Wandering intravitreal worm of Brugia malayi from Central India.

Abstract

Listen

Translate article

The intraocular filarial worm is rare. Most published reports are from south-east Asia.[1] The photo essay of Retina showed an intravitreal case.[2] Here is a report of intravitreal Brugia malayi. A 37-year-old farmer from central India had sudden painless decreased vision in the left eye for 12 days. His BCVA was 20/300 < N36 with left exotropia 15°. Slit-lamp examination showed an anterior chamber reaction. Dilated fundus showed vitritis++ with multifocal retinochoroiditis with live worm wandering in the mid-vitreous cavity [Fig. 1a–d].Figure 1: (a-c) Wandering intravitreal worm in fundus photo and (d) B-scan USG showing in the mid-vitreous cavityThe patient underwent 25-gauge vitrectomy. Vitreous strands surrounding white thread-like glistening cylindrical worm was utilized for grasping with forceps, [Fig. 2] and transferred to formalin and sent for morphological and microscopic examination. After lactophenol staining was observed under the coverslip and 40× illumination. It measured 6.05 mm. Slightly swollen head with oral opening with double stylet was observed [Fig. 3a]. The body had twisted curves. It appeared non-segmented smooth with irregular kinks at places [Fig. 3b] with cuticle around, which was coming out at places. [Fig. 3c] Ventrally coiled tail was grasped opened and seen under the microscope as pointed with excretory and secretory pores [Fig. 3d]. It was diagnosed as adult B. malayi as this is the only other filarial worm found in the Indian subcontinent.[3] Postoperatively patient had BCVA of 20/126, N24 vision with other parameters normal.Figure 2: Intraoperative photograph, the parasite is being removed with microforcepsFigure 3: (a) Microscopic photograph showing swollen head end with 2 stylets (b) body of the worm with irregular kinks (c) pointed caudal end showing the excretory and secretory pore (d) and body of the worm with cuticle coming outIntravitreal filariasis reported till now are few.[4] The first B. malayi microfilaria with uveitis in AC was reported by Anandakanan in 1977 in India. Rao et al.[5] in 2008 reported the first intravitreal live adult Brugian filariasis from Orissa. If removed on time prognosis is usually good. Microfilaria is one of the tropical diseases targeted for elimination by 2020. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgement Optometrist Mr. Sunil Chauhan, Mr. Sishir Shukla, Lab. Technician: Ms. Savita Sen.