[Atypical ocular toxocariasis in a child: A case report]. / Toxocarose oculaire atypique chez un enfant : à propos d'un cas.

INTRODUCTION: Ocular toxocariasis is a rare disease, predominantly affecting children and young adolescents, and usually presenting as unilateral posterior uveitis. We report the case of a child with toxocariasis associated with serous retinal detachment. OBSERVATION: A 8-year-old child with no previous history of toxocariasis was referred for a 1-year decline in visual acuity, unimproved by optical correction, with vitreous condensation on examination, without central or peripheral granulomas, and serous retinal detachment on OCT. The diagnosis was made after extensive questioning, with evidence of contact with dogs and positive serology. Medical treatment combining corticosteroid therapy and antiparasitic therapy was initiated, and the clinical picture improved. DISCUSSION: Ocular toxocariasis is a rare infection, unilateral in 90% of cases. Its clinical manifestation in children is pars planitis, posterior uveitis with a posterior pole chorioretinal focus associated with vitreoretinal traction and/or peripheral granuloma. In our case, the patient presented with vitreous condensation only, with OCT serous retinal detachment and no peripheral or central granulomas. Positive plasma serology or ocular samples confirmed the diagnosis. CONCLUSION: Ocular toxocariasis should not be ruled out in the absence of a typical clinical picture, and seropositivity enables confirmation of the diagnosis when clinical suspicion arises.

Irreversible Ocular Lesions in a Dog With Angiostrongylus Vasorum Infection.

This report describes a 10-month-old dog with a sudden loss of vision and severe dyspnoea. The ocular examination revealed bilateral panuveitis, lens subluxation, secondary glaucoma, and retinal detachment. In addition, the ocular ultrasound showed in the vitreous body of the right eye, a small doubled-lined foreign body compatible with an intraocular parasite. Radiographs of the thorax revealed an increased opacity with mixed lung pattern (alveolar and bronchial) and thoracic ultrasonography showed several subpleural nodules. The presence of Angiostrongylus vasorum first stage larvae was confirmed with 324 larvae per gram of feces and an antigen test for the parasite (AngioDetect, IDEXX) also yielded a positive result. The severe and irreversible ocular lesions described in this case enhanced the complexity of the clinical picture of canine angiostrongylosis. Infection with the parasite should be included in the list of differential diagnoses for ocular uveitis to avoid potentially serious complications related to a missed or delayed diagnosis.

Intravitreal Angiostrongylus cantonensis: first case report in South America.

This study reports the first case of intravitreal angiostrongyliasis in South America treated with posterior worm removal via pars plana vitrectomy. This was a retrospective, observational case study. Data from medical charts, wide-field digital imaging, ocular ultrasound, and visual evoked potential studies were reviewed. A 20-month-old boy presented with eosinophilic meningitis and right eye exotropia. Polymerase chain reaction analysis of the cerebrospinal fluid showed a positive result for Angiostrongylus cantonensis. Fundus examination revealed a pale optic disc, subretinal tracks, vitreous opacities, peripheral tractional retinal detachment, and a dead worm in the vitreous cavity. The patient underwent pars plana vitrectomy with worm removal. This case report illustrates the first case of intravitreal angiostrongyliasis in South America, possibly related to the uncontrolled spread of an exotic invasive species of snail.

Intravitreal Angiostrongylus cantonensis: first case report in South America / Angiostrongylus cantonensis intravítreo: primeiro relato de caso na América do Sul

ABSTRACT This study reports the first case of intravitreal angiostrongyliasis in South America treated with posterior worm removal via pars plana vitrectomy. This was a retrospective, observational case study. Data from medical charts, wide-field digital imaging, ocular ultrasound, and visual evoked potential studies were reviewed. A 20-month-old boy presented with eosinophilic meningitis and right eye exotropia. Polymerase chain reaction analysis of the cerebrospinal fluid showed a positive result for Angiostrongylus cantonensis. Fundus examination revealed a pale optic disc, subretinal tracks, vitreous opacities, peripheral tractional retinal detachment, and a dead worm in the vitreous cavity. The patient underwent pars plana vitrectomy with worm removal. This case report illustrates the first case of intravitreal angiostrongyliasis in South America, possibly related to the uncontrolled spread of an exotic invasive species of snail.

RESUMO O objetivo deste estudo foi relatar o primeiro caso na América do Sul de angiostrongilíase intravítrea tratada com vitrectomia posterior via pars plana e remoção do verme. Este foi um relato de caso observacional. O prontuário médico, sistema de imagem digital de campo amplo, ultrassonografia ocular, e potenciais evocados visuais foram revistos. Um menino de 1 ano e 8 meses de idade manifestou meningite eosinofílica e exotropia olho direito. A análise de PCR do liquor foi positiva para Angiostrongylus cantonensis. O exame de fundo de olho revelou disco óptico pálido, faixas sub-retinianas, opacidades vítreas, descolamento de retina tracional periférico e um verme morto no vítreo. O paciente foi submetido a vitrectomia posterior via pars plana com a remoção do verme. Concluindo, este é o primeiro relato de caso de angiostrongilíase intravítrea na América do Sul, possivelmente relacionado com a disseminação de uma espécie de lesma exótica neste continente.

Atypical Presentation of Ocular Toxoplasmosis: A Case Report of Exudative Retinal Detachment and Choroidal Ischemia.

A 24-year-old healthy male presented with a chief complaint of blurred vision in the right eye for 1-week. Fundus examination indicated right exudative retinal detachment and choroidal ischemia. The patient responded well to anti-toxoplasmosis medications and steroids. Exudative retinal detachment and choroidal ischemia are atypical presentations of ocular toxoplasmosis. However, both conditions responded well to anti.parasitic therapy with steroid.

Molecular Diagnosis of Human Taenia martis Eye Infection.

Taenia martis, a tapeworm harbored in the intestine of mustelids, is a rarely encountered zoonotic cysticercosis pathogen. The larval stage closely resembles the Taenia solium cysticercus, but the natural host and thus the epidemiology of the disease is different. We here report a human eye infection diagnosed molecularly in a previously healthy female German patient. The case represents the third human infection described worldwide; the two previous cases were also European, involving eye and brain.

Unusual presentation of subretinal cysticercosis with hypopyon uveitis.

Subretinal cysticercosis presenting with anterior uveitis and hypopyon is rare. A 7-year-old boy presented with pain and hypopyon in the right eye. Ultrasonography showed a cystic lesion with scolex. Because visual prognosis was poor, he was treated conservatively. Timely diagnosis would facilitate early therapy and prevent visual loss.

Retinal detachment associated with ocular toxoplasmosis.

PURPOSE: To assess the frequency of retinal detachment (RD) and associated clinical features in ocular toxoplasmosis. METHODS: A review of the medical records of patients diagnosed with ocular toxoplasmosis and follow-up of 6 months or more was conducted. All patients were seen at the Casey Eye Institute at the Oregon Health & Science University over a 9-year period (2003-2012). Demographic data, presence of RD and/or vitritis, and treatments were reviewed. Main outcome measures were the rate of RD in ocular toxoplasmosis, degree of vision loss, and final anatomical status of the retina. Disease- and treatment-related factors associated with poor visual outcome were also analyzed. RESULTS: Thirty-five eyes of 28 patients with ocular toxoplasmosis and sufficient follow-up were studied. Median age of patients was 40 years (range, 7-93 years). Median follow-up time was 22.5 months (range, 6-96 months). Four of thirty-five eyes (11.4%) developed RD with a frequency of 0.06 RD events per patient-year of follow-up in this sample in a single center. Of four patients with RD, three underwent pars plana vitrectomy and one underwent laser retinopexy. Two of the 4 patients had recurrent RD requiring scleral buckle. At final follow-up, all patients who underwent surgical repair had attached retinas; however, 3 of 4 patients had severe vision loss (20/200 or worse). CONCLUSION: Retinal detachment occurred in 11% of eyes in this study that led to severe vision loss despite successful RD repair.

Toxocariasis of the optic disc.

A healthy 46-year-old man presented with decreased vision in the right eye after ingestion of raw meat. On funduscopic examination, a cystic lesion was found on an edematous right optic disc with adjacent serous retinal detachment. Optical coherence tomography confirmed a peripapillary serous retinal detachment and a well-demarcated cystic lesion (200 × 200 × 500 µm) in the right eye. The patient had moderate eosinophilia and was seropositive for anti-Toxocara IgG antibody. Diagnosed with ocular toxocariasis, he was treated with systemic corticosteroids and albendazole with improvement in vision and fundus appearance.

Clinical pattern of ocular toxoplasmosis treated in a referral centre in Serbia.

PURPOSE: To analyze the clinical pattern of ocular toxoplasmosis (OT) in a referral centre in Serbia. PATIENTS AND METHODS: The medical records of consecutive patients admitted for OT to the single referral centre for uveitis in Serbia between 2006 and 2010 were retrospectively analyzed. OT was diagnosed on the basis of typical fundus lesions and positive serology for Toxoplasma. RESULTS: In a total of 457 uveitis patients, OT was the third leading cause, with 59 patients (12.9%). Most OT cases (73%) were monocular. An active primary retinal lesion was observed in 36% and recurrent OT in 64% patients. Localization of lesions was central/paracentral (44%), juxtapapillar (27%), peripheral (19%), and multifocal (10%). Other ocular manifestations of inflammation included vitritis (44%), anterior uveitis (19%), and retinal vasculitis (10%). Complications included choroidal neovascularization in two and exudative retinal detachment with cataract, glaucoma, and cystoid macular oedema in one patient each. The detection of Toxoplasma-specific IgM antibodies in a single patient indicates a low rate of OT concomitant with acute infection. After treatment, the mean best-corrected visual acuity (BCVA) increased significantly. However, 14 (24%) patients ended up legally blind in the affected eye, of which 2 (3%) with bilateral blindness, all with a very poor BCVA (0.047 ± 0.055) at presentation. Visual impairment and treatment outcome were both associated with central localization of lesions (P<0.0001 and P=0.006, respectively). CONCLUSION: OT is a significant cause of posterior uveitis in Serbia. Patients should be aware of the recurring nature of OT and react immediately if symptoms occur.

Clinical, tomographic, and angiographic findings in patients with acute toxoplasmic retinochoroiditis and associated serous retinal detachment.

PURPOSE: To describe the clinical, optical coherence tomographic, and angiographic findings in patients with acute toxoplasmic retinochoroiditis (RC) associated with serous retinal detachment (SRD). METHODS: The study included 60 eyes with acute toxoplasmic RC. RESULTS: Of 60 eyes, 14 (23.3%) were found to have SRD. The SRD was visible on fundus examination in 6 cases and detectable only by optical coherence tomography (OCT) in the 8 remaining cases. It involved the fovea in 9 eyes. There was evidence of associated choroidal ischemia on fluorescein angiography and indocyanine green angiography in 5 eyes. Findings seen at the acute stage gradually resolved over a period of 2-6 weeks in all patients. CONCLUSIONS: SRD, accurately detected by OCT, is a common complication of acute toxoplasmic RC that should be considered as a potential cause of visual loss. Choroidal ischemia might contribute to the development of such complication.

Ophthalmomyiasis with a singular subretinal track.

PURPOSE: To report 3 cases of myiasis with a singular subretinal track in the Northeastern part of United States. DESIGN: Noninterventional case series. METHODS: Three patients from Pennsylvania were referred for evaluation of a linear and serpiginous retinal scar. Funduscopic examination and fluorescein angiography were performed to assess the referred retinal lesion. RESULTS: Funduscopic examination showed a singular subretinal track from the superior periphery to either the posterior pole or inferior midperiphery in the study cases. Fluorescein angiography showed exudative retinal detachment in all 3 cases. Laser photocoagulation of the subretinal worm was performed in all reported cases. CONCLUSIONS: Our case series represents a report of singular subretinal tracks presumably caused by the warble fly larva in the Northeastern part of United States.

Prevalence, clinical features, and causes of vision loss among patients with ocular toxocariasis.

BACKGROUND: To describe the prevalence, clinical features, and causes of vision loss among patients with ocular toxocariasis seen at a uveitis referral center. METHODS: A review was completed of the charts of patients with ocular toxocariasis who were examined between 1977 and 1996 at the Francis I. Proctor Foundation of the University of California at San Francisco. The prevalence of ocular toxocariasis among all uveitis patients seen at the center was determined. Demographic features, symptoms, and signs in all patients were evaluated. RESULTS: Ocular toxocariasis occurred in 22 (1.0%) of 2,185 uveitis patients. The mean patient age was 16.5 years. Inflammation was usually unilateral (90.9%). Toxocara uveitis presented as a granuloma in the peripheral retina in 50% of cases, as a granuloma in the macula in 25% of cases, and as a moderate to severe vitreous inflammation mimicking endophthalmitis in 25% cases. The primary causes of vision loss were vitritis (52.6%), cystoid macular edema (47.4%), and traction retinal detachment (36.8%). CONCLUSIONS: Ocular toxocariasis is an uncommon cause of uveitis that mainly affects younger patients. Inflammation is typically unilateral and presents as either a granuloma in the peripheral or posterior retina or a moderate to severe vitreous inflammation mimicking endophthalmitis.