Ocular toxocariasis: a rare presentation of a posterior pole granuloma with an associated choroidal neovascular membrane.

BACKGROUND: Ocular toxocariasis is a rare infection caused by the nematode larvae of toxocara canis, which is commonly found in dogs. Human transmission is usually via geophagia, the ingestion of food contaminated with the toxocara eggs, or contact with infected puppies, often resulting in devastating ocular and/or systemic effects. Distribution is worldwide; however, a higher incidence is demonstrated in the United States. METHODS: A 17-year-old black woman sought treatment at a neighborhood health center with a report of gradual decrease in vision from her left eye over a 3-month period. Her ocular and systemic histories were unremarkable. Anterior segment evaluation revealed no signs of anterior uveitis. The posterior pole showed a 1.5 DD, round, raised, white, subretinal lesion adjacent to the fovea with an overlying serous retinal detachment and retinal hemorrhage. RESULTS: She was referred to a retinologist who performed both fluorescein and indocyanine green (ICG) angiographies. A serum toxocara ELISA test was also ordered. Fluorescein angiography revealed hyperfluorescence consistent with the granuloma. The ICG demonstrated an occult choroidal neovascular membrane (CNV) underlying the area of hemorrhage inferotemporal to the granuloma. CONCLUSION: This paper illustrates the case presentation and includes an extensive review of the ocular and systemic manifestations of toxocariases. A description of ICG videoangiography, therapeutic approaches, and management will also be discussed.

Role of indocyanine green fluorescence videoangiography in evaluation of subretinal disease.

BACKGROUND: Indocyanine green (ICG) is a sterile, water-soluble, tricarbocyanine dye that can be used in fundus angiography as an adjunct to sodium fluorescein. It has a peak spectral absorption of 805 nm in blood plasma or blood, as compared with fluorescein, which has a peak spectral absorption of 465 nm. Because the absorption and emission of ICG lies around 835 nm, transmission of energy by the retinal pigment epithelium (RPE) and serosanguinated material is more efficient in this region than in the region of visible light energy. ICG has the property of being approximately 98% bound to blood protein, disallowing extravasation of excessive dye in the highly fenestrated choroidal vasculature. METHODS: The characteristics of ICG are discussed, including administration and dosage, adverse reactions and use of infrared filters for fundus photography. In addition, two cases are presented to illustrate the clinical application of ICG for diagnosis and treatment of choroidal neovascular membranes. RESULTS: ICG videoangiography can be used to reveal subfoveal choroidal neovascular membranes not previously identified with fluorescein; angiograms can also be used to dramatically highlight retinal and choroidal changes. CONCLUSIONS: The use of ICG for fundus videoangiography provides a more accurate and complete evaluation in certain cases of subretinal and choroidal disease.

Diagnosing inclusion conjunctivitis.

BACKGROUND: Diagnosing adult inclusion and neonatal conjunctivitis can be challenging. They are sexually transmitted diseases that can easily be managed without any serious ocular or systemic sequelae if recognized and treated early on. METHODS: A proper differential diagnosis and careful examination is essential in the management of chlamydial conjunctivitis. RESULTS: Two case reports of patients with laboratory-confirmed inclusion conjunctivitis will be presented. CONCLUSIONS: A careful history and ophthalmic evaluation, along with laboratory studies, which revealed inclusion bodies, confirmed the diagnosis of adult inclusion conjunctivitis. Therefore, proper treatment and management of each case occurred.

Geographic (serpiginous) choroiditis.

Geographic (serpiginous) choroiditis, also known as Geographic Helicoid Peripapillary Choroidopathy, is a rare, chronic, and progressive, bilateral disorder primarily involving the choriocapillaris, retinal pigment epithelium, and the overlying sensory retina. Progression typically occurs as pseudopodial extensions away from the optic discs and usually infringes upon the macula and foveal region. The disease occurs fairly acutely, in young to middle age patients with no sexual predilection. These patients commonly present with sudden, painless vision loss in one eye, which later, most likely will affect the other eye. The disease is always bilateral, but usually asymmetrical in appearance. It presents with active and inactive stages. The etiology is essentially unknown. This paper will present a case of geographic choroidopathy with differential diagnosis considerations and appropriate optometric management.