SUMMARYOcular toxocariasis is rare and therefore the spectrum of clinical disease is difficult to establish. We present a review of the clinical features and laboratory findings in a group of patients with positive Toxocara serology and ocular toxocariasis. The clinical spectrum was diverse and milder disease was commoner than might be sup posed from reviews of the literature. Eosinophilia was unusual, but featured in two cases of unilateral pars planitis.
to the diagnostic criteria of Mason and Barnes7 and O'Duffy8 were included in the study.The pathergy test was performed by 2 methods. The skin of the flexor aspect of the left forearm was cleaned with 70% isopropyl alcohol and pricked intradermally with a sterile hypodermic needle (size 25G). After similar skin preparation 0-1 ml of 0-9% saline was injected intradermally on the flexor aspect of the right forearm. The injection sites were read at 48 hours by the patient and classified as negative, positive (red and raised), or strongly positive (red and raised with a pustule) with reference to illustrations provided. These illustrations were similar to those shown in the report of Yazici et The database consisted of the age and sex of each patient and the presence or absence at any time of aphthous ulceration, genital ulceration, uveitis, skin lesions (pyoderma and/or erythema nodosum), arthritis, thrombophlebitis, and a positive pathergy test.
LondonSummary:The diagnosis of ocular toxocariasis is difficult to make with certainty. New methods of antigen detection are helpful. Surgical intervention may playa role in improving the prognosis, but the place of specific chemotherapy remains undefined. We discuss three case histories to illustrate these points.We suggest that the visual prognosis need not be so poor as commonly believed, and outline a suggested plan of management.Toxocara infection is common in the United Kingdom. 2.6% of adults have specific antitoxocaral antibodies! and surveys in chil Acuity was hand movements. There was a subreti nal inflammatory lesion in the upper temporal quadrant, with vitreoretinal traction producing a band running to the optic disc (Fig. 1). There was a dense cellular infiltration of the vitreous.Anti-toxocara antibodies were found in serum and at higher levels in ocular fluid. Toxocara anti gen was demonstrated in the vitreous and aqueous by a 2-site capture ELISA using a Toxocara canisspecific monoclonal antibody9.He was treated with thiabendazole (50 mg/Kg/ day) and oral prednisolone for 7 days. Vitrectomy
Twelve patients with active Behçet's uveitis with marked deterioration of visual acuity in at least one eye were treated with cyclosporin A (CyA). An initial improvement in the severity of ocular inflammation and systemic features occurred in all cases and persisted until the dose was reduced or the drug withdrawn when a rapid recurrence of symptoms was noted. The visual acuity also initially improved in ten patients and this was maintained in seven cases until the dose of CyA was reduced. At this time, acuity was unchanged in two patients and was worse in three others-two of the latter as a result of vitreous haemorrhage in the absence of active inflammation. Seven of the 12 patients had therapy stopped because of complications; severe malaise and nausea (three cases), decreased renal function (three cases), and blindness (one case). Cyclosporin A is of value in the control of Behçet's uveitis but toxicity limits its use and the benefits only last while the patient is on this therapy.
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