Rathinam Sivakumar R, Usha Kim R, Rao Narsing A
Aravind Eye Hospital, Madurai, India.
Am J Ophthalmol. 2002 Jun;133(6):773-9. doi: 10.1016/s0002-9394(02)01435-6.
To describe the epidemiologic, clinical, and histopathologic features of a presumed trematode granulomatous anterior uveitis, primarily in children from south India.
Prospective, noncomparative, case series.
Children with clinical evidence of granulomatous anterior uveitis were selected for the study. Those who presented with distinct anterior chamber nodules were evaluated. Demographic details, such as clinical findings and course of illness, were noted. Patients underwent either medical treatment or surgical aspiration of the lesion based on the size of the lesion. Aspirated materials were subjected to histopathologic analysis and cultures for bacteria and fungi. Response to treatment and final visual status were evaluated.
One hundred thirteen patients with anterior chamber nodules were seen between 1998 and 2000. Ninety-three (82.4%) were males and 20 (17.7%) were females. The median age was 11.0 years. All patients were from south India and all gave a history of bathing or swimming in the local pond or river. All had normal systemic work ups. Of the 113 patients, 110 had anterior chamber nodules and three had both anterior chamber and subconjunctival nodules. Aspirates of the anterior chamber lesions revealed lymphocytes, intact and necrotic neutrophils, and eosinophils admixed with histiocytes. One subconjunctival nodule showed necrotizing granuloma, displaying the tegument of a trematode. Those patients who were followed had good visual recovery after medical or surgical intervention or both.
The present study shows a newly recognized granulomatous anterior uveitis caused by a presumed water-borne trematode infection. This infection appears to be a common cause of pediatric granulomatous anterior uveitis in south India.
描述一种推测由吸虫引起的肉芽肿性前葡萄膜炎的流行病学、临床和组织病理学特征，主要针对印度南部儿童。
前瞻性、非对照病例系列研究。
选择有肉芽肿性前葡萄膜炎临床证据的儿童进行研究。对出现明显前房结节的患儿进行评估。记录人口统计学细节，如临床发现和病程。根据病变大小，患者接受药物治疗或病变手术抽吸。抽吸物进行组织病理学分析以及细菌和真菌培养。评估治疗反应和最终视力状况。
1998年至2000年期间共诊治113例有前房结节的患者。男性93例（82.4%），女性20例（17.7%）。中位年龄为11.0岁。所有患者均来自印度南部，均有在当地池塘或河流中洗澡或游泳史。所有患者全身检查均正常。113例患者中，110例有前房结节，3例既有前房结节又有结膜下结节。前房病变抽吸物显示淋巴细胞、完整和坏死的中性粒细胞以及与组织细胞混合存在的嗜酸性粒细胞。一个结膜下结节显示坏死性肉芽肿，可见吸虫的外皮。接受随访的患者经药物或手术干预或两者联合干预后视力恢复良好。
本研究显示一种新认识的推测由水传播吸虫感染引起的肉芽肿性前葡萄膜炎。这种感染似乎是印度南部儿童肉芽肿性前葡萄膜炎的常见病因。
