Nematode-induced low-grade chronic inflammation of the iris.

PURPOSE: There are thousands of parasitic nematode species that have been identified. Many have been documented to invade the eye and periorbital tissues. Whether adult or larvae, alive or dead, they can result in a wide range of ocular and systemic manifestations. Classification of the nematode can be helpful in the treatment planning for these patients. CASE REPORT: A 60-year-old Hispanic male presented without complaints. During routine examination, the presence of peripheral anterior synechiae, posterior synechiae, and focal cataract were linked to an immobile, partly degenerated 2 to 3 mm long coiled nematode in the anterior chamber. CONCLUSION: Results from DNA analysis were most consistent with a member of the Trichostrongylus or Metastrongylus genera, or a new nematode species.

Cysticercosis in the anterior chamber: a case report.

Cysticercosisis a public health problem and its occurrence in the anterior chamber of the eye israre. It occurs following ingestion of poorly cooked infested meat of pigs, sheep and dogs etc. Clinical evaluation and investigations were done to determine the cause of defective vision in a 45 year old female patient. A cyst was removed surgically from the anterior chamber by visco expression followed by a course of medication. The cyst was taken for histopathological examination. Investigations revealed mild eosinophilia on blood examination and an erythrocyte sedimentation rate of 95 mm/hr. Histology showed a cystic lesion with a thin fibrocollagenous wall and a hyalinised scolex within the lumen.A high index of suspicion is required for appropriate diagnosis and subsequent management of patients with anterior chamber cysticercosis.

Acute acquired toxoplasmic retinochoroiditis in a patient with anterior uveitis, amplified by immunosuppressive therapy.

BACKGROUND: A 24-year-old immunocompetent man with anterior uveitis developed a bilateral multifocal retinochoroiditis after an acute febrile multisystemic illness. HISTORY AND SIGNS: Because of his history of idiopathic uveitis the multisystemic illness was treated with oral prednisone. When a retinochoroiditis occurred cyclosporine was added. This was followed by an extensive flare-up of the retinochoroiditis. The diagnosis of toxoplasmosis was then established by a positive polymerase chain reaction (PCR) from aqueous humour and confirmed by isolation of the parasite in several organs. THERAPY AND OUTCOME: On the base of kept frozen sera the acute febrile episode was found to be an acquired toxoplasmosis. On re-examination all evidence of pre-existing Fuchs' uveitis was gathered. The immunosuppressive therapy was discontinued and the patient was kept under anti-toxoplasmic maintenance therapy for 1 year without recurrence of the retinochoroiditis. CONCLUSIONS: The case illustrates a possible consequence of immunosuppressive therapy in infection with toxoplasmosis and the importance of the diagnosis of a pre-existing noninfectious uveitis.

Angiostrongylus cantonensis in anterior chamber.

Live worm in anterior chamber is a rare finding. We hereby report a case of ocular Angiostrongylus cantonensis, which, to the best of our knowledge, is the third case report from India. A 70-year-old female presented with the complaints of watering and foreign body sensations in right eye since 2 months. On examination, a translucent worm of approximately 15 mm length was found freely moving in anterior chamber. Patient underwent surgical removal of live worm, which was identified as A. cantonensis. Educating people regarding importance of hygiene is important for prevention of worm infestation.

First report of equine Setaria digitata (von Linstow 1906) infestation in Malaysia.

The occurrence of Setaria digitata in a horse is reported for the first time in Malaysia. An 8-year-old Thoroughbred cross mare was referred to the University Veterinary Clinic with the primary complaint of corneal opacity and excessive eye discharge. After initial treatment with Terramycin eye ointment, corneal opacity cleared partially to reveal a moving thread-like cylindrical worm in the anterior chamber of the eye. The parasite was successfully removed surgically, and examination under the light microscope revealed that the isolated worm (length = 45 mm) was a 5th stage larva of S. digitata based on morphological criteria. Confirmation of the species of the worm was through molecular methods. The 12S rRNA gene was PCR-amplified, and the purified amplicon was directly sequenced. Phylogenetic analyses revealed that the isolated roundworm showed 100% sequence similarity with that of S. digitata in NCBI GenBank database (Accession no.: KY284626.1). This report is the first confirmed case of equine ocular setariasis by S. digitata in Malaysia. The current study provides evidence that S. digitata is an etiological agent of ocular infection and its presence in Malaysia.

Ocular parasitosis: a rare cause of hypertensive uveitis.

A middle-aged Asian gentleman presented with four weeks' history of recurrent redness, pain and deterioration of vision in his right eye. He was diagnosed with chronic, unilateral, granulomatous hypertensive uveitis. During one of the serial examinations a single, off-white, extremely motile, thread-like worm about 15 mm long was noted in the anterior chamber. Surgical retrieval of the worm was unsuccessful. The worm disappeared in the eye and was never seen again. Patient suffered from chronic waxing and waning granulomatous inflammation with uncontrolled high intraocular pressure despite treatment. The vision dropped down to no perception of light. Therapeutic success in such patients depends upon early and complete surgical removal of the worm, which could be a real challenge as worms are highly motile and only visible sporadically, as in this case. Ocular parasitosis should be kept in mind as a differential diagnosis in treating non-responsive chronic hypertensive granulomatous inflammation, especially if the patient is of Southeast Asian origin or has recently visited the region.

Worm in anterior chamber of the eye.

We report a case of a 42-year-old female patient who presented to the ophthalmology outpatient department with painful red eye for 1 month. Slit-lamp microscopy showed a live worm in the anterior chamber of left eye. The worm was surgically removed under topical anaesthesia. It was sent to the microbiology department for further identification and was found to be adult female Loaloa.

An Encounter with a Worm in Anterior Chamber: A Case Report.

BACKGROUND: Several parasites are known to affect the eyes, some of them even causing blindness. Data on helminths infecting the eye are scant and mostly limited to case reports from different countries. CASE: A 53 years old female presented with complaint of redness, foreign body sensation and diminution of vision in right eye since one month. OBSERVATIONS: On examination a live motile worm was found wriggling in the anterior chamber which was surgically removed. The microscopic findings were in favour of Dirofilaria. However, detailed histopathological examination and determination of species couldn't be done. CONCLUSION: The occurrence of parasite in eye is an uncommon event. Most of these parasites are found in subconjunctival or subretinal regions. Those in anterior chamber is a very rare event. Recently Dirofilaria is being recognised as an emerging zoonosis.

A live cysticercosis in anterior chamber leading to glaucoma secondary to pupilary block.

A 28-year-old woman presented with pain and redness in her left eye. On examination, a free-floating cyst of size 4 mm with prominent scolex was observed in the anterior chamber. Scolex was occasionally moving in and out of its bag. To prevent the cyst migrating to the posterior chamber, pilocarpine eye drops were instilled. After 2 hours, the patient developed total pupilary block with iris bombe. The intraocular tension was 48 mm Hg. The diagnosis of cysticercosis leading to glaucoma secondary to pupilary block was made. The cyst was removed surgically by viscoexpression. The histopathology proved to be a cysticercosis.

Fibrinous anterior uveitis due to cysticercus cellulosae.

PURPOSE: To report a case of fibrinous anterior uveitis due to cysticercus cellulosae in anterior chamber. DESIGN: Retrospective, interventional case study. METHODS: Patient underwent complete ophthalmic and systemic evaluation with relevant investigations. Viscoexpression of anterior chamber cysts were done under general anaesthesia. RESULTS: A 10-year-old male child presented as unilateral fibrinous iridocylitis with secondary glaucoma. Two cysts of cysticercus cellulosae were seen after control of inflammation. Complete resolution of uveitis occurred once the cysts were removed by viscoexpression. CONCLUSION: Cysticercus cellulosae can present as fibrinous anterior uveitis with secondary glaucoma. Removal of the cyst can cause complete resolution of uveitis.

Persistent corneal edema secondary to presumed dead adult filarial worm in the anterior chamber.

We present three cases of persistent corneal edema secondary to presumed dead adult filarial worms lying in the anterior chamber with their attachment to the endothelium. Two of them were initially diagnosed as descemet's fold with corneal edema. Two patients underwent penetrating keratoplasty and in one case, surgical removal was partly possible with clearing of cornea.

Ocular dirofilariasis by Dirofilaria immitis in a child in Iran: A case report and review of the literature.

This report describes a rare case of ophthalmic dirofilariasis in a 2-year-old boy with redness, irritation, pain and foreign body sensation in the right eye. Slit lamp examination demonstrated a thread-like whitish nematode in the anterior chamber of the right eye that twisted around itself. The nematode worm (35mm long and 150-200µm width) was removed surgically. The presence of the smooth cuticular surface without longitudinal ridges and the vulva showed that it could be a female Diroflaria immitis. PCR amplification was done to verify the Diroflaria species. PCR amplification and sequence analysis of mitochondrial 12S rDNA confirmed that recovered worm was D. immitis. Ocular dirofilariasis caused by D. immitis is very rare, but it must be considered in humans living in endemic areas.

The reliability of anterior segment lesions as indicators of onchocercal eye disease in Guatemala.

World Health Organization certification criteria for onchocerciasis elimination use anterior segment eye lesion prevalence as an indicator of mass ivermectin treatment program success. Lesions either contain visible microfilaria (noninflammatory punctate keratitis [PK] or microfilariae in anterior chamber [MFAC]), or microfilaria obscured by inflammation (inflammatory PK). To assess the utility of these disease indicators, two experienced ophthalmologists independently examined persons from endemic (N = 325) and nonendemic (N = 348) Guatemalan communities. Thirty-six (11.1%) and nine (2.6%) persons from endemic and nonendemic areas respectively had lesions found by either ophthalmologist (prevalence ratio = 4.3, 95% CI 2.1-8.8, P < 0.001). All lesions in nonendemic areas were inflammatory PK in whom no persons were seropositive for onchocerciasis. Overall, observer agreement was moderate (Kappa = 0.49), and most (61%) discordance occurred with inflammatory PK lesions. Our findings suggest that inflammatory punctate keratitis is neither a specific nor a reliable indicator of onchocercal eye disease. Future prevalence surveys should rely upon noninflammatory lesions as disease indicators.

A case of anterior internal ophthalmomyiasis: case report.

A case of anterior internal ophthalmomyiasis is described. A 27-year-old female from Northern Brazil presenting with anterior uveitis and vitritis had a fly larva surgically removed from the anterior chamber of the left eye. The species was Cochliomyia hominivorax. The larva was covered by macrophages and foreign body giant cells characterizing a foreign body granulomatous reaction.

Failure of Acanthamoeba castellanii to produce intraocular infections.

PURPOSE: This study examined possible mechanisms to explain why Acanthamoeba castellanii remains restricted to the cornea and rarely produces intraocular infections. The first hypothesis proposed that trophozoites cannot penetrate Descemet's membrane and the corneal endothelium to enter the anterior chamber (AC). The second hypothesis proposed that the trophozoites can enter the AC; however, the aqueous humor (AH) contains factors that either induce encystment or kill the amoebae. METHODS: Descemet's membrane was isolated from pig corneas and was used to determine whether Acanthamoeba trophozoites could penetrate this membrane in vitro. In addition, the capacity of trophozoites to survive in AH was determined in vitro. Trophozoites (10(6)) were injected into the AC of hamster eyes, and the number of amoebae in the AC was determined by histopathology 1 to 15 days later. RESULTS: The amoebae penetrated Descemet's membrane within 24 hours of in vitro culture. Penetration was prevented by addition of serine protease inhibitors or a chicken monoclonal antibody against the Acanthamoeba serine protease MIP-133. Although AH induced encystment of the amoebae, cysts remained viable. Injection of amoebae into the AC induced a robust neutrophil infiltrate, which was associated with complete clearance by day 15 after AC injection. CONCLUSIONS: The findings suggest that A. castellanii is capable of penetrating Descemet's membrane and entering the AC. However, a robust neutrophil response is associated with the disappearance of intraocular trophozoites and suggests that cells of the innate immune apparatus are important in preventing Acanthamoeba keratitis from progressing to become an intraocular infection.

Fasciola hepatica in the human eye.

During intraocular surgery of a 44-year-old woman from Guilan Province in north Iran, a small flat parasite was removed from the anterior chamber angle of the left eye. According to morphological characterisation of the parasite, it was identified as Fasciola hepatica. The route of entry of the parasite was not identified. Meanwhile, stool and serology examinations of the patient for diagnosis of Fasciola infection were negative. In endemic areas of F. hepatica infection, ocular involvement should be considered in cases of uveitis, despite no other systemic involvement.

A randomized, double-blind, controlled trial of the effects of ivermectin at normal and high doses, given annually or three-monthly, against Onchocerca volvulus: ophthalmological results.

A three-year randomized, controlled, double-blind trial was conducted in Cameroon to determine whether ivermectin, given at three-monthly intervals and/or at high doses (800 microg/kg), had a greater effect on adult Onchocerca volvulus than standard doses (150 microg/kg annually). As several patients complained of transitory subjective visual problems after treatment, some of them being of an unexpected type, we organized two series of detailed ophthalmological examinations to evaluate whether they were associated with ocular lesions. Analysis showed that these complaints were significantly more frequent in the two groups treated with high doses of ivermectin than in the reference group. In the ophthalmological examinations, the only differences recorded between the groups were a lower prevalence and mean number of microfilariae in the anterior chamber in the groups treated three-monthly, and, at the first examination round, a higher prevalence of early lesions of the iris in the group treated at high doses annually. These findings do not allow us to explain the cause of the transitory ocular complaints, nor why they were more frequent in the groups treated at high doses. However, one may conclude that using doses of ivermectin higher than the standard one should be considered with caution.