Sustainable Control of Onchocerciasis: Ocular Pathology in Onchocerciasis Patients Treated Annually with Ivermectin for 23 Years: A Cohort Study
Sustainable Control of Onchocerciasis: Ocular Pathology in Onchocerciasis Patients Treated Annually with Ivermectin for 23 Years: A Cohort Study
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DOI：
10.1371/journal.pone.0098411
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发表时间：
2014-06-02
期刊：
影响因子：
3.7
通讯作者：
Soboslay, Peter T.
中科院分区：
文献类型：
--
作者：
Banla, Meba;Tchalim, Solim;Soboslay, Peter T.
在一组每年接受伊维菌素治疗23年的盘尾丝虫感染患者中评估眼部病理学的演变和持续性。患者居住在多哥中部和卡拉地区的农村地区，眼部检查包括视力测试、前眼段裂隙灯检查和眼底检眼镜检查。伊维菌素治疗前，活O。在52%和42%的患者（n = 82）的右前房和左前房中观察到微丝蚴扭转（MF），在24%和15%的病例中分别在右角膜和左角膜中观察到死亡MF。在初始治疗（PIT）后23年，无患者（n = 82）出现前房和角膜MF。23岁时，点状角膜炎（PK）病变完全消退，无可见的角膜瘢痕（p < 0.0001），硬化性角膜炎（SK）减少一半，但主要发生在病变处于早期演变阶段的患者中。早期虹膜睫状体炎从42%（rE）和40%（lE）下降到13%（rE + lE）（p < 0.0001），但晚期虹膜睫状体炎在23年PIT时与伊维菌素治疗前相比增加（p < 0.001）。晚期视乳头炎和脉络膜视网膜炎没有消退，而伊维菌素治疗前28%（rE）和27%（lE）的早期视乳头炎消退至17%（rE）和18%（lE），伊维菌素治疗前51%（rE + lE）的早期脉络膜视网膜炎在23年PIT时分别为12%（rE）和13%（lE）（p < 0.0001）。因此，每年定期伊维菌素治疗消除和防止O。微丝蚴扭转进入前眼房和角膜;点状角膜炎病变完全消退，早期硬化性角膜炎和虹膜睫状体炎消退，而前眼段和后眼段的晚期病变仍在进行。总之，每年伊维菌素治疗可能会防止眼部病变的出现，在这些人群仍然暴露于O。肠扭转感染
The evolution and persistence of ocular pathology was assessed in a cohort of Onchocerca volvulus infected patients treated annually with ivermectin for 23 years. Patients were resident in rural Central and Kara Region of Togo and ocular examinations included testing of visual acuity, slit lamp examination of the anterior eye segment and the eye fundus by ophthalmoscopy. Before ivermectin treatment, vivid O. volvulus microfilariae (MF) were observed in the right and left anterior eye chamber in 52% and 42% of patients (n = 82), and dead MF were seen in the right and left cornea in 24% and 15% of cases, respectively. At 23 years post initial treatment (PIT), none of the patients (n = 82) presented with MF in the anterior chamber and cornea. A complete resolution of punctate keratitis (PK) lesions without observable corneal scars was present at 23 years PIT (p < 0.0001), and sclerosing keratitits (SK) lessened by half, but mainly in patients with lesions at early stage of evolution. Early-stage iridocyclitis diminished from 42%(rE) and 40%(lE) to 13% (rE + lE)(p < 0.0001), but advanced iridocyclitis augmented (p < 0.001) at 23 years PIT compared to before ivermectin. Advanced-stage papillitis and chorioretinitis did not regress, while early-stage papillitis present in 28%(rE) and 27%(lE) of patients at before ivermectin regressed to 17%(rE) and 18%(lE), and early-stage chorioretinitis present in 51%(rE + lE) of cases at before ivermectin was observed in 12%(rE) and 13%(lE) at 23 years PIT (p < 0.0001). Thus, regular annual ivermectin treatment eliminated and prevented the migration of O. volvulus microfilariae into the anterior eye chamber and cornea; keratitis punctata lesions resolved completely and early-stage sclerosing keratitits and iridocyclitis regressed, whilst advanced lesions of the anterior and posterior eye segment remained progressive. In conclusion, annual ivermectin treatments may prevent the emergence of ocular pathology in those populations still exposed to O. volvulus infection.