探讨眼弓蛔虫病(OT)诊断与鉴别诊断的方法。

收集2016年11月至2021年2月就诊于西安市人民医院(西安市第四医院)眼科，曾在外院误诊的OT患者11例(11只眼)进行研究。其中，男性7例(7只眼)，女性4例(4只眼)；年龄4~47岁，平均年龄(21.4±13.8)岁。采集患者病史，收集临床表现，就诊过程，影像学检查结果，眼内液检测结果。年龄和眼压以 ±s描述。职业、居住地、猫狗接触史、主诉、既往病史、视力、眼部表现、影像学检查结果、眼内液检测结果、诊断及鉴别诊断采用例数(眼数)和百分比进行描述。随访6个月，观察临床诊断是否有修正。

11例均为单眼患病。其中，18岁以下者6例(6只眼)，占54.55%(6/11)；18岁以上者5例(5只眼)，占45.45%(5/11)。有玻璃体混浊者11例(11只眼)，占100.00%(11/11)；玻璃体机化分层者7例(7只眼)，占63.64%(7/11)；玻璃体增殖及牵拉性视网膜脱离者4例(4只眼)，占36.36%(4/11)。超声生物显微镜(UBM)检查显示前部玻璃体混浊者4例(4只眼)，占36.36%(4/11)；睫状体后有异常高回声者3例(3只眼)，占27.27%(3/11)，提示周边肉芽肿形成。B型超声检查玻璃体可见异常回声者9例(9只眼)，占81.82%(9/11)。其中，表现为特异性的条索状或带状分层回声者5例(5只眼)，占45.45%(5/11)；表现为点团状回声者4例(4只眼)，占36.36%(4/11)。B型超声显示有牵拉性视网膜脱离者6例(6只眼)，占54.55%(6/11)。荧光素眼底血管造影(FFA)显示视盘着染、荧光素渗漏及视网膜血管显著渗漏者6例(6只眼)，占54.55%(6/11)。其中，表现出视网膜毛细血管"羊齿蕨样"渗漏者3例(3只眼)，占27.27%(3/11)。光学相干断层扫描(OCT)检查结果显示显著黄斑水肿者3例(3只眼)，占27.27%(3/11)。首诊外院误诊为非感染性葡萄膜炎者4例(4只眼)，占36.36%(4/11)；陈旧性视网膜脱离者2例(2只眼)，占18.18%(2/11)；永存原始玻璃体增生症者2例(2只眼)，占18.18%(2/11)；视网膜母细胞瘤者1例(1只眼)，占9.09%(1/11)；黄斑水肿者1例(1只眼)，占9.09%(1/9)；Coat′s病伴新生血管型青光眼者1例(1只眼)，占9.09%(1/11)。眼内液弓蛔虫免疫球蛋白(Ig)G均远高于3U者7例(7只眼)，占63.64%(7/11)。11例(11只眼)OT分型为典型者9例(9只眼)，占81.82%(9/11)。其中，后极部肉芽肿型2例(2只眼)，占18.18%(2/11)；周边肉芽肿型4例(4只眼)，占36.36%(4/11)；眼内炎型3例(3只眼)，占27.27%(3/11)。OT分型为非典型者2例(2只眼)，占18.18%(2/11)。随访6个月以上，临床诊断无修正。

OT多为单眼发病，儿童和成人均可患病。OT临床表现复杂多样，可有后极部和(或)周边肉芽肿、眼内炎及玻璃体视网膜增殖等典型表现，B型超声和UBM检查可辅助诊断。也可仅表现为全葡萄膜炎或中间葡萄膜炎，伴黄斑水肿和视网膜毛细血管"羊齿蕨样"渗漏等非典型改变。眼内液弓蛔虫抗体检测对OT诊断具有重要价值。

To explore the methods of diagnosis and differential diagnosis of ocular toxocariasis (OT).

11 patients (11 eyes) who were diagnosed OT at Department of Ophthalmology Xi′an People′s Hospital (Xi′an Fourth Hospital) and had ever misdiagnosed by other hospital from November 2016 to February 2021 were collected. Among them, there were 7 males (7 eyes) and 4 females (4 eyes) with an average age was (21.4±13.8) years (ranged from 4 to 47 years). The patient′s medical history, clinical manifestations, diagnostic procedure, imaging results and intraocular fluid test results were recorded. Age and intraocular pressure were described by ±s. Occupation, place of residence, contact history of cats or dogs, main complaint, past medical history, visualacuity, eye manifestations, imaging examination results, intraocular fluid test results and differential diagnosis were described by the number of cases and percentage. The patients were followed up for 6 months to observe whether the clinical diagnosis was corrected.

All 11 cases were monocular. There were 6 cases (6 eyes) under 18 years, accounting for 54.55% (6 /11), and 5 cases (5 eyes) over 18 years, accounting for 45.45% (5/11). There were 11 cases (11 eyes) with vitreous opacity, accounting for 100.00% (11/11), 7 cases (7 eyes) with vitreous stratification, accounting for 63.64% (7/11), and 4 cases (4 eyes) with vitreous proliferation and traction retinal detachment, accounting for 36.36% (4/11). Ultrasound biomicroscopy (UBM) showed there were 4 cases (4 eyes) with anterior vitreous opacity, accounting for 36.36% (4/11), and 3 cases (3 eyes) with abnormal hyperecho, accounting for 27.27% (3 / 11), suggesting the formation of peripheral granuloma; 9 cases (9 eyes) with abnormal vitreous echo by B-mode ultrasound, accounting for 81.82% (9/11), including 5 cases (5 eyes) with specific strip and strip layered echo, accounting for 45.45% (5/11), 4 cases (4 eyes) with point and mass echo, accounting for 36.36% (4/11). There were 6 cases (6 eyes) with traction retinal detachment by B-mode ultrasound, accounting for 54.55% (6/11). Fundus fluorescein angiography showed there were 6 cases (6 eyes) with optic disc staining / fluorescein leakage and significant retinal vascular leakage, accounting for 54.55% (6/11), of which 3 cases (3 eyes) showed "fern like" leakage of retinal capillaries, accounting for 27.27% (3/11). Optical coherence tomography showed significant macular edema in 3 cases (3 eyes), accounting for 27.27% (3/11). During the first misdiagnosis, there were 4 cases (4 eyes) with non infective uveitis, 2 cases (2 eyes) with old retinal detachment, 2 cases (2 eyes) with persistent primitive vitreous hyperplasia, 1 case (1 eye) with retinoblastoma, 1 case (1 eye) with macular edema, 1 case (1 eye) of Coat′s disease with neovascular glaucoma, accounting for 36.36% (4/11), 18.18% (2/11), 18.18% (2/11), 9.09% (1/11), 9.09% (1/9), 9.09% (1/11), respectively. The immunoglobulin (Ig) g of Toxocara lumbricoides in intraocular fluid was much higher than that of 3 U, accounting for 63.64% (7/11). Of the OT types, there were typical 9 cases (9 eyes), accounting for 81.82% (9/11), including 2 cases (2 eyes) with posterior pole granuloma, accounting for 18.18% (2/11), 4 cases (4 eyes) with peripheral granuloma, accounting for 36.36% (4/11), and 3 cases (3 eyes) with endophthalmitis, accounting for 27.27% (3/11); there were atypical 2 cases (2 eyes), accounting for 18.18% (2/11). The patients were followed up for more than 6 months, and the clinical diagnosis was not corrected.

OT is mostly monocular, which can be found in children and adults. The clinical manifestations of OT are complex and diverse, including posterior pole and (or) peripheral granuloma, endophthalmitis, vitreoretinal proliferation and other typical manifestations. B-mode ultrasound and UBM can assist in the diagnosis, which can also only show panuveitis or intermediate uveitis, accompanied by atypical changes such as macular edema and "fern like" leakage of retinal capillaries. The detection of Toxocara antibody in intraocular fluid is of great significance in the auxiliary diagnosis of OT.