Recurrent vitreous opacity caused by intraocular Toxocara larva: a case report and literature review.

BACKGROUND: Toxocara larva entity has seldom been reported on the surface of the retina. We report on an unusual case of recurrent vitreous opacity caused by intraocular Toxocara larva after vitrectomy. CASE PRESENTATION: A 34-year-old male was referred to our clinic with a 6-month history of decreased visual acuity in the right eye characterized as red, painless, and progressive. Optos fundus photograph showed optic disc elevation with granuloma, and proliferative membrane starting from the optic disc and running towards the superior temporal retina due to the movement of a Toxocara larva, which was covered by the proliferative membrane in the superior temporal retina. Since it adhered closely to the retina, the lesion in the superior temporal retina was not removed to avoid induction of an iatrogenic retinal break and the larva was not found during the first diagnostic pars plana vitrectomy. Intraocular Anti-Toxocara IgG was 45.53U (< 3, enzyme-linked immunosorbent assay (ELISA)), and the Goldmann-Witmer coefficient was 8.55, confirming the diagnosis of ocular toxocariasis. After this operation, visual acuity improved to 20/200. However, vitreous opacity worsened again, and the proliferative membrane expanded around the Toxocara larva three weeks after the operation. Toxocara larva was found and removed in the superior temporal region during the second operation. His visual acuity improved to 20/100, vitreous opacity disappeared, and the retina was stable two months after the second operation. CONCLUSION: It is advisable to remove suspected Toxocara larva to prevent the reoccurrence of ocular toxocariasis.

Ocular Toxocariasis: Long-Term Follow-Up and Prognosis of Patients following Vitrectomy.

Purpose: To investigate the outcomes of surgical treatment in patients with ocular toxocariasis and identify prognostic factors.Methods: We retrospectively reviewed the medical records of 56 consecutive patients who underwent vitrectomy.Results: The mean follow-up was 20.7 months. Visual acuity (VA) improved in 70.4% of patients by the final visit, but VA was better than Snellen 20/70 in only 31.5% of patients. Preoperative VA was closely correlated with final VA (P = 0.001). Macular involvement was associated with final VA worse than 20/70 (P = 0.03). The most common postoperative complications were ocular hypertension (19.6%) and retinal detachment (12.5%). Seven patients (12.5%) experienced recurrent inflammation postoperatively, but no preoperative factors were associated with recurrent inflammation.Conclusion: Surgical treatment could rescue visual function in patients with ocular toxocariasis but their prognosis was unfavorable. Preoperative VA was associated with final VA, whereas macular involvement was associated with poor visual outcomes.

Surgical treatment of ocular toxocariasis: anatomic and functional results in 45 patients.

PURPOSE: To evaluate the anatomic and functional outcome after surgery in patients with complicated ocular toxocariasis. METHODS: A retrospective review of the medical records of pediatric patients who underwent a surgical procedure for ocular toxocariasis from July 1990 to January 2005. Patients with postoperative follow-up shorter than 6 months were excluded from the study. Best-corrected visual acuity (BCVA) was arbitrarily divided into 5 groups: 1) no light perception (NLP); 2) light perception (LP) and hand motion (HM); 3) finger counting (FC) to 20/400; 4) 20/300 to 20/60; and 5) 20/50 to 20/20. RESULTS: Forty-five patients with a mean age of 8.1 years (range 6-10) were included in the study. The ocular toxocariasis presentation most commonly encountered was peripheral granuloma (38%). Twenty-one eyes presented with BCVA in the LP/HM group, 18 (40%) eyes in the FC to 20/400 group, 5 (12%) eyes in the 20/300 to 20/60 group, and 1 (5%) eye in the 20/50 to 20/20 group. The most common surgical procedure was pars plana vitrectomy (PPV) in 58% of the eyes. Four eyes (9%) presented with postoperative BCVA of NLP, 2 eyes (4%) in the LP/HM group, 12 eyes (27%) in the FC to 20/400 group, 19 eyes (42%) in the 20/300 to 20/60 group, and 8 eyes (18%) in the 20/50 to 20/20 group. CONCLUSIONS: Surgical treatment of severe ocular complications secondary to toxocara infections results in satisfactory anatomic results and may improve the overall visual outcome of these patients.

Pseudoretinoblastoma in enucleated eyes of Asian patients.

INTRODUCTION: Retinoblastomas of the eye are a cause of childhood blindness and have a high rate of mortality, as well as a hereditary mode of transmission. Other conditions that mimic retinoblastomas are known as pseudoretinoblastomas, and are managed differently. Although pseudoretinoblastoma and the accuracy of retinoblastoma diagnosis have been reviewed in Caucasian patients, published studies in Asian patients are lacking. The purpose of this article is to report our experience with pseudoretinoblastomas in two major ophthalmological centres in Asia. METHODS: A case series of 28 enucleations carried out for suspected retinoblastoma at the Singapore National Eye Centre and KK Women's and Children's Hospital, Singapore, between January 1991 and December 2002, is reported. All cases were subjected to a detailed history from parents, followed by external ocular examination, slit-lamp biomicroscopy and binocular indirect ophthalmoscopy. Ancillary studies, such as B-scan ultrasonography and computed tomography, were employed as necessary to confirm the diagnosis. Histology was obtained on all cases. RESULTS: Of the 28 cases, 25 (89 percent) were found on histological analysis to be retinoblastomas. Three (11 percent) were pseudoretinoblastomas. There were two cases of Coat's disease and a case of presumed ocular toxocariasis. These three cases were described in detail. CONCLUSION: Although our sample size is small, the percentage of confirmed retinoblastomas was found to be only slightly higher than that found in western countries. Our findings are consistent with their findings that Coat's disease and presumed ocular toxocariasis are the more common causes of pseudoretinoblastoma.

[Ocular parasitosis--particular aspects]. / Parazitoze oculare--aspecte particulare.

The goal of this study cases are presented in this study. The first case was emphasized in a patient with an epibulbar tumor and the second case was diagnosed with Toxocara Canis. In both cases the ophthalmoscopic images and the clinical evolution were unusual on the other hand etiological diagnosis in both cases was difficult. In the first case, the surgical procedure was effective, but in the second case the specific antiparasitic treatment could not stop the evolution of corioretinal's lesions; it required laser therapy.

Cerebral toxocariasis: a possible cause of epileptic seizure in children.

INTRODUCTION: Toxocariasis is a worldwide human helminthiasis, which is mostly asymptomatic and caused by toxocara canis, a roundworm in dogs. These can cause visceral larva migrans syndrome in humans who ingest contaminated soil. CNS manifestation with a focal mass lesion is very rare, seizures often being the first symptom. CASE REPORT: We describe an 11-year-old girl presenting with a generalized epileptic seizure and eosinophilia in blood. Under antibiotic therapy under the assumption of toxoplasmosis the lesion did not decrease and surgical resection was considered. We used computer-assisted surgery (CAS) for careful tissue resection. Postoperatively the diagnosis of toxocariasis was confirmed and albendozole medication was administered for 7 days. The patient developed well without neurological deficits or seizures. CONCLUSION: We conclude that although neurological involvement is rare in toxocariasis, a cerebral infection in a child with epileptic seizures and eosinophilia should be considered.

[Ocular toxocariasis. Diagnostic and therapeutic options]. / Okuläre Toxocariasis. Diagnostische und therapeutische Optionen.

BACKGROUND: The diagnosis of ocular toxocariasis can be difficult and the aim of this study was to evaluate the benefit of ELISA testing of vitreous body fluid. PATIENTS AND METHODS: We present five consecutively treated patients with ocular symptoms of toxocariasis, three of these patients presenting with epiretinal membranes and subretinal granulomas were vitrectomized. Vitreous and body fluid and serum were tested for toxocara antibodies by ELISA. Moreover vitreous body fluid of 10 patients with epiretinal membranes of other origins were examined by the same ELISA. RESULTS: In all three operated patients toxocara antibodies were detected in the vitreous fluid but ELISA testing of serum samples was negative in two of the three patients. Visual acuity increased or remained stable in the operated patients. The ELISA test was negative in all vitreous fluid samples of the control group. CONCLUSIONS: ELISA testing of vitreous body fluid can prove the presence of toxocara infection when no systemic signs of infection are present and no antibodies are detectable in the serum. Well-timed vitrectomy is a suitable therapy for vitreo-retinal complications in ocular toxocariasis to improve prognosis and to confirm the diagnosis.

[Importance of pars plana vitrectomy in the diagnosis of ocular toxocariasis]. / Význam pars plana vitrektomie v diagnostice ocní toxokarózy.

A retrospective study evaluates the importance of pars plana vitrectomy (PPV) in four patients with ocular form of toxocarosis. The results of laboratory determination of the titres of antibodies against Toxocara canis (the ELISA method) in samples of vitreous body were compared with those in the serum of the patient. The individual cases exemplify the problems in interpretation of laboratory findings and document the authors' experience in considering the diagnosis of ocular toxocarosis in individual cases. The authors' experience indicates that PPV is of diagnostic as well as of therapeutic significance.

[Submacular surgery in ocular toxocariasis: a clinic-pathologic correlation]. / Cirugía submacular en toxocariasis intraocular: una correlación clínico-patológica.

PURPOSE: To present a clinico-pathologic report on ocular toxocariasis in a nine-year-old boy with a submacular fibravascular membrane who underwent submacular surgery. MATERIALS AND METHODS: A nine-year-old boy affected by chronic ocular toxocariasis in his right eye was treated. Fundus examination disclosed multiple vitreous strands attached to the retina in the inferonasal quadrant and a submacular membrane with a surrounding exudative macular detachment. Vitrectomy surgery with submacular membrane removal was performed. RESULTS: Visual acuity improved from hand motion to 20/400 after two months of follow-up. The pathological findings revealed a fibrovascular scar without parasitic remnants in the serial section of the tissue. CONCLUSION: In this case of ocular toxocariasis, submacular surgery turned out to be a good alternative treatment to improve the patient's visual acuity. Through this kind of surgery it could be possible not only to treat vitreoretinal complications of the disease but also to excise submacular membranes and reattach the retina in the macular area.

Cirugía submacular en toxocariasis intraocular: una correlación clínico-patologica / Submacular surgery in ocular toxocariasis: a clinic-pathologic correlation

Objetivo: Presentar un reporte clínico-patológico de toxocariasis ocular en un paciente de nueve años de edad con una membrana fibrovascular submacular, que fue tratado mediante cirugía submacular. Materiales y Métodos: Un niño de nueve años de edad afectado por toxocariasis crónica en su ojo derecho recibió tratamiento. El examen de fondo de ojos reveló múltiples bandas vítreas adheridas a la retina en el cuadrante Inferonasal y una membrana submacular, rodeada por un desprendimiento macular exudativo. Se llevó a cabo una vitrectomía con remoción de la membrana submacular. Resultados: La agudeza visual mejoró de movimientos de manos a 20/400 luego de dos meses de seguimiento. Los hallazgos anatomopatológicos revelaron una cicatriz fibrovascular sin restos parasitarios en los cortes seriados del tejido. Conclusión: En este caso de toxocariasis ocular la cirugía submacular resultó ser una buena alternativa para mejorar la visión del paciente. Mediante este tipo de cirugía seria posible no sólo tratar las complicaciones vitreoretinlanas de esta enfermedad sino también resecar membranas submaculares y reaplicar la retina en el área macular.

Purpose: To present a clinico-pathologic report on ocular toxocariasis in a nine-year-old boy with a submacular fibravascular membrane who underwent submacular surgery. Materials And Methods: A nine-year-old boy affected by chronic ocular toxocariasis in his right eye was treated. Fundus examination disclosed multiple vitreous strands attached to the retina in the inferonasal quadrant and a submacular membrane with a surrounding exudative macular detachment. Vitrectomy surgery with submacular membrane removal was performed. Results: Visual acuity improved from hand motion to 20/400 after two months of follow-up. The pathological findings revealed a fibrovascular scar without parasitic remnants in the serial section of the tissue. Conclusion: In this case of ocular toxocariasis, submacular surgery turned out to be a good alternative treatment to improve the patient's visual acuity. Through this kind of surgery it could be possible not only to treat vitreoretinal complications of the disease but also to excise submacular membranes and reattach the retina in the macular area.

Cirugía submacular en toxocariasis intraocular: una correlación clínico-patologica / Submacular surgery in ocular toxocariasis: a clinic-pathologic correlation

Objetivo: Presentar un reporte clínico-patológico de toxocariasis ocular en un paciente de nueve años de edad con una membrana fibrovascular submacular, que fue tratado mediante cirugía submacular. Materiales y Métodos: Un niño de nueve años de edad afectado por toxocariasis crónica en su ojo derecho recibió tratamiento. El examen de fondo de ojos reveló múltiples bandas vítreas adheridas a la retina en el cuadrante Inferonasal y una membrana submacular, rodeada por un desprendimiento macular exudativo. Se llevó a cabo una vitrectomía con remoción de la membrana submacular. Resultados: La agudeza visual mejoró de movimientos de manos a 20/400 luego de dos meses de seguimiento. Los hallazgos anatomopatológicos revelaron una cicatriz fibrovascular sin restos parasitarios en los cortes seriados del tejido. Conclusión: En este caso de toxocariasis ocular la cirugía submacular resultó ser una buena alternativa para mejorar la visión del paciente. Mediante este tipo de cirugía seria posible no sólo tratar las complicaciones vitreoretinlanas de esta enfermedad sino también resecar membranas submaculares y reaplicar la retina en el área macular.(AU)

Purpose: To present a clinico-pathologic report on ocular toxocariasis in a nine-year-old boy with a submacular fibravascular membrane who underwent submacular surgery. Materials And Methods: A nine-year-old boy affected by chronic ocular toxocariasis in his right eye was treated. Fundus examination disclosed multiple vitreous strands attached to the retina in the inferonasal quadrant and a submacular membrane with a surrounding exudative macular detachment. Vitrectomy surgery with submacular membrane removal was performed. Results: Visual acuity improved from hand motion to 20/400 after two months of follow-up. The pathological findings revealed a fibrovascular scar without parasitic remnants in the serial section of the tissue. Conclusion: In this case of ocular toxocariasis, submacular surgery turned out to be a good alternative treatment to improve the patients visual acuity. Through this kind of surgery it could be possible not only to treat vitreoretinal complications of the disease but also to excise submacular membranes and reattach the retina in the macular area. (AU)

Vitrectomy update for macular traction in ocular toxocariasis.

PURPOSE: To study the results of modern vitrectomy in traction and combined traction-rhegmatogenous retinal detachment involving the macula in cases of ocular toxocariasis. METHODS: This was a cohort study of patients seen in different institutions in the United States. Ten eyes of 10 patients were studied. Vitrectomy was performed in all eyes, combined with membrane removal, scleral buckle, fluid-gas exchange, silicone oil, or lensectomy in certain cases. The anatomic and visual results of surgery were reviewed. RESULTS: Ten eyes from 10 patients ranging in age from 2 to 33 years (median, 6 years) were reviewed. Follow-up ranged from 3 months to 8 years (median, 2 years). All eyes achieved macular attachment following surgery; vision improved in 5 (50%) eyes, and was unchanged in 5 (50%). Histologic specimens from six eyes were reviewed, and revealed combinations of fibrous tissue, eosinophils, plasma cells, lymphocytes, and giant cells. One specimen revealed an encysted Toxocara canis organism. CONCLUSION: Inflammation created in response to Toxocara larvae may lead to traction retinal detachment of the macula. Vitreoretinal surgery has a good chance of reattaching the macula and improving vision.

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.

[An attempt to extract an intraretinal nematode located in the papillomacular bundle]. / Extraktionsversuch einer intraretinalen Nematode im papillomakulären Bündel.

BACKGROUND: The nematode infection of the retina is a rare disease with sight threatening prognosis. Untreated eyes usually become blind. There are different types of clinical progression: granuloma causing tractional detachment chronic inflammation called diffuse unilateral subacute neuroretinitis (DUSN) and rapid loss of vision named "ocular wipe-out syndrome". Efficient drugs are not available. The progression of the disease can be stopped by killing the nematode by means of photocoagulation. For parasites in the periphery of the fundus this is the therapy of choice. Photocoagulation of the nematode close to the posterior pole can cause severe damage to the visual functions. There is a need for a less detrimental treatment. PATIENT AND METHODS: We report on a 48-year-old woman with an intraretinal nematode inside the papillomacular bundle. At an early stage of the disease with normal visual acuity the eye was vitrectomized and a posterior vitreous detachment performed. It was intended to extract the worm out of the retina in toto. The retina over the parasite was incised parallel to the nerve fibers, a tiny hook inserted and the worm pulled out. RESULTS: Only one half of the parasite could be removed since the adhesion of the parasite to the retina was stronger than its own cohesion. Nevertheless the inflammation rapidly regressed. Finally a small area of pigment mottling persisted around the former location of the parasite corresponding to a relative scotoma in the visual field. Visual acuity remained unchanged at full vision. CONCLUSION: We demonstrated that nematode larvae can be removed successfully from the central retina using vitrectomy techniques. By that means the damage to the visual functions can be limited. Near the posterior pole surgical extraction of the worm may be favorable compared to photocoagulation.

Pars plana vitrectomy and subretinal surgery for ocular toxocariasis.

The clinical course of ocular toxocariasis and the chronological development of peripheral retinal and macular granulomas are reported. Removing the epiretinal as well as subretinal component of the granuloma via pars plana vitrectomy and retinotomy techniques yielded an excellent clinical result. Clinicopathologic correlation of the specimen confirmed the diagnosis with histological evidence of degenerated larval structures in granulomatous inflammation.

Diffuse unilateral subacute neuroretinitis. Report of transvitreal surgical removal of a subretinal nematode.

BACKGROUND: The precise identification of nematodes which cause diffuse unilateral subacute neuroretinitis (DUSN) has been unsuccessful. Shape and size are useful in the initial stages of identification, but histopathologic examination usually is necessary for accurate classification. Intact nematodes recovered from patients with DUSN have been mentioned scarcely in the literature. The authors report the first case of DUSN in which a viable nematode was removed successfully via a transvitreal surgical approach and recovered for parasitologic study. METHODS: Bimanual pars plana vitrectomy was performed in a 9-year-old Brazilian boy with typical DUSN in its late stage. During surgery, a motile subretinal nematode was confirmed temporal to the macular area. A retinotomy was created adjacent to the nematode. The subretinal material then was aspirated with a 20-gauge soft-tip needle, and parasitologic examination was performed. RESULTS: Based on length (630 m x 10(-6)) and width (30 m x 10(-6)) of the nematode and other features such as a small buccal capsule, an esophagus one third of body length, and tapered tail, a morphologic identification of the nematode was made as a third-stage Toxocara larva. Histopathologic examination could not be performed for confirmation because of subsequent deterioration of the specimen. CONCLUSIONS: Although direct laser photocoagulation of the nematode is the treatment of choice for DUSN, surgical transvitreal removal of the nematode may be indicated in selected cases. This method for treatment allows removal of the nematode for parasitologic identification.

[Ocular toxocara canis in a 30-year-old adult]. / Toxocara canis oculaire chez un adulte de 30 ans.

Pars plana vitrectomy was performed in a 30-year-old patient who presented a posterior traction detachment due to an inflammatory granuloma. The granuloma removed in toto during surgery revealed characteristic features of toxocariasis lesion (first case described in the literature). An ELISA test performed on a vitreous sample was strongly positive. Retinotomy around the granuloma was necessary to re-attach the retina and silicone oil was used as a tamponade for 4 months. VA improved from HM to 15/200 after silicone removal.