Transretinal membrane formation in diffuse unilateral subacute neuroretinitis.

Abstract

Diffuse unilateral subacute neuroretinitis (DUSN) is characterized by unilateral visual loss with vitreous inflammation, optic disc swelling, and the presence of gray-white lesions in the deep retina, and can be associated with intraocular nematode infection. To date, no cases of transretinal membrane formation in DUSN have been reported. A 22-year-old woman was examined for a 2-week history of unilateral decreased vision and neuroretinitis. A subretinal nematode was identified and a diagnosis of DUSN was made. The nematode was destroyed with laser photocoagulation. An epiretinal membrane and traction retinal detachment persisted and the membrane was removed surgically, at which time it was noted to be transretinal, passing through a full-thickness retinal defect into the subretinal space. Laser photocoagulation was performed with the argon green laser (400 mW, 400 microns, 100 msec). Subsequent removal of the epiretinal portion of the transretinal membrane was performed via a pars plana approach. The membrane was studied by transmission electron microscopy (TEM). The laser photocoagulation was successful in destroying the nematode. Partial resolution of the neurosensory detachment resulted in marked improvement in visual acuity. The membrane consisted of a pauicellular collagenous stroma with scattered fibroblasts and mononuclear inflammatory cells. Removal of membranes affecting the macula may be of benefit in selected patients with DUSN.