Diffuse Unilateral Subacute Neuroretinitis Research Articles

Diffuse unilateral subacute neuroretinitis secondary to Toxocara spp. infection in a Venezuelan migrant.

A Venezuelan migrant presenting with sudden onset painful unilateral visual loss was diagnosed with diffuse unilateral subacute neuroretinitis (DUSN), probably secondary to Toxocara spp. infection. Parasitic eye infections may be difficult to diagnose and treat. The risk of acquiring zoonotic infections from domestic animals is highlighted.

Acquired vertical pendular nystagmus in diffuse unilateral subacute neuroretinitis: A diagnostic dilemma

<br>A retinal infectious pathology, an acquired vertical nystagmus, and a suspicious neuroimaging result! Independently, these three entities are not uncommon. However, when they are consecutively observed in a young patient, it ramifies into an intriguing clinical scenario. A 17-year-old diagnosed case of diffuse unilateral subacute neuroretinitis presented to us with acute-onset vertical oscillations. On neuroimaging, she was found to have cerebellar dysgenesis. This case prompted us to revisit the pathogenesis of acquired vertical nystagmus and evaluate whether it resulted from disturbance of afferent (severe visual impairment) or efferent (cerebellar dysfunction) components of the neural integrator mechanism.<br>

Diffuse unilateral subacute neuroretinitis in children: Report of three cases

Rationale: Diffuse unilateral subacute neuroretinitis is a form of posterior uveitis and has a few clinical presentations according to the onset of presentation.Patients’ concern: A girl (5-year-old) and 2 boys (both 12-year-old) were included in this report. Upon presentation, the visual acuity ranges from 6/12 to 6/60. All three cases had different symptoms (case 1: floaters; case 2: eye redness and pain; case 3: central scotoma). All of them had variable posterior uveitis features (case 1: vitritis and focal retinitis; case 2: subretinal larva track; case 3: choroiditis).Diagnosis: Diffuse unilateral subacute neuroretinitis.Intervention: All 3 patients were treated with oral albendazole.Outcome: All patients showed remarkable resolution of inflammatory reactions of the eye and also improvement of vision.Lesson: High index of suspicion should be made for children and young adults who are previously healthy but presented with suddenly onset of reduced vision with clinical features of posterior uveitis of variable degree. Clinical features together with a full blood picture can help to diagnose the problem when other parameters are negative.

Commentary: Role of PASCAL and optical coherence tomography angiograpgy in the treatment of diffuse unilateral subacute neuroretinitis caused by large live motile worm.

Commentary: Role of PASCAL and optical coherence tomography angiograpgy in the treatment of diffuse unilateral subacute neuroretinitis caused by large live motile worm.

Amblyopia or Pathology? Diffuse Unilateral Subacute Neuroretinitis in a Pediatric Patient

Background: Diffuse unilateral subacute neuroretinitis (DUSN) is a retinal disorder cause by a subretinal nematode. The disorder tends to affect children and young adults. It is characterized by unilateral retinal pigment epithelium changes, vitritis, retinal vessel narrowing and, in advanced stages, optic atrophy. Patients are generally asymptomatic or report a painless loss of vision. It has been described in the United States as well as Latin America, Asia and Europe. Case Report: A 9 year old female, recently adopted from the Ukraine, presented for an eye exam after failing a vision screening. Uncorrected visual acuity was 20/20 OD, 20/30 OS with hyperopia OS&gt;OD. A dilated examination revealed pigment epithelial changes in the macula OS only. Examination by a retinal specialist included ocular coherence topography and a fluorescein angiography. Blood work and stool samples were normal. A diagnosis of DUSN was made and laser photocoagulation was performed around the suspected worm. The patient tolerated the procedure well. After treatment, and with her eyeglasses, visual acuity was 20/25 OS. Conclusion: Diffuse unilateral subacute neuroretinitis (DUSN) is a condition that can be detected on a routine exam in asymptomatic patients. Recognition of the condition and prompt treatment is important to help delay disease progression and preserve visual acuity.

Diffuse Unilateral Subacute Neuroretinitis (DUSN).

Diffuse unilateral subacute neuroretinitis (DUSN) is caused by a subretinal live and mobile nematode. Acute phase: Patients usually present with severe pain, decreased vision, vitritis/papillitis, and tracks of grayish-white lesions-and a live nematode. Late phase: Arterial narrowing, optic atrophy, diffuse disruption of the retinal pigment epithelium (RPE), with severe visual loss.

Observation and Clinical Pattern in Patients with White Dot Syndromes: The Role of Color Photography in Monitoring Ocular Changes in Long-Term Observation.

BackgroundThe aim of this study was to assess the clinical course and distinctive features of different white dot syndromes (WDS) in patients attending the Ophthalmology Department, Medical University of Warsaw in the years 1995–2015.Material/MethodsSixty-two (62) patients (43 females and 19 males), aged 18 to 77 years, referred with a WDS were included in this prospective study, with observation period ranging from 5 months to 16 years. All patients underwent a complete ophthalmological examination and multimodal imaging studies.ResultsIn this cohort of 62 patients, the following WDS entities were identified: multifocal choroiditis with panuveitis (MFCPU), multifocal choroiditis (MFC), punctate inner choroidopathy (PIC), birdshot, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), subretinal fibrosis and uveitis, multiple evanescent white dot syndrome (MEWDS), serpiginous choroiditis, and single cases of acute annular outer retinopathy (AAOR).ConclusionsThe study was performed at a Polish referral center and may to some extent reflect the varied geographical distribution of white dot syndromes, as none of the subjects was found to suffer from acute zonal occult outer retinopathy (AZOOR), acute macular neuroretinopathy (AMN), or diffuse unilateral subacute neuroretinitis (DUSN). Long-term follow-up is warranted by the evolution of lesions in the eye fundus, while management depends on correct diagnosis of WDS. When the posterior pole is involved in some cases of the WDS an immunosuppressive treatment, the use of the PDT or anti-VEGF injections were necessary.

Diffuse Unilateral Subacute Neuroretinitis Caused byAncylostomaHookworm

Diffuse unilateral subacute neuroretinitis is an ocular infectious disease caused by several distinct nematodes. Definite identification of the involved nematodes is rarely achieved. We report on the molecular-based genetic identification of an Ancylostoma ceylanicum hookworm implicated in a case of diffuse unilateral subacute neuroretinitis in a child.

Diffuse Unilateral Subacute Neuroretinitis Associated with Cutaneous Larva Migrans

A seven year old girl presented with history of diminished vision in her left eye. The detailed examination of the right eye was unremarkable. The anterior segment of the involved eye was unremarkable with the supero-temporal retina showing outer retinal yellow-white lesions associated with pigmentary changes. The child had itchy scaly lesions over the right sole. A diagnosis of diffuse unilateral subacute neuro-retinitis with cutaneous larva migrans was made. The retinal lesions were subjected to laser photo coagulation and systemic single dose of ivermectin was administered. There was no recurrence of the retinal lesions and the foot lesions healed. The present case highlights the importance of examination of the extremities and the role of single dose of ivermectin in the management of DUSN with cutaneous larva migrans.

Update on Baylisascariasis, a Highly Pathogenic Zoonotic Infection.

Baylisascaris procyonis, the raccoon roundworm, infects a wide range of vertebrate animals, including humans, in which it causes a particularly severe type of larva migrans. It is an important cause of severe neurologic disease (neural larva migrans [NLM]) but also causes ocular disease (OLM; diffuse unilateral subacute neuroretinitis [DUSN]), visceral larva migrans (VLM), and covert/asymptomatic infections. B. procyonis is common and widespread in raccoons, and there is increasing recognition of human disease, making a clinical consideration of baylisascariasis important. This review provides an update for this disease, especially its clinical relevance and diagnosis, and summarizes the clinical cases of human NLM and VLM known to date. Most diagnosed patients have been young children less than 2 years of age, although the number of older patients diagnosed in recent years has been increasing. The recent development of recombinant antigen-based serodiagnostic assays has aided greatly in the early diagnosis of this infection. Patients recovering with fewer severe sequelae have been reported in recent years, reinforcing the current recommendation that early treatment with albendazole and corticosteroids should be initiated at the earliest suspicion of baylisascariasis. Considering the seriousness of this zoonotic infection, greater public and medical awareness is critical for the prevention and early treatment of human cases.

Clinical experience in treatment of diffuse unilateral subretinal neuroretinitis

PurposeTo describe the clinical features, management, and outcomes of patients with diffuse unilateral subacute neuroretinitis (DUSN).MethodsA noncomparative, consecutive analysis of case series from two tertiary care campuses of LV Prasad Eye Institute, India, between January 2011 and April 2014 was performed. Medical records of the patients presenting with DUSN (early or late stage) were reviewed.ResultsThe current study included 13 patients. The majority (10/13, 76.92%) of the patients were aged 20 years or less. All patients had unilateral eye involvement. Visual acuity at presentation was 20/200 or worse in 9/13 (69.23%) patients. A delay in diagnosis occurred in 6/13 patients, and initial diagnosis in these patients included retinitis pigmentosa (4 patients) and posterior uveitis (2 patients). Clinical features included early presentation (prominent vitritis, localized retinitis, and vasculitis) in 7/13 (53.85%) patients and late presentation (attenuation of vessels, retinal pigment epithelium atrophic changes, and optic atrophy) in 6/13 (46.15%) patients. Worm could not be identified in any of the cases. All the patients received laser photocoagulation of retina and oral albendazole treatment for a period of 30 days. With treatment, visual acuity improved in seven patients (six early stage, one late stage) and remained unchanged in six patients. Mean follow-up period was 8.69 months (range, 1–21 months). The mean central foveal thickness in the affected eye, done by optical coherence tomography, during the late stage of the disease was 188.20±40 µm (range, 111–242 µm), which was significantly thinner than the fellow eye, 238.70±36.90 µm (range, 186–319 µm), P=0.008.ConclusionDUSN is a serious vision threatening disease, which may progress to profound vision loss in the later stage of the disease. Visualization of subretinal worm is usually not possible. Treatment with high-dose albendazole therapy and laser photocoagulation may alter the blood–retinal barrier and may be useful in achieving visual recovery.

STRUCTURAL AND FUNCTIONAL RETINAL CHANGES IN EYES WITH DUSN

To report novel spectral domain optical coherence tomography and electrophysiologic findings in diffuse unilateral subacute neuroretinitis. Six patients with a diagnosis of diffuse unilateral subacute neuroretinitis were retrospectively ascertained. All patients had received oral treatment with albendazole; resolution of the inflammatory lesions without subsequent relapse was noted. Spectral domain optical coherence tomography was performed using a Spectralis HRA OCT (Heidelberg Engineering). The inner and outer retinal volumes were calculated for the macular area. The contralateral eyes acted as controls. All six patients underwent standardized full-field electroretinography and pattern electroretinography. Some had multifocal electroretinography. Inner retinal volume significantly differed between affected and control eyes (P < 0.02), but there was no significant difference in outer retinal volume. Electroretinography data showed a mixed pattern of inner and outer retinal dysfunction, with inner retinal dysfunction being greater; reduction in b:a ratio of the scotopic bright flash electroretinography was a consistent observation in those patients (5/6) with generalized retinal dysfunction. Two patients showed definite photoreceptor involvement, with probable involvement in a third. Of the four patients in whom serial data are available, there was definite evidence of progressive inner and outer retinal dysfunction in one patient, with inner retinal dysfunction being greater, and probably in a second patient. The data provide anatomical and functional evidence of both inner and outer retinal dysfunction in diffuse unilateral subacute neuroretinitis, even though the worm is usually assumed to be located in the subretinal space. The mechanism is unclear.

Evaluation of patients with diffuse unilateral subacute neuroretinitis by spectral domain optical coherence tomography with enhanced depth imaging

BackgroundThe purpose of this study was to determine the value of spectral domain optical coherence tomography (SD-OCT) in assessing patients with diffuse unilateral subacute neuroretinitis (DUSN).MethodsThis was an observational case series with clinical imaging correlation performed at the Retina and Vitreous Institute of Londrina and State University of Londrina, Paraná, Brazil. The series comprised ten consecutive patients with a confirmed diagnosis of DUSN, ie, seven patients with late-stage disease and three with early-stage disease, who were assessed by SD-OCT for mean macular, retinal nerve fiber layer, and choroidal thickness using enhanced depth imaging software.ResultsComparing the affected eye with the healthy fellow eye, significant diffuse atrophy of the retinal layers with a decrease in mean macular (P=0.004) and retinal nerve fiber layer (P=0.002) thickness was found in all cases. There was no difference in choroidal thickness (P=0.262).ConclusionThe correlation of SD-OCT results with central vision and funduscopic findings may explain the profound loss of visual function in patients with DUSN.

Neuroretinite unilateral subaguda difusa (DUSN): atualização continuada

Diffuse unilateral subacute neuroretinitis (DUSN) is a form of uveitis that can potentially lead to blindness. In Brazil and other parts of South America, diffuse unilateral subacute neuroretinitis is an important cause of posterior uveitis in children and healthy young adults. If diagnosed and treated in early stage, allows a resolution of symptoms with improvement of visual acuity. If the disease progresses to the late stage, can result in significant visual loss. In this study, through a literature review, we describe the main characteristics of this disease, including the following aspects: history, etiology, physiopathology, clinical features, diagnosis, differential diagnosis and treatment.

Diffuse Unilateral Subacute Neuroretinitis

Diffuse unilateral subacute neuroretinitis (DUSN) is a usually unilateral inflammatory disease characterized by an insidious, usually severe loss of peripheral and central vision. Clinical characteristics are manifested in early and late stages. Parasites of different sizes and several species of nematodes have been reported as the etiology of DUSN without conclusive evidence about the specific agent. Because serologic testing has been variable, the definitive diagnosis is made when the clinical characteristics of DUSN are found in conjunction with an intraocular worm. Laser photocoagulation, pars plana vitrectomy, thiabendazole, and albendazole have been used to treat DUSN with variable success.

Clinical Features of 121 Patients With Diffuse Unilateral Subacute Neuroretinitis

To describe the determinant clinical signs to diagnose diffuse unilateral subacute neuroretinitis (DUSN) and the main features related to identification of the live worm. Retrospective study performed at the Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil, between 2003 and 2008. Patients with early- or late-stage diffuse unilateral subacute neuroretinitis were included. All patients underwent complete ophthalmologic examination and had a minimum of 6 months of follow-up. A total of 121 patients were included. Most patients were younger than 20 years (69.42%). Visual acuity was 20/400 or worse in 86 patients (71.7%). Nine patients (7.43%) presented in the early stage and 112 (92.57%) patients presented in the late stage. Subretinal tracks (91.7%), focal alterations of the retinal pigment epithelium (89.3%), small white spots (80.2%), and optic nerve atrophy (76.9%) were the most frequent clinical features. The subretinal worm was identified in 48 patients (39.66%), and laser treatment to destroy it was performed in all cases. The most common location of the nematode was the posterior pole (21 patients). It was observed that the younger the age, the higher the indices of larvae identification (P=.022). Multifocal yellow-white lesions and vitritis were correlated with identification of the worm (P=.001). Mean logarithm of the minimal angle of resolution visual acuity was 1.466 (20/600) and 1.281 (20/400) before and after laser treatment, respectively (P<.005). Identification of clinical signs and diagnosis of diffuse unilateral subacute neuroretinitis in its early stage, followed by prompt location and destruction of the worm by photocoagulation, may improve the vision of affected patients.

Migrating behavior of presumed Toxocara presenting as punctate inner choroidopathy, idiopathic choroidal neovascularization, and diffuse unilateral subacute neuroretinitis.

To document the intraretinal migration of presumed toxocara larvae mimicking punctate inner choroidopathy, idiopathic choroidal neovascularization, and diffuse unilateral subacute neuroretinitis. Sequential color photographs, fluorescein angiograms, and optical coherence tomography were performed in three unrelated adult patients with presumed ocular toxocariasis. Characteristic fundoscopic manifestations simulating punctate inner choroidopathy, idiopathic choroidal neovascularization, and diffuse unilateral subacute neuroretinitis were reported in these patients, respectively. Presumed toxocara larvae must be included as a potential cause of different inflammatory diseases as a result of its migration through the retinal layers.

Optical Coherence Tomography in Ophthalmology

Optical coherence tomography (OCT) is an optical signal acquisition and processing method that captures micrometer-resolution three-dimensional images from within biological tissues. In recent years, OCT has become an important imaging technology used in diagnosing and following macular pathologies. It has complemented fluorescein angiography in many cases, especially in the diagnosis and management of various retinal disorders, including macular edema and age-related macular degeneration. In addition, further development enabled application of optical coherence tomography in evaluation of the integrity of the nerve fiber layer, optic nerve cupping, anterior chamber angle, or corneal topography. In this special issue, a number of researchers and physicians prepared twelve papers to discuss developments on the application of OCT for ocular diseases diagnosis. It comprises three review articles, six original articles, and three case reports. One of the review articles is an overview on the usefulness of OCT for the anterior segment entities by our work group. The other two review papers deal with the use of OCT in ophthalmic tumors and on the simultaneous confocal scanning laser ophthalmoscopy combined with high-resolution spectral domain. Three case reports show unique features of OCT in patients with fundus abnormalities as diffuse unilateral subacute neuroretinitis, central serous chorioretinopathy, and punctate inner choroidopathy. Original papers on various subjects such as glaucoma diagnostics, retinal detachment, or retinitis pigmentosa offer novel insights into ophthalmology research. We expect this special issue to be a contribution to the progress in imaging in ophthalmology. The diversity of papers illustrates the wide utility of OCT in ophthalmology.

Diffuse unilateral subacute neuroretinitis in a young boy: a case report

We report a case of diffuse unilateral subacute neuroretinitis in a young boy with no clinical visualization of nematode. The diagnosis was made based on clinical findings and detection of Toxocara immunoglobulin G by Western blot test. An 11-year-old Malay boy presented with progressive blurring of vision in the left eye for a duration of 1 year. It was associated with intermittent floaters. Visual acuity in the left eye was 6/45 and improved to 6/24 with pinhole. There was positive relative afferent pupillary defect, impaired color vision, and presence of red desaturation in the left eye. There were occasional cells in the anterior chamber with no conjunctiva injection. Posterior segment examination revealed mild-to-moderate vitritis and generalized pigmentary changes of the retina with attenuated vessels. The optic disk was slightly hyperemic with mild edema. There was presence of multiple, focal, gray-white subretinal lesions at the inferior part of the retina. Full blood picture results showed eosinophilia with detection of Toxocara immunoglobulin G by Western blot test. Investigations for other infective causes and connective tissue diseases were negative. The diagnosis of diffuse unilateral subacute neuroretinitis secondary to Toxocara was made based on clinical findings and laboratory results. He was treated with oral albendazole 400 mg daily for 5 days and oral prednisolone 1 mg/kg with tapering doses over 6 weeks. At 1 month follow-up, the inflammation had reduced, and multiple, focal, gray-white subretinal lesions were resolved; however there was no improvement of vision.

Imaging in the Diagnosis and Management of Diffuse Unilateral Subacute Neuroretinitis

Garcia Filho, Carlos A. de A. MD; Garcia, Carlos A. de A. MD; Arevalo, J. Fernando MD, FACS Author Information