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 Table of Contents  
PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 2  |  Page : 223-224

The tale of a coiled worm


1 Vitreo-retina and Uveitis Services, L. V. Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India
2 Retina-Vitreous Service, Mithu Tulsi Chanrai campus, L. V. Prasad Eye Institute, Bhubaneswar, Odisha, India
3 Retina-Vitrous service, Pushpagiri Vitreo-retina Institute, Hyderabad, Telangana, India

Date of Submission18-Jun-2020
Date of Acceptance24-Nov-2020
Date of Web Publication01-Apr-2021

Correspondence Address:
Dr. Vishal Govindahari
Consultant, Pushpagiri Vitreo-retina Institute, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1961_20

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  Abstract 


Keywords: Diffuse unilateral sub-acute neuroretinitis (DUSN), retinitis, photoocagulation


How to cite this article:
Kaza H, Kolavali RR, Govindahari V. The tale of a coiled worm. Indian J Ophthalmol Case Rep 2021;1:223-4

How to cite this URL:
Kaza H, Kolavali RR, Govindahari V. The tale of a coiled worm. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 May 12];1:223-4. Available from: https://www.ijoreports.in/text.asp?2021/1/2/223/312346



Existence of intraocular nematode is rare. We report existence and the challenges faced in the management of intraocular nematode.


  Case Report Top


A 57-year-old gentleman presented with diminished vision in left eye (LE) for two weeks. Best-corrected visual acuity (BCVA) in LE was 20/40, and 20/25 in right eye (RE). Examination of RE revealed no abnormalities, while of the LE anterior segment revealed non-granulomatous keratic precipitates with 1 + cells. Fundus examination revealed disc edema with hyperemia, crops of multiple yellowish ill-defined retinitis lesions nasal to the disc and temporal to fovea, prominent retinitis lesion along the inferior-temporal arcade with surrounding localized neurosensory detachment and foci of vitreous inflammation. Serology was negative for Toxoplasmosis (IgG & IgM), HIV (ELISA) and Syphilis (Venereal disease research laboratory test {VDRL test},  Treponema pallidum Scientific Name Search emagglutination test {TPHA}). On subsequent follow-up, healed retinitis lesions with a live coiled worm was noted in the inferior-temporal arcade [Figure 1]. Diagnosis of LE diffuse unilateral sub-acute neuroretinitis (DUSN) was made. After patient counseling, photocoagulation was performed over the live worm along with a scatter laser in the midperiphery [Figure 2]. Oral anti-helminthic drugs (Tablet Albendazole 400 mg twice a day for four weeks and tapering dosage of oral corticosteroids (1 mg/kg body weight for four weeks) were commenced after photocoagulation. Eight weeks following therapy, BCVA in LE was 20/30 P with quiet anterior chamber, subtle disc pallor, laser scars and inner retinal folds at macula. Regular fundus evaluation and physician consultation to rule out systemic involvement was explained.
Figure 1: Fundus photography pre-laser. Left eye colour fundus photo demonstrating crops of yellow-white retinitis lesions temporal to the macula (arrow heads) and presence of coiled live worm (white arrow) along the inferior-temporal quadrant with surrounding subretinal fluid. Note the optic disc oedema with hyperaemia (star)

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Figure 2: Fundus photography post-laser Colour fundus photo (a) reveals laser marks (arrow head) encircling the dead worm (arrow). The corresponding autofluorescence (b and c) demonstrating the uncoiling of the worm after photocoagulation (arrow)

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  Discussion Top


DUSN is caused by larvae of nematodes like Baylisascaris procyonis, Toxocara canis and Ancylostoma caninum.[1] Definitive diagnosis is made by visualization of live worm, which is very rare considering light-sensitivity of the worm. If detected, laser photocoagulation is the treatment of choice. During photocoagulation, worm is delineated from the surrounding retina initially, followed by direct hit over the worm.[2] Photocoagulation in the mid-periphery disrupts blood–retinal barrier and improves oral anti-helminthic penetration, while oral steroids reduce inflammation.[3] The above case illustrates the challenges in detection and management of intraocular nematodes.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Arevalo JF, Arevalo FA, Garcia RA, de Amorim Garcia Filho CA, de Amorim Garcia CA. Diffuse unilateral subacute neuroretinitis. J Pediatr Ophthalmol 2013;50:204-12.  Back to cited text no. 1
    
2.
Gass JD, Gilbert WR Jr, Guerry RK, Scelfo R. Diffuse unilateral sub-acute neuroretinitis. Ophthalmology 1978;85:521–45.  Back to cited text no. 2
    
3.
Relhan N, Pathengay A, Raval V, Nayak S, Choudhury H, Flynn HW Jr. Clinical experience in treatment of diffuse unilateral subretinal neuroretinitis. Clin Ophthalmol 2015;9:1799-805.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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