China
Africa
Explore chapters and articles related to this topic
Posterior uveitis
Published in Gwyn Samuel Williams, Mark Westcott, Carlos Pavesio, Bushra Thajudeen, Practical Uveitis, 2017
Gwyn Samuel Williams, Mark Westcott
There are other ocular diseases caused by worms, namely diffuse unilateral subacute neuroretinitis (DUSN) and onchocerciasis, also called river blindness. These diseases are fascinating and covered in quite a lot of detail in many textbooks but unlike Toxocara canis are vanishingly rare in a typical Western ophthalmic practice and will not be considered here. Every time I have myself considered any one of these rare diagnoses it turns out to be an unusual presentation of a far more common disease.
Vitreoretinal Surgery in Rare Conditions
Published in Pradeep Venkatesh, Handbook of Vitreoretinal Surgery, 2023
Uveitis, particularly intermediate and posterior forms, have a propensity to result in secondary affliction of the vitreous and retina. This could vary from cystoid macular edema that can be managed by medical therapy to other pathologies like vitreous haemorrhage, vitreous opacification from inflammatory membranes, epiretinal membrane, macular hole, tractional retinal detachment, rhegmatogenous detachment, and combined traction–rhegmatogenous detachment. Anterior vitrectomy may have a useful role in certain patients with severe and chronic anterior uveitis, as in the uveitis of juvenile rheumatoid arthritis. Vitrectomy is also sometimes used for obtaining samples by the procedure of vitreous biopsy. No two uveitis cases behave similarly, so the approach must be rationalized, taking into consideration the benefits (in terms of vision potential) vis-à-vis the risks. The need for vitreous surgery in non-infective uveitis seems infrequent, as is highlighted by the fact that although there are several reports in literature, most have a small sample of patients. The indications for vitrectomy in uveitis include vitreous haemorrhage, disabling vitreous membranes, resistant vitritis, epiretinal membrane, macular hole, tractional retinal detachment, rhegmatogenous retinal detachment, combined tractional–rhegmatogenous detachment, lens-induced uveitis, dislocated posterior segment drug delivery devices, remove parasitic cysts [cysticercosis, subretinal worms in diffuse unilateral subacute neuroretinitis (DUSN), hydatid cyst], and to obtain vitreous sample (Vitreous biopsy). Vitreous haemorrhage occurs in conditions like pars planitis and uveitic entities known to produce secondary vasculitis as in serpiginous choroidopathy and acute posterior multifocal placoid pigment epitheliopathy or neovacularization as in sarcoidosis and Behcet’s disease. Vitreous haemorrhage is also a frequent presentation in patients with idiopathic retinal vasculitis and neuroretinitis [IRVAN] syndrome. Extensive vitreous membranes may be seen following severe attacks of intermediate uveitis, acute retinal necrosis, and Behcet’s disease. Such membranes may also be the presenting feature in patients with intraocular lymphoma, a frequently underdiagnosed cause of masquerade syndrome.
Multifocal Chorioretinitis with Serous Macular Detachment in Diffuse Unilateral Subacute Neuroretinitis (DUSN): Unique Presentation and a Diagnostic Dilemma
Published in Ocular Immunology and Inflammation, 2023
Amit Kumar Deb, Jawahar Satya Babu, Priyanka Ramanathan, Sandip Sarkar, Goutham Raja, Charita Abburu
Diffuse unilateral subacute neuroretinitis (DUSN) is an infectious, progressive retinal disorder resulting in severe visual disturbances.1 The parasitic organisms most commonly implicated are Baylisascaris procyonis, Ancylostoma caninum, and Toxocara canis.2 DUSN commonly presents as a unilateral condition in children and young adults, but bilaterality has also been observed.3 Clinical manifestations in the acute phase includes mild vitreous inflammation, optic disc edema, gray-white retinal lesions, and pigmentary changes in retinal epithelium. Late-stage DUSN is characterized multifocal choroiditis, progressive retinal pigmentary epithelial (RPE) changes, narrowing of retinal arteriole, and optic disc atrophy.1,4 Serous macular detachment in DUSN has not been reported before in the literature. Serous detachment with multifocal choroiditis is commonly seen in conditions like Vogt–Koyanagi–Harada (VKH) syndrome, sympathetic ophthalmia, tuberculosis (TB), sarcoidosis etc.5 We, hereby, describe a case of DUSN who presented with unique features of serous macular detachment with multifocal choroiditis and no visible worm initially, thereby, posing a diagnostic dilemma.
Diffuse Unilateral Subacute Neuroretinitis Evolving With Submacular Granuloma
Published in Ocular Immunology and Inflammation, 2021
Thiago José Muniz Machado Mazzeo, Nelson Batista Sena, Mario Martins Motta, André Luiz Land Curi
Diffuse unilateral subacute neuroretinitis (DUSN) is an ocular infectious disease, that can lead to severe visual impairment and blindness. It usually occurs in healthy young individuals and depending on the stage of the disease it may present as vitritis, multifocal gray-white lesions in the outer retina, derangement of the retinal pigment epithelium, narrowing of the retinal vessels and optic atrophy.1,2
Extensive Chorio-retinal Damage Due to Dirofilaria Repens- Report of a Case
Published in Ocular Immunology and Inflammation, 2021
Prasad Gupta, Suchitra Pradeep, Jyotirmay Biswas, Pukhraj Rishi, Raman Muthusamy
A 43-year-old man from Bihar, carpenter by profession, presented with complaints of floaters in the left eye associated with episodes of redness for 6 months and blurred vision in the left eye for 3 months. The patient consulted locally and was diagnosed to have some retinal disease for which topical steroids and posterior sub-tenon triamcinolone injection was given. His medical history was significant for treatment of filariasis 4 months back and pulmonary tuberculosis 15 years ago. The patient did not have any ocular complaints prior to this episode and had undergone ocular examination by a local ophthalmologist prior to this episode which was unremarkable. On examination, his best correct visual acuity (BCVA) was 6/6 N6 in right eye and 6/60 N36 in left eye. Ocular adnexal findings were unremarkable. Color vision was normal in right eye but defective in left eye (21/21 right eye, 0/21 left eye). Intraocular pressure by Goldmann applanation tonometry was 16 and 42 mm of Hg in the right and left eye respectively. On slit lamp examination, both eyes had shallow anterior chamber and underwent YAG peripheral iridotomy. The anterior chamber was quiet. The intraocular pressure came down to 10 mm Hg in the left eye after YAG-Peripheral iridotomy. Right eye fundus was unremarkable. Left eye fundus showed vitreous floaters, hyperemic disc, epiretinal membrane, extensive retinal pigment epithelium atrophy, and mottling. In the vitreous cavity, a slender worm was discovered (Figure 1). A diagnosis of Diffuse Unilateral Subacute Neuroretinitis (DUSN) secondary to worm infestation was made. Optical coherence tomography (OCT) of left eye showed thick epiretinal membrane and retinal thickening over the macula. Visual fields showed central and inferior defect in the left eye. Peripheral blood smear for microfilaria was negative. The patient underwent left eye 23-gauge pars plana vitrectomy with epiretinal membrane and worm removal under steroid and anti-helminthic cover. The surgical steps included core vitrectomy followed by clearing of the vitreous around the worm. The worm was sucked into the cutter after attaching 5cc syringe at the aspiration line. The worm was regurgitated back into the bowl. The epiretinal membrane was removed while inducing the posterior vitreous detachment at the macula, the worm was sent in saline for histopathological study. The worm examined under light-microscope showed nerve ring, esophagus, deirids, first portion of intestine, and the vulvar opening. The cephalic end was tapered with two spots while the caudal end was hook shaped (Figure 2). It was suggestive of Dirofileria repens infestation. Nested PCR was done using primer DR COI-FI-5ʹ AGT GTT GAT GGT CAA CCT GAA TTA-3ʹDR COI-RI-5ʹ GCC AAA ACA GGA ACA GAT AAA ACT-3ʹ. The PCR analysis showed partial COX1 gene (209bp) of Dirofilaria repens. At 6 weeks post-surgery, BCVA was 6/6 and 6/36 in the right and left eye respectively. An electroretinogram suggested reduced photopic and scotopic response in the left eye (Figure 3). The OCT done at 6 weeks post-surgery showed normal foveal contour with intact inner retinal layers and loss of the photoreceptor layers (Figure 4).