Abstract：Objective: To investigate the efficacy of 25G minimally invasive vitrectomy assisted by chandelier illumination in the treatment of ocular toxocariasis (OT), and to analyze the postoperative complications. Methods: This was a retrospective case series study. Twenty-seven patients (27 eyes) who were diagnosed with ocular toxocariasis in Xuzhou Municipal Hospital from December 2014 to February 2019 were included in the study. All patients underwent 25G minimally invasive vitrectomy assisted by chandelier illumination after systemic and local corticosteroid treatment for 1-2 months. The perfusion tube and chandelier illumination were placed away from the peripheral lesions and the vitreous and drawstring were removed. Laser photocoagulation, gas-liquid exchange, or filling the vitreous cavity with air, C3F8 or silicone oil were performed during the operation according to the retinal condition. Some of the procedures were combined with lens extraction and/or scleral buckling. Clinical features, optical coherence tomography and fundus photography examinations were analyzed as well as treatment conditions and postoperative complications. The recurrence rate of uveitis and the one-time anatomical retinal reduction rate during the postoperative follow-up period were calculated. Data were analyzed by a t test. Results: Among the 27 patients, 11 eyes had peripheral granuloma, 11 eyes had posterior granuloma and 5 eyes had endophthalmitis. Thirteen eyes underwent vitrectomy for tractional retinal detachment (TRD), 23 eyes for epiretinal membrane (ERM), and 11 eyes for TRD combined with ERM. Postoperative followup was conducted for 6-44 months (17.6±11.0). Four eyes (15%) had low intraocular pressure in the early postoperative period and 1 eye (4%) had high intraocular pressure in the late postoperative period. Anatomical reduction was achieved in 11 of the 13 eyes with TRD after a single operation, and the onetime retinal reduction rate was 85%. ERM recurred in 2 of 23 eyes (9%). Retinal detachment occurred after surgery in 2 of 15 TRD eyes (15%), and 3 eyes had cataract after surgery (11%). In the 27 eyes, 4 eyes (15%) had recurrent inflammation 1-5 months after the operation. In one eye, inflammation disappeared after the second operation. In the other 3 eyes, the inflammation was controlled within 2 months after systemic and local corticosteroid treatment. The best corrected visual acuities (logMAR) preoperatively and at the last postoperative follow-up were 1.46±0.66 and 1.13±0.66. Postoperative visual acuity improved compared to preoperative visual acuity (t=4.009, P<0.001). Conclusions: 25G minimally invasive vitrectomy assisted by chandelier illumination can effectively control uveal inflammation and a relatively satisfactory curative effect can be achieved.
Giuliari GP, Ramirez G, Cortez RT. Surgical treatment of ocular toxocariasis:anatomic and functional results in 45 patients. Eur J Ophthalmol, 2011, 21(4): 490-494. DOI: 10.5301/EJO.2010. 6118.
[2]
Liu Y, Zhang Q, Li J, et al. Clinical characteristics of pediatric patients with ocular toxocariasis in China. Ophthalmologica, 2016, 235(2): 97-105. DOI: 10.1159/000443215.
[3]
Zhou M, Chang Q, Gonzales JA, et al. Clinical characteristics of ocular toxocariasis in Eastem China. Graefes Arch Clin Exp Ophthalmol, 2012, 250(9): 1373-1378. DOI: 10.1007/s00417- 012-1971-2.
[4]
Zhang T, Guo D, Xu G, et al. Ocular toxocariasis: Long-term follow-up and prognosis of patients following vitrectomy. Ocul Immunol Inflamm, 2020, 28(3): 517-523. DOI: 10.1080/ 09273948.2019.1597897.
[5]
Jee D, Kim KS, Lee WK, et al. Clinical features of ocular toxocariasis in adult korean patients. Ocul Immunol Inflamm, 2016, 24(2): 207-216. DOI: 10.3109/09273948.2014.994783.
[6]
Despreaux R, Fardeau C, Touhami S, et al. Ocular toxocariasis: Clinical features and long-term visual outcomes in adult patients. Am J Ophthalmol, 2016, 166: 162-168. DOI: 10.1016/ j.ajo.2016.03.050.
Woodhall D, Starr MC, Montgomery SP, et al. Ocular toxocariasis: Epidemiologic, anatomic, and therapeutic variations based on a survey of ophthalmic subspecialists. Opthalmology, 2012, 119(6): 1211-1217. DOI: 10.1016/j.ophtha.2011.12.013.
[10]
Rubinsky-Elefant G, Hirata CE, Yamamoto JH, et al. Human toxocariasis: Diagnosis, worldwide seroprevalences and clinical expression of the systemic and ocular forms. Ann Trop Med Parasitol, 2010, 104(1): 3-23. DOI: 10.1179/136485910X12607 012373957.
[11]
Ellis GS Jr, Pakalnis VA, Worley G, et al. Toxocara canis infestation: Clinical and epidemiological associations with seropositivity in kindergarten children. Ophthalmology, 1986, 93(8): 1032-1037. DOI: 10.1016/s0161-6420(86)33625-x.
Macpherson CN. The epidemiology and public health importance of toxocariasis: A zoonosis of global importance. Int J Parasitol, 2013, 43(12-13): 999-1008. DOI: 10.1016/ j.ijpara.2013.07.004.
[15]
Benson WE, Belmont JB, Irvine AR, et al. Vitrectomy for complications of ocular toxocariasis. Trans Pa Acad Ophthalmol Otolaryngol, 1983, 36(1): 25-30.
[16]
Amin HI, McDonald HR, Han DP, et al. Vitrectomy update for macular traction in ocular toxocariasis. Retina, 2000, 20(1): 80- 85. DOI: 10.1097/00006982-200001000-00015.
[17]
Oray M, Abu Samra K, Ebrahimiadib N, et al. Long-term side effects of glucocorticoids. Expert Opin Drug Saf, 2016, 15(4): 457-465. DOI: 10.1517/14740338.2016.1140743.
Ewais WA, Nossair AA, ALY LS. Scleral self-indentation during chandelier- assisted peripheral vitrectomy under air for rhegmatogenous retinal detachment: A retrospective cohort study. Retina, 2019, 39(2): 358-363. DOI: 10.1097/ IAE.0000000000001955.
浙公网安备 33030202001892号