Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
BMC Ophthalmol. 2022 Dec 22;22(1):505. doi: 10.1186/s12886-022-02687-2.
Toxocara larva entity has seldom been reported on the surface of the retina. We report on an unusual case of recurrent vitreous opacity caused by intraocular Toxocara larva after vitrectomy.
A 34-year-old male was referred to our clinic with a 6-month history of decreased visual acuity in the right eye characterized as red, painless, and progressive. Optos fundus photograph showed optic disc elevation with granuloma, and proliferative membrane starting from the optic disc and running towards the superior temporal retina due to the movement of a Toxocara larva, which was covered by the proliferative membrane in the superior temporal retina. Since it adhered closely to the retina, the lesion in the superior temporal retina was not removed to avoid induction of an iatrogenic retinal break and the larva was not found during the first diagnostic pars plana vitrectomy. Intraocular Anti-Toxocara IgG was 45.53U (< 3, enzyme-linked immunosorbent assay (ELISA)), and the Goldmann-Witmer coefficient was 8.55, confirming the diagnosis of ocular toxocariasis. After this operation, visual acuity improved to 20/200. However, vitreous opacity worsened again, and the proliferative membrane expanded around the Toxocara larva three weeks after the operation. Toxocara larva was found and removed in the superior temporal region during the second operation. His visual acuity improved to 20/100, vitreous opacity disappeared, and the retina was stable two months after the second operation.
It is advisable to remove suspected Toxocara larva to prevent the reoccurrence of ocular toxocariasis.
眼内幼虫实体在视网膜表面很少见报道。我们报告了一例罕见的玻璃体混浊复发病例，由眼内幼虫引起，且在玻璃体切除术后发生。
一名 34 岁男性因右眼视力下降 6 个月就诊，表现为眼红、无痛和进行性加重。Optos 眼底照相显示视盘抬高伴有肉芽肿，增殖膜从视盘开始并向颞上视网膜延伸，这是由于一条 Toxocara 幼虫的运动所致，这条幼虫被颞上视网膜的增殖膜覆盖。由于它与视网膜紧密粘连，因此在第一次诊断性经睫状体平坦部玻璃体切除术时未去除颞上视网膜的病变部位，以避免诱发医源性视网膜裂孔，也未发现幼虫。眼内抗 Toxocara IgG 为 45.53U（<3，酶联免疫吸附测定（ELISA）），Goldmann-Witmer 系数为 8.55，证实了眼弓蛔虫病的诊断。手术后，视力提高至 20/200。然而，玻璃体混浊再次加重，术后 3 周增殖膜围绕 Toxocara 幼虫扩展。在第二次手术中，在颞上区域发现并取出了 Toxocara 幼虫。他的视力提高至 20/100，玻璃体混浊消失，第二次手术后两个月视网膜稳定。
建议去除疑似 Toxocara 幼虫，以防止眼弓蛔虫病复发。
