Toxoplasmosis in the outer retina.

Objective: To present a case of ocular toxoplasmosis. Materials and methods: A sixteen-year-old female patient presented to our clinic with complaints regarding decreased vision in her right eye (BCVA 0.5), starting five days before the exam. Her anamnestic data revealed a previous history of ocular toxoplasmosis in her left eye. OCT scans of the inner retina identified a huge cystic space, located posterior to the inner line, off the outer plexiform layer, with a small amount of hyperreflective foci. Other features of OCT included membranous-like structures on inner borders and elongation and splitting of the inner segment/outer segment junction. In later stages, beginning signs of retinitis and scaring could be observed. Results: The patient was treated with sulfamethoxazole/trimethoprim and prednisolone. After two weeks, total regression occurred and visual acuity and OCT remained stable for 6 months (BCVA 1.0). Discussion: Ocular toxoplasmosis can cause significant vision loss due to retinitis and scarring. Following treatment with sulfamethoxazole/trimethoprim and prednisolone, the patient's condition improved significantly and her visual acuity remained stable. Conclusion: On clinical examination and using OCT, rare morphological cystoid spaces (CS) can be identified as huge outer retina cysts (HORC), which are pathognomonic for posterior uveitis. Abbreviations: HORC = huge outer retinal cyst, OCT = optical coherence tomography, BCVA = best corrected visual acuity, CS = cyst space, OPL = outer plexiform layer, HRF = hyper reflective foci, RPE = retinal pigment epithelium, IS = inner segment, OS = outer segment, ERM = epiretinal membrane, PORT = punctate outer retinal toxoplasmosis, ELM = external limiting membrane.

Atypical Presentation of Foster Kennedy Syndrome due to Neurocysticercosis: A Rare Case Report.

This case highlights the atypical presentation of Foster-Kennedy syndrome (FKS) associated with Neurocysticercosis (NCC), a prevalent cause of space-occupying lesions in areas endemic to the parasite. We report a newly diagnosed case of NCC in a 13-year-old boy who presented with a one-day history of abnormal movements of the left side of the body and no ocular complaints. Fundus examination of the patient revealed temporal disc pallor and a cup disc ratio (CDR) of 0.6 in the right eye suggesting unilateral optic disc atrophy and a hyperaemic disc with CDR 0.3 and blood vessel tortuosity in the left eye suggesting contralateral impending disc edema, mimicking the classic triad of FKS. He was diagnosed with NCC based on clinical features and radiological findings and was started on Carbamazepine (400 mg), Prednisolone (60 mg), Albendazole (400 mg), Acetazolamide (750 mg), and Vitamin B12 complex. Abbreviations: BCVA = Best Corrected Visual Acuity, CDR = Cup-Disc Ratio, CT = Computed Tomography, FKS = Foster Kennedy Syndrome, IDSA = Infectious Diseases Society of America, ICP = Intracranial Pressure, IOP = Intraocular Pressure, MRI = Magnetic Resonance Imaging, NCC = Neurocysticercosis, OOC = Orbital/Ocular Cysticercosis, OD = Right Eye, OS = Left Eye, OU = Both Eyes, RNFL = Retinal Nerve Fibre Layer, WNL = Within Normal Limits.

Double trouble: orbital rhabdomyoma with trichinellosis.

Rhabdomyoma of the orbit is a rare tumor with very few cases reported in the literature. We herein describe a 5-year-old boy who presented to us with a deviation of his left eye. Magnetic Resonance Imaging (MRI) showed a well-defined homogeneous intraconal mass in the superomedial aspect compressing the optic nerve. An excision biopsy was performed and the diagnosis of rhabdomyoma was confirmed on histopathology and immunohistochemistry with a coincidental finding of Trichinella spiralis larvae within the excised specimen. We report this phenomenon in two rare diseases with a predilection for striated muscle occurring simultaneously in a single patient.

Outcomes of keratoplasty in a cohort of Pythium insidiosum keratitis cases at a tertiary eye care center in India.

PURPOSE: To assess outcomes of keratoplasty performed in patients diagnosed with keratitis caused by Pythium insidiosum (PI). DESIGN: Retrospective review. METHODS: Preoperative, intra operative and post operative data of patients diagnosed with PI keratitis and who underwent keratoplasty for their condition from January 2020 to December 2021 were collected from the central patient database of a tertiary eye care hospital in India. The data were analyzed for anatomic success, elimination of infection, graft survival, incidence of repeat keratoplasty, final visual acuity and varied complications. RESULTS: In total, 16 eyes underwent penetrating keratoplasty for PI keratitis during the study period. Mean time to keratoplasty from onset of symptoms was 31.3 days and mean graft size was 10.4 mm. Nine out of the 16 cases had recurrence of infection following surgery, seven of which required a repeat keratoplasty for elimination of infection. Mean graft size for repeat keratoplasty performed in recurrent cases was 11.7 mm. Globe was successfully salvaged in 14 out of 16 patients (87.5 %). Three grafts remained clear at 6-month follow up while 11 grafts failed. Mean improvement in uncorrected visual acuity from 2.32 to 2.04 logMAR was observed at last follow up. Endo-exudates, graft infiltration, graft dehiscence, secondary glaucoma and retinal detachment were the various complications noted after keratoplasty. CONCLUSION: PI keratitis is a tenacious and potentially blinding condition. Keratoplasty remains the choice of treatment in this condition, however recurrence of disease and graft failure are common. Large sized grafts, meticulous per-operative removal of infection, adjuvant cryotherapy, and intraoperative and post operative use of antibiotics can help in improving outcome of keratoplasty in these patients.

Orbital intramuscular hydatid cyst causing compressive optic neuropathy: a case report and literature review.

BACKGROUND: Echinococcosis, commonly known as hydatid disease, is a zoonotic infection resulting from the tapeworm Echinococcus granulosus. The occurrence of hydatid cysts in the orbital region is uncommon, representing less than 1% of all reported hydatid cases. This report details a unique case of an intramuscular hydatid cyst in the orbital region that led to compressive optic neuropathy. CASE PRESENTATION: A 22-year-old male from Kabul, Afghanistan presented with a five-month history of progressive proptosis in his left eye, associated with a gradual decrease in vision over the past three weeks. The left eye exhibited upward globe dystopia, ocular motility limitation, mild conjunctival injection, and chemosis. Diagnosis was achieved through imaging and histopathological examination. Treatment involves surgical removal of the cyst and prolonged albendazole therapy. The postoperative course showed significant improvement in the patient's condition and restoration of his vision. CONCLUSIONS: Despite its rarity, this case underscores the importance of awareness and knowledge of hydatid disease among physicians, especially those working in endemic areas. It emphasizes the importance of including hydatid disease in the differential diagnosis of orbital masses, particularly in endemic regions.

"Demodicosis" Mimicking PreSeptal Cellulitis: Severe Periocular and Facial Inflammation Caused by "Normal" Skin Flora.

Due to their relatively high prevalence and commensalism, the pathogenicity of Demodex mites has been debated. Recent data, however, show Demodex to be associated with skin and ocular surface diseases such as rosacea, blepharitis, and keratitis. Here the authors report the first known case, to the best of the their knowledge, of Demodex infestation mimicking preseptal cellulitis in an adult human. A 29-year-old male bilaterally blind from advanced retinopathy of prematurity presented with a 2-month history of right-greater-than-left upper eyelid and periocular/cheek swelling, redness, and ocular discharge that did not resolve with oral antibiotics or oral steroids. Based on MRI findings, biopsies of the right lacrimal gland, right orbital fat, and right upper eyelid preseptal skin were obtained which revealed marked intrafollicular Demodex mite density and budding yeasts in the upper eyelid skin. This case serves to alert clinicians to this entity that may not otherwise be usually considered in ophthalmic clinical practice.

Long-term Outcomes of Surgeries for Retinal Detachment Secondary to Parasitic or Viral Infectious Retinitis.

PURPOSE: This study sought to compare the long-term outcomes of surgeries for retinal detachment (RD) secondary to viral or parasitic infectious retinitis. METHODS: A total of 47 eyes that received pars plana vitrectomy with or without scleral buckling due to RD secondary to polymerase chain reaction-proven viral (cytomegalovirus, varicella zoster virus, and herpes zoster virus) or parasitic (toxoplasma and toxocara) retinitis from October 1, 2006, to June 30, 2023, in a single medical center were retrospectively enrolled. RESULTS: Mean follow-up period was 59.03 ± 55.24 months in viral retinitis and 34.80 ± 33.78 months in parasitic retinitis after primary reattachment surgery. During follow-up, nine eyes (24.3%) with viral retinitis and five eyes (50.0%) with parasitic retinitis developed retinal redetachment. Visual acuity success at final follow-up was achieved in 19 eyes (51.4%) with viral retinitis and six eyes (60.0%) with parasitic retinitis (p = 0.64). The incidence of retinal redetachment during the 1st postoperative year was significantly higher in parasitic retinitis compared with viral retinitis (crude incidence, 0.21 vs. 0.85; p = 0.02). Hazard ratio analysis adjusted for age and sex showed 4.58-fold (95% confidence interval, 1.22-17.27; p = 0.03) increased risk of retinal redetachment in parasitic retinitis compared with viral retinitis during the 1st postoperative year. Tamponade with silicone oil and preoperative diagnostic vitrectomy were associated with significantly decreased risk of retinal redetachment in patients with parasitic retinitis. CONCLUSIONS: Compared with RD secondary to viral retinitis, RD secondary to parasitic retinitis showed higher incidence of retinal redetachment during the 1st postoperative year. Tamponade with silicone oil and preoperative diagnostic vitrectomy were associated with significantly decreased risk of retinal redetachment in patients with parasitic retinitis.

[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.

Role of Topical 5-Fluorouracil in Demodex -Associated Blepharitis.

PURPOSE: The aim of this study was to report clinical observations suggesting the efficacy of topical 1% 5-fluorouracil (5-FU) in treating Demodex -associated blepharitis. METHODS: An observational retrospective review of 13 eyes from 13 individuals with conjunctival neoplastic lesions and concomitant Demodex lash infestation that received topical 1% 5-FU eye drops. Patients underwent slit-lamp examination at each follow-up visit. Clinical photographs of the lash line were obtained after treatment initiation. In a subset of patients, lashes were epilated bilaterally and microscopically analyzed for presence of Demodex mites before and after treatment initiation. RESULTS: The mean age of the population was 68 ± 14 years (range: 30-84 years) and 92% were male. In all 13 patients, a marked reduction in cylindrical dandruff was noted in the treated eye by slit-lamp examination after 2 cycles of 5-FU. There was complete resolution of cylindrical dandruff in 10 of 13 treated eyes compared with 0 resolution of cylindrical dandruff in untreated eyes ( P = 0.0001). In the 6 patients who received epilation, the lashes from the treated eye showed no Demodex , whereas lashes from the fellow untreated eye revealed persistent Demodex . CONCLUSIONS: Topical 1% 5-FU shows efficacy in treating Demodex -associated blepharitis. Further studies are indicated to reproduce our findings and evaluate the potential use of 5-FU as a treatment ingredient.

Characterisation of ocular involvement in an experimental model of neuroschistosomiasis mansoni

The Global Burden of Disease Study 2010 listed schistosomiasis among the leading 100 causes of death in Brazil, responsible for 3.6% of the estimated total of deaths globally. Eye and adnexa are very rarely affected by schistosomiasis mansoni, with limited documentation of ocular pathology in this setting. This short communication reports ocular histolopathological findings in a murine model of neuroschistosomiasis mansoni. Lesions were found in the bulbar conjunctiva, lacrimal gland, choroid and corneoscleral limbus.

Austrodiplostomum compactum metacercariae (Digenea: Diplostomidae) in Schizodon intermedius (Characiformes: Anostomidae) from Jurumirim reservoir, Brazil / Metacercárias de Austrodiplostomum compactum (Digenea: Diplostomidae) em Schizodon intermedius (Characiformes: Anostomidade) do reservatório de Jurumirim, Brasil

Abstract This study reports the occurrence of Austrodiplostomum compactum metacercariae in the freshwater fish Schizodon intermedius (ximborê/piava) from a Neotropical reservoir in the Paranapanema River, state of São Paulo, Brazil. From a total of 75 fish collected, we found 38 infected with A. compactum metacercariae (prevalence = 50.67%) in the eyes. The mean intensity of infection and mean abundance were 9.05 ± 4.26 (1-155) and 4.59 ± 2.20 (0-155), respectively. Poulin's Discrepancy Index was 0.87 and four specimens presented more than 10 metacercariae in their eyes. No correlation was observed between parasite abundance and standard length, total weight and condition factor (p>0.05). These metacercariae are reported for the first time in S. intermedius.

Resumo Este estudo reporta a ocorrência de metacercárias de Austrodiplostomum compactum na espécie de peixe de água doce Schizodon intermedius (ximborê/piava), oriunda de um reservatório Neotropical no rio Paranapanema, Estado de São Paulo, Brasil. Um total de 75 peixes foram coletados, sendo que 38 estavam infectados com metacercárias de A. compactum (prevalência = 50,67%) nos olhos. A intensidade média de infecção e abundância média foram 9,05 ± 4,26 (1-155) e 4,59 ± 2,20 (0-155), respectivamente. O Índice de Discrepância de Poulin foi de 0,87, e quatro exemplares apresentaram mais do que 10 metacercárias em seus olhos. Não foram observadas correlação entre abundância média e comprimento padrão, peso total e fator de condição (p>0,05). Esse é o primeiro registro dessa espécie de metacercária para S. intermedius.

Parasitism by Sphincterodiplostomum musculosum (Digenea, Diplostomidae) metacercariae in the eyes of Steindachnerina insculpta (Characiformes, Curimatidae) / Parasitismo por metacercárias de Sphincterodiplostomum musculosum (Digenea, Diplostomidae) nos olhos de Steindachnerina insculpta (Characiformes, Curimatidae)

New occurrences and effects of parasitism by metacercariae in fish eyes have recently been discussed in many studies. The aim of the present study was to evaluate the infection levels of the eye flukes Sphincterodiplostomum musculosum Dubois, 1936 (metacercariae) in Steindachnerina insculpta (Fernádez-Yépez, 1948) from three ecosystems under the influence of the Jurumirim reservoir (Paranapanema, Taquari and Veados Rivers). A total of 174 fish specimens were sampled between April 2011 and April 2012. There were high levels of infection by S. musculosum metacercariae in the eyes of S. insculpta from all the sampled ecosystems, thus presenting broad geographical distribution. The histological analyses revealed that the metacercariae were apparently lodged behind the retina. The smaller fish from the Taquari River were less parasitized by metacercariae than the adults. This pattern can be explained by the cumulative effect of parasitism, as demonstrated by the positive correlation between the abundance of metacercariae and fish body size.

Novas ocorrências e efeitos do parasitismo por metacercárias em olhos de peixe têm sido recentemente discutidas em muitos estudos. O objetivo deste estudo foi avaliar os níveis de infecção dos vermes de olho Sphincterodiplostomum musculosum Dubois, 1936 (metacercárias) em Steindachnerina insculpta (Fernádez-Yépez, 1948) de três ecossistemas influenciados pelo reservatório de Jurumirim (Rios Paranapanema, Taquari e Veados). Um total de 174 espécimes de peixes foi amostrado de Abril/2011 a Abril/2012. Metacercárias de S. musculosum mostraram altos níveis de infecção nos olhos de S. insculpta em todos os ecossistemas amostrados apresentando ampla distribuição geográfica. As análises histológicas revelaram que, aparentemente, estas metacercárias estavam alojadas por trás da retina. Os peixes menores do rio Taquari estavam menos parasitados por metacercárias do que os adultos. Esse padrão pode ser explicado pelo efeito cumulativo de parasitismo, evidenciado pela correlação positiva entre a abundância de metacercárias e tamanho do corpo dos peixes.

Sensibilidad antibiótica de bacterias obtenidas de queratitis e infecciones intraoculares en la Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia / Antibiotic susceptibility patterns of bacteria isolated from keratitis and intraocular infections at Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia

Introducción. La resistencia bacteriana es crítica para la selección de los antibióticos en el tratamiento de las infecciones, por ello es vital conocer su estado actual en nuestro medio. Objetivo. Determinar la sensibilidad antibiótica bacteriana in vitro obtenida de los cultivos de queratitis e infecciones intraoculares. Materiales y métodos. Se llevó a cabo un estudio retrospectivo en la Fundación Oftalmológica de Santander (FOSCAL), entre junio de 2011 y enero de 2012. Resultados. Se examinaron 92 muestras. Se identificaron 110 bacterias, 27 hongos y 12 amebas de vida libre. Del total de bacterias Gram positivas, 1,1 %, 0 %, 1,1 %, 16,9 %, 29,3 % y 85 % fue resistente a imipenem, moxifloxacina, gatifloxacina, levofloxacina, ciprofloxacina y tobramicina, respectivamente, mientras que la resistencia a estos mismos fármacos se presentó, respectivamente, en 0 %, 8,3 %, 0 %, 0 %, 18,2 % y 27,3 % de las bacterias Gram negativas. Los porcentajes de resistencia de los estafilococos positivos para coagulasa resistentes a la meticilina fueron 0 %, 0 %, 0 %, 7 %, 17 % y 100 %, respectivamente, y los porcentajes de los estafilococos negativos para coagulasa resistentes a la meticilina fueron 3 %, 0 %, 0 %, 24 %, 44 % y 100 %, respectivamente. Los porcentajes de resistencia bacteriana globales (tanto para bacterias Gram positivas como para Gram negativas) a imipenem, moxifloxacina, gatifloxacina, levofloxacina, ciprofloxacina y tobramicina fueron 1 %, 1 %, 1 %, 15,1 %, 28 % y 64,5 %, respectivamente. Conclusiones. Los niveles de resistencia bacteriana para imipenem, moxifloxacina y gatifloxacina fueron menores que para levofloxacina, ciprofloxacina y tobramicina. Los niveles de resistencia para la tobramicina fueron muy altos, lo que pone en duda su utilidad clínica en las infecciones oculares en nuestro medio.

Introduction: Bacterial resistance is critical for the selection of antibiotics in the treatment of infections, so it is vital to know its current status in our geographical area. Objective: To determine in vitro antibiotic susceptibility of bacterial isolates obtained from keratitis and intraocular infections. Materials and methods: A retrospective study of microbiological tests in Fundación Oftalmológica de Santander (FOSCAL) was carried out between June, 2011, and January, 2012. Results: A total of 92 samples were examined and 110 bacteria, 27 fungi and 12 free-living amoebae were identified. Polymicrobial infections constituted 50% of the total; 1.1%, 0%, 1.1%, 16.9%, 29.3% and 85% of Gram-positive bacteria were resistant to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin, respectively, while 0%, 8.3%, 0%, 0%, 18.2% and 27.3% of Gram-negative bacteria were resistant to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin, respectively. For methicillin-resistant coagulase-positive staphylococci, resistance percentages to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin were 0%, 0%, 0%, 7%, 17% and 100%, respectively. For methicillin-resistant coagulase-negative staphylococci, resistance percentages to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin were 3%, 0%, 0%, 24%, 44% and 100%, respectively. Overall bacterial resistance to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin, for both Gram-positive and Gram-negative, was 1%, 1%, 1%, 15.1%, 28% and 64.5%, respectively. Conclusions: The levels of bacterial resistance to imipenem, moxifloxacin and gatifloxacin were lower than for levofloxacin, ciprofloxacin and tobramycin. The levels of resistance to tobramycin were very high, which calls into question its usefulness in this region of our country.

Achados ultrassonográficos em toxocaríase ocular / Ultrasonographic findings in ocular toxocariasis

OBJETIVO: Avaliar achados ultrassonográficos nas três principais formas de apresentação da toxocaríase ocular (granulomas de periferia e polo posterior e endoftalmite crônica), em pacientes com diagnóstico confirmado de toxocaríase ocular. MÉTODOS: Foram analisados no estudo 11 pacientes (11 olhos), de forma prospectiva, com diagnóstico de toxocaríase forma ativa, com teste ELISA positivo. Os pacientes foram submetidos ao exame de ultrassonografia ocular (transdutor 10 MHz, técnica de contato). RESULTADOS: Na série de 11 pacientes, com idade média de 7,9 anos (variando de 2 a 17 anos), 73% homens, referiram contato prévio com cães (91%), e com solo (50%), sem referência à perversão do apetite. Na avaliação dos olhos comprometidos (11 olhos), o exame oftalmológico revelou a seguinte distribuição das três formas de toxocaríase ocular: 7 (63,6%), granuloma de polo posterior; 1 (9,1%), endoftalmite crônica; 2 (18,2%), granuloma periférico; e 1 (9,1%), quadro associado de granuloma de polo posterior e endoftalmite crônica. Acuidade visual comprometida: sem percepção luminosa (3 olhos, 27,3%); visão de vultos (4 olhos, 36,4%); contar dedos a 10 cm (1 olho, 9,1%); 20/200 (1 olho, 9,1%); 20/70 (1 olho, 9,1%); indeterminado (1 olho, 9,1%). Sorologia para Toxocara canis foi positiva (teste ELISA) em 100% dos casos. Oftalmoscopia foi difícil ou impossível em 64% dos casos devido à opacidade de meios. Características ultrassonográficas observadas: membranas vítreas com retina aplicada (100%); lesões de parede (granulomas) com refletividade alta (80%) ou média (20%). CONCLUSÃO: O achado ultrassonográfico mais consistente no olho portador de toxocaríase foi a presença de massa retiniana de alta refletividade, localizada no polo posterior ou periferia, que pode ser calcificada, e que apresenta como principal característica a aderência de membranas vítreas. Em combinação com a história, exame clínico e sorologia, a ultrassonografia pode ajudar no diagnóstico da toxocaríase ocular, principalmente nos casos com opacidade de meios.

PURPOSE: To evaluate ophthalmic ultrasound findings in the three presentation forms of ocular toxocariasis (peripheral or posterior pole granulomas and chronic endophthalmitis), in patients with confirmed diagnosis of ocular toxocariasis. METHODS: 11 patients (11 eyes) with clinical and confirmed diagnosis of active ocular toxocariasis, presented positive ELISA test, were analyzed, prospectively, in the study. The patients were submitted to an ocular ultrasound examination (10-MHz transducer, contact technique). RESULTS: In the series of 11 patients, mean age was 7.9 years-old (range from 2 to 17 y), 73% male, referring previous contact with dogs (91%), and with the soil (50%), no referral of appetite perversion. In the analyses of compromised eyes (11 eyes), the ophthalmoscopic examination revealed the following distribution of the 3 forms of ocular toxocariasis: 7 cases (63.6%), posterior pole granuloma; 1 (9.1%), chronic endophthalmitis; 2 (18.2%), peripheral granuloma; and 1 (9.1%), posterior pole granuloma associated with chronic endophthalmitis. Visual acuity impairment: no light perception (3 eyes, 27.3%); hand motion (4 eyes, 36.4%); counting fingers at 10 cm (1 eye, 9.1%); 20/200 (1 eye, 9.1%); 20/70 (1 eye, 9.1%); undefined (1 eye, 9.1%). Serology was positive to Toxocara canis (ELISA test) in 100% of the cases. Ophthalmoscopy was difficult or impossible in 64% of the cases due to the media opacity. Ultrasound findings noted were vitreous membranes with retinal attachment (100%); parietal lesions (granulomas) with high (80%) or medium (20%) reflectivity. CONCLUSION: The most consistent ultrasound finding in the eye with toxocariasis was a high-reflectivity retinal mass, located in posterior pole or periphery, which may be calcified, and which has as main characteristic the adherence of vitreous membranes. In addition to clinical history, systemic evaluation and serology, the ultrasound can help in the diagnosis of ocular toxocariasis, especially in media opacities.

Subconjunctival Loa loa worm: first case report in Brazil / Verme subconjuntival da espécie Loa loa: primeiro caso no Brasil

We report the first case of ocular infestation by Loa loa in Brazil. Loiasis is caused by infestation with Loa loa, a filarial parasite originally found in the rainforests of western and central Africa. It is transmitted by the bite of the fly Chrysops and has been recently described in other places other than Africa, in African immigrants or travellers. Our case is a 33 year-old woman from Cameroon who was living in São Paulo, Brazil, for 5 years. She was asymptomatic until one morning she started feeling "something moving" in the left eye. Under topical anesthesia, on the slit lamp, a moving worm was removed from the subconjunctival space, which later was confirmed to be a male Loa loa adult specimen. Blood tests revealed microfilaraemia of 129 mf/mL. The patient was treated with 400 mg oral albendazole for 3 weeks and 60 mg prednisone. This report illustrates an unusual ocular disease, which is extremely rare outside of Africa, but easily diagnosed and treated. Ophthalmologists should be aware of it, in face of an increasingly globalized world.

Este é o primeiro relato na literatura nacional e internacional de infestação ocular por Loa loa no Brasil. A loíase é uma filariose causada pelo parasita Loa loa, encontrado nas florestas tropicais da África equatorial. A transmissão se dá pela picada do mosquito Chrysops e casos têm sido descritos em países não africanos, em imigrantes e viajantes. O presente caso trata-se de uma paciente de 33 anos natural de Camarões e residente em São Paulo, Brasil, há 5 anos. Até então assintomática, uma manhã sentiu algo "se mexendo" em seu olho esquerdo. Sob anestesia tópica, na lâmpada de fenda, um verme altamente móvel foi removido do espaço subconjuntival e enviado para identificação, que confirmou tratar-se de um espécime macho adulto de Loa loa. Testes sanguíneos revelaram microfilaremia de 129 mf/mL. A paciente foi tratada com albendazol 400 mg e prednisona 60 mg esquema regressivo por 3 semanas. Este relato ilustra uma doença excepcionalmente rara no Brasil, e praticamente desconhecida dos oftalmologistas em nosso país.

Detección de lesiones oculares en niños seropositivos para Toxocara canis / Prevalence of ocular lesions in children seropositive to Toxocara canis

Intraocular invasion by Toxocara canis is one of the most commonly recognized etiologies of uveitis and blindness in children. In order to estimate the prevalence of ocular lesions caused by toxocariasis in a pediatric referral hospital, we conducted a retrospective analysis of clinical charts of all children seropositive to Toxocara canis, who also had an eye exam between the years 2005 and 2009 at the Calvo Mackenna Children's Hospital in Santiago, Chile. We identified 175 children [mean age 6 years (range 0.66-15)] seropositive to Toxocara canis, who had dilated eye exam. Only one child [(0.57 percent); 95 percent CI, -0.55 - 1.69] had ophthalmoscopic findings compatible with Toxocara canis infection. The patient also suffered from decreased vision of the affected eye. The information gained from this study may be of useful for the implementation of algorithms for the ophthalmological examination of children seropositive to Toxocara canis in public hospitals in Chile.

La invasión intraocular por el nematodo Toxocara canis constituye una de las causas más frecuentes de uveitis en los niños, pudiendo conducir a la ceguera. Para conocer la prevalencia de lesiones oculares en niños con serología positiva para este parásito en un hospital pediátrico de referencia, realizamos un estudio retrospectivo de las fichas clínicas de los pacientes referidos para examen oftalmológico en el Hospital Luis Calvo Mackenna entre los años 2005 y 2009. Encontramos 175 niños con serología positiva y examen oftalmológico, cuya edad promedio al momento del examen fue de 6 años (rango 0,66-15). En sólo un niño [(0,57 por ciento); 95 por ciento IC, -0,55-1,69] se encontraron lesiones oculares atribuibles a T. canis. El paciente presentaba además disminución de visión. La información obtenida en este estudio podría ser de utilidad en el diseño de un algoritmo para el examen oftalmológico de niños seropositivos a T. canis en el ambiente hospitalario en Chile.

Human ocular sparganosis in southern Brazil / Esparganose ocular humana no sul do Brasil

We report the first case of human ocular sparganosis in the state of Santa Catarina, southern Brazil. A young female patient presented with three periocular moveable inflammatory masses in her right eye, during two years. By surgical excisional biopsy, a helminth larval stage was removed and identified as sparganum. Clinical, laboratory and epidemiological data on this parasite are presented.

Registra-se o primeiro caso de esparganose ocular humana no estado de Santa Catarina, sul do Brasil a partir de paciente adulta que apresentou três massas inflamatórias móveis perioculares, localizadas no olho direito, durante dois anos. Com a excisão cirúrgica o material foi para a biópsia e um estágio larval de helminto foi identificado como espargano. Dados clínicos, laboratoriais e epidemioógicos são apresentados neste trabalho.

Intraretinal worm documented by optical coherence tomography in a patient with diffuse unilateral subacute neuroretinitis: case report / Larva intrarretiniana documentada pela tomografia de coerência óptica em um paciente com neurorretinite subaguda difusa unilateral: relato de caso

Our purpose is to report a case of diffuse unilateral subacute neuroretinitis (DUSN) in which an ophthalmoscopically visible worm was found and optical coherence tomography (OCT) scans allowed the precise localization of the parasite in the intraretinal layers. Our findings suggest that the parasite moves in the inner portions of the retina possibly explaining the severe degenerative neural changes that it causes.

Nosso objetivo é relatar um caso de neurorretinite subaguda unilateral difusa (DUSN), onde uma larva oftalmoscopicamente visível foi detectada e, através do escaneamento pela tomografia de coerência óptica (OCT), foi possível estabelecer a localização precisa do parasita entre as camadas da retina. Nossos resultados sugerem que o movimento do parasita nas camadas mais internas da retina possa explicar as graves alterações neuronais degenerativas encontradas.

Ocular lesions in gerbils (Meriones unguiculatus) infected with low larval burden of Toxocara canis: observations using indirect binocular ophthalmoscopy / Lesões oculares em gerbils (Meriones unguiculatus) infectados com baixo número de larvas do Toxocara canis: observações com oftalmoscopia binocular indireta

To study the frequency of ocular lesions in 30 gerbils infected with 100 embryonated eggs of Toxocara canis, indirect binocular ophthalmoscopy was performed 3, 10, 17, 24, 31 and 38 days after infection. All the animals presented larvae in the tissues and 80 percent presented ocular lesions. Hemorrhagic foci in the choroid and retina were present in 92 percent of the animals with ocular lesions. Retinal exudative lesions, vitreous lesions, vasculitis and retinal detachment were less frequent. Mobile larvae or larval tracks were observed in four (13.3 percent) animals. Histological examination confirmed the ophthalmoscopic observations, showing that the lesions were focal and sparse. In one animal, there was a larva in the retina, without inflammatory reaction around it. The results demonstrated that gerbils presented frequent ocular lesions after infection with Toxocara canis, even when infected with a small number of embryonated eggs. The lesions observed were focal, consisting mainly of hemorrhages with signs of reabsorption or inflammation in different segments of eye, and differing from the granulomatous lesions described in ocular larva migrans in humans.

Para verificar a freqüência de lesões oculares em 30 gerbils infectados com 100 ovos larvados de Toxocara canis foi realizada a oftalmoscopia binocular indireta nos dias 3, 10, 17, 24, 31 e 38 após a infecção.Todos os animais apresentavam larvas nos tecidos e 80 por cento apresentavam lesões oculares, dos quais 92 por cento tinham lesões hemorrágicas focais na coróide e na retina. Lesões exudativas da retina, lesões do vítreo, vasculite e descolamento da retina foram menos freqüentes. Larva móvel ou traços de larva em quatro (13,3 por cento) animais. O estudo histológico confirmou as observações da oftalmoscopia, mostrando que as lesões eram focais e esparsas. Em um animal havia uma larva na retina, sem reação inflamatória em torno dela. Os resultados demonstraram que os gerbils apresentam freqüentes lesões oculares após infecção com o Toxocara canis mesmo quando infectados com pequeno número de ovos larvados. As lesões observadas eram focais, principalmente focos de hemorragia com sinais de reabsorção ou focos de inflamação nos diferentes segmentos do olho, diferentes das lesões granulomatosas descritas na larva migrans ocular humana.

Lagochilascariasis leading to severe involvement of ocular globes, ears and meninges / Infecção humana por Lagochilascaris minor com envolvimento ocular, auditivo e das meninges

A case report of a 31 year-old woman from Paraíba State (North-Eastern Brazil) that presented severe involvement of ocular globes, ears and meninges. Diagnosis was established after enucleation of her left eye, when adult worms were seen in the midst of a granulomatous inflammatory process. Her response to the initial treatment with levamisole and cambendazole was good, but there was a relapse after the fifth month of treatment even with maintenance doses of both medications. She later received ivermectin and albendazol and responded well.

Paciente do sexo feminino, com 31 anos, procedente da Paraíba, apresentava envolvimento severo de ambos os globos oculares, com perda da visão à esquerda, comprometimento da audição e das meninges. Após enucleação do olho esquerdo fragmento de helminto identificado como Lagochilascaris minor foi observado em processo inflamatório granulomatoso. Inicialmente a paciente foi tratada com levamisol e cambendazol, com bom resultado. Verificou-se, todavia, piora do quadro após cinco meses, com eliminação de larvas do ascarídeo em lesão presente na órbita esquerda, embora a medicação fosse mantida com administração periódica. Houve boa resposta terapêutica, com regressão do quadro, após substituição dos anti-helmínticos anteriores pela associação ivermectina e albendazol.