“眼中之虫”：印度南部盘尾丝虫性弥漫性单侧亚急性神经视网膜炎的治疗原理
"Worm in the eye": the rationale for treatment of DUSN in south India.
作者信息
Myint K, Sahay R, Mon S, Saravanan V R, Narendran V, Dhillon B
机构信息
Eye Pavilion, Royal Infirmary of Edinburgh, Edinburgh EH3 9HA, UK.
出版信息
Br J Ophthalmol. 2006 Sep;90(9):1125-7. doi: 10.1136/bjo.2006.094490. Epub 2006 May 17.
AIM
To discuss the rationale for different techniques of treatment for DUSN (diffuse unilateral subacute neuroretinitis) and their effectiveness in two patients from south India.
METHODS
Two rare cases of live worms in DUSN from India are reported, where filarial Brugia malayi is endemic. Both cases presented with progressive unilateral loss of vision with no history of animal contact. They were 40 year old, apparently healthy men. In case 1, the worm (1500-2000 microm) was easy to identify with wriggling movements among crisscrossing diffuse subretinal tracks. The worm was destroyed by a single shot of laser to its advancing end, which was followed by oral steroid to control the inflammation caused by the dead worm. In case 2, the worm was small and difficult to identify. Initially diffuse neuroretinitis was diagnosed and treated with intravenous methylprednisolone and oral corticosteroid. A week later, a small live worm (400-600 microm) was found and subsequently destroyed by laser photocoagulation followed by a combination of anthelminthics.
RESULTS
The patients' vision had improved to 6/60-6/36 from counting fingers after a few weeks.
CONCLUSION
The role of a combination of laser treatment, systemic steroid, and anthelminthics is discussed.
目的
探讨不同治疗技术用于治疗弥漫性单侧亚急性神经视网膜炎（DUSN）的理论依据及其对两名来自印度南部患者的疗效。
方法
报告了两例来自印度的DUSN活虫罕见病例，当地为马来布鲁线虫流行区。两例患者均表现为进行性单眼视力丧失，无动物接触史。他们是40岁的健康男性。病例1中，蠕虫（1500 - 2000微米）在纵横交错的弥漫性视网膜下轨迹中蠕动，易于识别。通过对蠕虫前进端单次激光照射将其摧毁，随后口服类固醇以控制死虫引起的炎症。病例2中，蠕虫较小，难以识别。最初诊断为弥漫性神经视网膜炎，给予静脉注射甲泼尼龙和口服皮质类固醇治疗。一周后，发现一条小活虫（400 - 600微米），随后通过激光光凝将其摧毁，接着联合使用驱虫药。
结果
几周后，患者视力从数指提高到6/60 - 6/36。
结论
讨论了激光治疗、全身类固醇和驱虫药联合使用的作用。
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