OSLI Retina

December 2020

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December 2020 ยท Vol. 51, No. 12 733 The Cutting Edge Edited by Yoshihiro Yonekawa, MD, and Peter H. Tang, MD, PhD The authors present an interesting case of a mid- dle-aged woman with fundus features consistent with late-stage diffuse unilateral subacute neu- roretinitis (DUSN), characterized by decreased vision to hand motions in the right eye and a live nematode larva that was found mov- ing on the retinal surface. Al- though initial laser photocoag- ulation was unsuccessful, the authors were able to remove the motile larva by surgically aspirating into a vitreous cut- ter. DUSN is typically associ- ated with a subretinal motile nematode larva, with migra- tion to the vitreous being ex- ceedingly rare. Treatment consists of direct laser photocoagulation of the organism when possible, or systemic anti-helminthic therapy such as oral albendazole. The particularly unique aspect of this case is the observation of a live, moving larva within the vitreous months after the subretinal insult that resulted in optic and chorioretinal atrophy as well as subretinal fibrosis. Difficulties with laser photocoagulation of this highly motile intravitre- al "target" led the surgeons to an elegant transvit- real approach. Key aspects of the surgery include clamping the infusion line to minimize vitreous turbulence and deferring the lifting of the pos- terior hyaloid before aspiration of the organism. The initial unsuccessful attempt to aspirate the larva with a soft tip cannula from above was fol- lowed by successful aspiration from the side with a vitreous cutter attached to a syringe on manual suction. The authors are to be congratulated for their refined and ingenious technique. This is a rare opportunity to surgically address an intra- vitreal moving larva that may have caused even more intraocular damage if were not removed in a timely manner. Daniel Vitor Vasconcelos-Santos, MD, PhD Adjunct Professor of Ophthalmology and Head of Uveitis Universidade Federal de Minas Gerais Belo Horizonte, Brazil Daniel Vitor Vasconcelos-Santos, MD, PhD Surgical Removal of Intraocular Parasite in a Patient With Diffuse Unilateral Subacute Neuroretinitis Anne L. Kunkler, MD; Nimesh A. Patel, MD; Nathan L. Scott, MD; Jayanth Sridhar, MD; Thomas A. Albini, MD ABSTRACT: Diffuse unilateral subacute neuroretini- tis (DUSN) is a rare ocular infectious disease caused by migrating larvae of a nematode. DUSN is often a diagnostic challenge as it is difficult to identify the pathogenic nematode on funduscopic examination because it moves frequently and often resides with- in the subretinal space. Herein, the authors present a patient with unilateral, chronic visual loss who was noted to have a live, motile worm within the vitreous cavity. Initial attempts to treat with laser photocoagulation were unsuccessful. In the accom- panying video, the authors report the first case of a live intraocular parasite successfully removed with pars plana vitrectomy. A 54-year-old woman presented with 4 months of progressive vision loss in her right eye. She was originally from Honduras and lived in Louisiana for the previous 12 years. At presenta- tion, her visual acuity was hand motions in the right eye and 20/25 in the left. An afferent pupillary de- fect was present on the right side. Anterior segment exam was unremarkable in both eyes. Posterior exam in the right eye was significant for mild vitritis, optic atrophy, and numerous yellow chorioretinal atrophic and fibrotic changes in the macula and posterior pole. A live, motile, intravitreal parasite was identified to reside on the surface of the retina. Posterior exam was unremarkable in the left eye.

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