Clinical characteristics and treatment prognosis of ocular toxocariasis_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhou Yongwei , Li Qiuming , Wu Jiahui , Lu Xiaoyan , Yang Ge , Hu zhirou , Zhen Fangyuan ,  Dong Shuqian

Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Henan Eye Hospital, Zhengzhou 450052, China;

Corresponding author：

Dong Shuqian, Email: dongshuqian2006@163.com

Keywords：

Ocular toxocariasis; Clinical characteristics; Glucocorticoid

DOI：

10.3760/cma.j.cn511434-20220124-00042

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Objective To observe the clinical characteristics and treatment prognosis of patients with ocular toxocariasis (OT). Methods A retrospective clinical trial. From March 2018 to September 2021, 40 eyes of 40 OT patients diagnosed by ophthalmic examination in the First Affiliated Hospital of Zhengzhou University were included in the study. All patients underwent best corrected visual acuity (BCVA) and scanning laser ophthalmoscope (SLO) examination. Color Doppler ultrasound flow imaging (CDFI), fluorescein fundus angiography (FFA) and optical coherence tomography (OCT) were performed in 25, 26 and 26 eyes, respectively. Among the 40 patients, there were 23 males (57.5%, 23/40) and 17 females (42.5%, 17/40). All patients were monocular. Thirty patients (75.0%, 30/40) were younger than 18 years old, with the mean age of (9.60±0.60) years. Ten patients (25.0%, 10/40) were great than or equal to 18 years old, with the mean age of (34.60±4.52) years. Thirty-three patients (82.5%, 33/40) lived in rural areas for a long time. There were 27 patients (67.5%, 27/40) with a history of contact with dogs and cats. In 40 eyes, peripheral granuloma (peripheral type), posterior pole granuloma (posterior pole type), vitreous opacity similar to endophthalmitis (turbid type) and hybrid type were 18(45.0%, 18/40), 11(27.5%, 11/40), 6(15.0%, 6/40) ang 5(12.5%,5/40), respectively. All patients were treated with drugs and/or surgery after definite diagnosis. There were 28 eyes of peripheral type, posterior pole type and hybrid type, 17 eyes were treated with surgery and 11 eyes with drug treatment, respectively. Five eyes with turbid type were only treated with drugs. In 40 patients, 33 patients participated in follow-up. The follow-up time after treatment was (18.78±9.44) months. The improvement of BCVA was observed. The number of eyes with different BCVA before and after treatment was compared by χ² test or Fisher's test. Results At the first visit, the BCVA ranged from light perception to 0.6, including 20 eyes with BCVA ＜0.1, 13 eyes with BCVA 0.1-0.3, and 7 eyes with BCVA ＞0.3. The posterior vitreous anterior limiting membrane was thickened in 24 eyes (60.0%, 24/40). There were 27 eyes (67.5%, 27/40) with lamellar vitreous opacity and 22 eyes (55.0%, 22/40) with peripheral/posterior pole granulomas. Among 25 eyes examined by CDFI, 14 eyes (56.0%, 14/25) showed characteristic stratified or diffuse opacity in vitreous body. Of the 26 eyes examined by FFA, 15 eyes (57.7%, 15/26) had "fern-like" leakage of retinal capillaries, and the lesion had a patchy non-perfused area. In 26 eyes examined by OCT, epiretinal membrane, cystoid macular edema and vitreoretinal traction were 8 (30.8%, 8/26), 5 (19.2%, 5/26) and 2 (7.7%, 2/26) eyes, respectively. At the last follow-up, compared with before treatment, the BCVA of 5 eyes with turbid type increased, and the difference was statistically significant (P＜0.05). In 28 eyes with peripheral type, posterior pole type and hybrid type, 17 eyes with surgical treatment improved BCVA, and the difference was statistically significant (χ²=6.258, P＜0.05). In 11 eyes only treated with drugs, BCVA remained unchanged, and the difference was not statistically significant (χ²=0.594, P＞0.05). Conclusions OT patients are mostly children; retinal granulomas, gray-white hyperplastic membrane behind lens or vitreous stratified opacity are specific characteristics. OT is mainly treated by glucocorticoid drugs and vitrectomy.

Citation： Zhou Yongwei, Li Qiuming, Wu Jiahui, Lu Xiaoyan, Yang Ge, Hu zhirou, Zhen Fangyuan, Dong Shuqian. Clinical characteristics and treatment prognosis of ocular toxocariasis. Chinese Journal of Ocular Fundus Diseases, 2023, 39(6): 483-488. doi: 10.3760/cma.j.cn511434-20220124-00042 Copy

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4.	Jee D, Kim KS, Lee WK, et al. Clinical features of ocular toxocariasis in adult Korean patients[J]. Ocul Immunol Inflamm, 2016, 24(2): 207-216. DOI: 10.3109/09273948.2014.994783.
5.	Martínez-Pulgarín D, Muñoz-Urbano M, Gomez-Suta L, et al. Ocular toxocariasis: new diagnostic and therapeutic perspectives[J]. Recent Pat Antiinfect Drug Discov, 2015, 10(1): 35-41. DOI: 10.2174/1574891x10666150410125057.
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9.	Zhou M, Chang Q, Gonzales JA, et al. Clinical characteristics of ocular toxocariasis in Eastern China[J]. Graefe's Arch Clin Exp Ophthalmol, 2012, 250(9): 1373-1378. DOI: 10.1007/s00417-012-1971-2.
10.	刘亚鲁, 张琦, 赵培泉. 眼弓蛔虫病[J]. 中华眼底病杂志, 2014, 30(1): 112-114. DOI: 10.3760/cma.j.issn.1005-1015.2014.01.033.Liu YL, Zhang Q, Zhao PQ. Ocular toxocariasis[J]. Chin J Ocul Fundus Dis, 2014, 30(1): 112-114. DOI: 10.3760/cma.j.issn.1005-1015.2014.01.033.
11.	王朱健, 周旻, 吉建, 等. 眼弓蛔虫病患者眼内液与血清犬弓蛔虫特异性IgG抗体检测[J]. 中华眼底病杂志, 2015, 31(1): 41-44. DOI: 10.3760/cma.j.issn.1005-1015.2015.01.011.Wang ZJ, Zhou M, Ji J, et al. Application of specific lug detection in intraocular fluid for the laboratory diagnosis of ocular toxocariasis[J]. Chin J Ocul Fundus Dis, 2015, 31(1): 41-44. DOI: 10.3760/cma.j.issn.1005-1015.2015.01.011.
12.	胡小凤, 刘旭辉, 汪晓娟, 等. 成人和儿童眼犬弓蛔虫病临床表现差异及眼内液检测特点[J]. 中华眼底病杂志, 2021, 37(7): 503-508. DOI: 10.3760/cma.j.cn511434-20210303-00115.Hu XF, Liu XH, Wang XJ, et al. Difference of clinical characteristics in ocular toxocariasis between adults and children and characteristics of anti-toxocaria antibody in intraocular fluids[J]. Chin J Ocul Fundus Dis, 2021, 37(7): 503-508. DOI: 10.3760/cma.j.cn511434-20210303-00115.
13.	Good B, Holland CV, Taylor MRH, et al. Ocular toxocariasis in schoolchildren[J]. Clin Infect Dis, 2004, 39(2): 173-178. DOI: 10.1086/421492.
14.	Ahn SJ, Ryoo NK, Woo SJ. Ocular toxocariasis: clinical features, diagnosis, treatment, and prevention[J]. Asia Pac Allergy, 2014, 4(3): 134-141. DOI: 10.5415/apallergy.2014.4.3.134.
15.	Woodhall D, Starr MC, Montgomery SP, et al. Ocular toxocariasis: epidemiologic, anatomic, and therapeutic variations based on a survey of ophthalmic subspecialists[J]. Ophthalmology, 2012, 119(6): 1211-1217. DOI: 10.1016/j.ophtha.2011.12.013.

1. Liu J, Li S, Deng G, et al. Ultrasound biomicroscopic imaging in paediatric ocular toxocariasis[J]. Br J Ophthalmol, 2017, 101(11): 1514-1517. DOI: 10.1136/bjophthalmol-2016-309850.
2. Schneier AJ, Durand ML. Ocular toxocariasis: advances in diagnosis and treatment[J]. Int Ophthalmol Clin, 2011, 51(4): 135-144. DOI: 10.1097/IIO.0b013e31822d6a5a.
3. 刘敬花, 李松峰, 邓光达, 等. 儿童眼弓蛔虫病临床特点分析[J]. 中华实验眼科杂志, 2019, 37(5): 371-375. DOI: 10.3760/cma.j.issn.2095-0160.2019.05.011.Liu JH, Li SF, Deng GD, et al. Clinical characteristics of pediatric ocular toxocariasis[J]. Chin J Exp Ophthalmol, 2019, 37(5): 371-375. DOI: 10.3760/cma.j.issn.2095-0160.2019.05.011.
4. Jee D, Kim KS, Lee WK, et al. Clinical features of ocular toxocariasis in adult Korean patients[J]. Ocul Immunol Inflamm, 2016, 24(2): 207-216. DOI: 10.3109/09273948.2014.994783.
5. Martínez-Pulgarín D, Muñoz-Urbano M, Gomez-Suta L, et al. Ocular toxocariasis: new diagnostic and therapeutic perspectives[J]. Recent Pat Antiinfect Drug Discov, 2015, 10(1): 35-41. DOI: 10.2174/1574891x10666150410125057.
6. Yoshida M, Shirao Y, Asai H, et al. A retrospective study of ocular toxocariasis in Japan: correlation with antibody prevalence and ophthalmological findings of patients with uveitis[J]. J Helminthol, 1999, 73(4): 357-361. DOI: 10.1017/s0022149x99000608.
7. 孙立梅, 李松珊, 曹丽明, 等. 成人眼弓蛔虫病的临床特征分析[J]. 中华眼底病杂志, 2020, 36(9): 685-690. DOI: 10.3760/cma.j.cn511434-20200722-00348.Sun LM, Li SS, Cao LM, et al. Clinical characteristics of ocular toxocariasis in adults[J]. Chin J Ocul Fundus Dis, 2020, 36(9): 685-690. DOI: 10.3760/cma.j.cn511434-20200722-00348.
8. Abd El-Aal NF, Basha MAA, Eid AM. New insight into the diagnostic cut-off value of serum anti-toxocara IgG for ocular toxocariasis in uveitis patients[J]. J Helminthol, 2018, 94: e12. DOI: 10.1017/S0022149X18000895.
9. Zhou M, Chang Q, Gonzales JA, et al. Clinical characteristics of ocular toxocariasis in Eastern China[J]. Graefe's Arch Clin Exp Ophthalmol, 2012, 250(9): 1373-1378. DOI: 10.1007/s00417-012-1971-2.
10. 刘亚鲁, 张琦, 赵培泉. 眼弓蛔虫病[J]. 中华眼底病杂志, 2014, 30(1): 112-114. DOI: 10.3760/cma.j.issn.1005-1015.2014.01.033.Liu YL, Zhang Q, Zhao PQ. Ocular toxocariasis[J]. Chin J Ocul Fundus Dis, 2014, 30(1): 112-114. DOI: 10.3760/cma.j.issn.1005-1015.2014.01.033.
11. 王朱健, 周旻, 吉建, 等. 眼弓蛔虫病患者眼内液与血清犬弓蛔虫特异性IgG抗体检测[J]. 中华眼底病杂志, 2015, 31(1): 41-44. DOI: 10.3760/cma.j.issn.1005-1015.2015.01.011.Wang ZJ, Zhou M, Ji J, et al. Application of specific lug detection in intraocular fluid for the laboratory diagnosis of ocular toxocariasis[J]. Chin J Ocul Fundus Dis, 2015, 31(1): 41-44. DOI: 10.3760/cma.j.issn.1005-1015.2015.01.011.
12. 胡小凤, 刘旭辉, 汪晓娟, 等. 成人和儿童眼犬弓蛔虫病临床表现差异及眼内液检测特点[J]. 中华眼底病杂志, 2021, 37(7): 503-508. DOI: 10.3760/cma.j.cn511434-20210303-00115.Hu XF, Liu XH, Wang XJ, et al. Difference of clinical characteristics in ocular toxocariasis between adults and children and characteristics of anti-toxocaria antibody in intraocular fluids[J]. Chin J Ocul Fundus Dis, 2021, 37(7): 503-508. DOI: 10.3760/cma.j.cn511434-20210303-00115.
13. Good B, Holland CV, Taylor MRH, et al. Ocular toxocariasis in schoolchildren[J]. Clin Infect Dis, 2004, 39(2): 173-178. DOI: 10.1086/421492.
14. Ahn SJ, Ryoo NK, Woo SJ. Ocular toxocariasis: clinical features, diagnosis, treatment, and prevention[J]. Asia Pac Allergy, 2014, 4(3): 134-141. DOI: 10.5415/apallergy.2014.4.3.134.
15. Woodhall D, Starr MC, Montgomery SP, et al. Ocular toxocariasis: epidemiologic, anatomic, and therapeutic variations based on a survey of ophthalmic subspecialists[J]. Ophthalmology, 2012, 119(6): 1211-1217. DOI: 10.1016/j.ophtha.2011.12.013.

Chinese Journal of Ocular Fundus Diseases

Clinical characteristics and treatment prognosis of ocular toxocariasis

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