眼トキソカラ症に対する治療法の検討

Evaluation of therapeutic modalities for ocular toxocariasis

　過去11年間に加療した眼トキソカラ症16例を検討した。男性11例，女性5例であり，すべて片眼性であった。年齢は9歳から73歳，平均38歳であり，12例が20歳以上であった。病型はwilk—insonらの3型に加え，異なる病型が同時にある混合型の4型に分類した。内訳は，周辺部型10例，後極部型2例，眼内炎型2例，混合型2例であった。病変がすでに固定している2例を除く14例に全身的に薬物を投与し，7例で病巣が沈静化した。再燃した7例中4例に網膜冷凍凝固を行い，3例が再燃した。硝子体手術は6例（再燃4例，増殖硝子体網膜症1例、硝子体出血1例）に行い，病巣が除去できた3例では以後再燃がなかった。最終視力は改善6例，不変7例，悪化1例であった。保存的治療後に再燃した例には硝子体手術が有効であるが，抗原が存在する病巣を除去する必要がある。

We reviewed 16 cases of ocular toxiocariasis seen during the past 11 years. The series com-prised 11 males and 5 females. Their age ranged from 9 to 73 years, average 38 years. Twelve cases were aged 20 years or older. All the cases were unilaterally involved. The intraocular manifestation was classified as peripheral 10 eyes, central 2 eyes, endophthalmitis 2 eyes after Wilkinson, and, additionally, mixed 2 eyes. Fourteen cases with active ocular lesions received systemic medications, followed by stabilization and recu-rrence in 7 cases each. Retinal cryotherapy was performed on 4 of the 7 recurred cases, resulting in further recurrence in 3 cases. Vitrectomy was performed on 6 cases which included recurrence 4 cases, vitreous hemorrhage 1 case and proliferative vitreoretinopathy 1 case. There was no further recurrence following vitrectomy with complete removal of the foci. The final visual acuity was evaluated as improved in 6 cases, un-changed in 7 cases and deteriorated in 1 case. The findings show that vitrectomy may be effective after failure of systemic medications and that it is imperative to remove the intraocular foci, where the antigen is su-pposed to exist.