015年3月至2021年12月于北京同仁医院眼科检查确诊并行PPV治疗的儿童OT患者53例53只眼纳入研究。其中,男性30例,女性23例;年龄(7.07±3.45)(4~14)岁;均为单眼发病。能配合检查者均行彩色多普勒超声、眼底彩色照相、光相干断层扫描检查。行最佳矫正视力(BCVA)检查43只眼;眼压检查47只眼;超声生物显微镜检查29只眼。根据肉芽肿位置将OT分为后极部肉芽肿型(后极型)、周边部肉芽肿型(周边型)、慢性眼内炎型。根据PPV后玻璃体腔是否植入Ozurdex,将患儿分为PPV后口服糖皮质激素组(A组)、PPV联合玻璃体腔植入Ozurdex组(B组),分别为37例37只眼、16例16只眼。两组患儿年龄(t=0.432)、性别构成比(χ^(2)=0.117)以及BCVA(χ^(2)=0.239)、临床类型(χ^(2)=0.312)分布比较,差异均无统计学意义(P>0.05)。手术后随访时间≥5个月。观察手术后1周和1、3、6个月眼压,末次随访时BCVA变化以及并发性白内障、黄斑前膜等并发症发生情况,记录随访期间患儿肥胖发生情况。组间计量资料比较采用独立样本t检验;计数资料比较采用χ^(2)检验。结果手术后1个月,A组、B组患眼眼压分别为(15.17±6.21)、(25.28±10.38)mm Hg(1 mm Hg=0.133 kPa);B组患眼眼压明显高于A组,差异有统计学意义(t=0.141,P=0.043)。末次随访时,两组患眼视力改善百分率比较,差异无统计学意义(χ^(2)=0.315,P=0.053);并发性白内障、黄斑前膜发生率比较,差异无统计学意义(χ^(2)=0.621,P>0.05)。A组37例中,随访期间出现肥胖症状32例(86.5%,32/37)。结论PPV联合玻璃体腔植入Ozurdex与PPV后口服糖皮质激素均可有效提高患眼视力;并发症发生率相似,但手术后口服糖皮质激素肥胖发生率较高。Objective To observe the efficacy of parsplana vitrectomy(PPV)combined with 0.7 mg dexamethasone sustained-release Ozurdex intravitreal implantation in the treatment of children with ocular toxocariasis(OT).Methods A retrospective clinical study.Fifty-three pediatric patients(53 eyes)diagnosed with OT and underwent PPV in Beijing Tongren Eye Center of Beijing Tongren hospital from March 2015 to December 2021 were included.There were 30 males and 23 females,with an average age of 7.07±3.45(4-14)years;all were unilateral.Color Doppler imaging,fundus color photography,optical coherence tomography examinations were performed for patients who can cooperated with the examiners.Forty-three eyes were examined by best corrected visual acuity(BCVA);47 eyes were examined by intraocular pressure;29 eyes were examined by ultrasound biomicroscopy.According to the location of granuloma,OT was divided into posterior pole granulomatous type(posterior type),peripheral granulomatous type(peripheral type),and chronic endophthalmitis type.According to whether Ozurdex was implanted into the vitreous cavity after PPV,the children were divided into the oral glucocorticoid group after PPV(group A)and the PPV combined with vitreous cavity implantation of Ozurdex group(group B),37 cases with 37 eyes and 16 cases with 16 eyes,respectively.There was no significant difference in age(t=0.432),sex composition ratio(χ^(2)=0.117),BCVA(χ^(2)=0.239),and clinical type(χ^(2)=0.312)between the two groups(P>0.05).The follow-up time after surgery was≥5 months.The intraocular pressure at 1 week and 1,3,and 6 months after surgery,the changes of BCVA and the occurrence of complications such as concurrent cataract and epimacular membrane were observed at the last follow-up,and the incidence of obesity in the children during the follow-up period was recorded.The measurement data between groups was compared by independent sample t test;the enumeration data was compared byχ^(2) test.Results One month after the operation,the intraocular pressure of group

关 键 词：儿童 弓蛔虫病 弓形虫病 眼 地塞米松 玻璃体内注射 

分 类 号：R779.6[医药卫生—眼科]