Intraocular Cysticercosis Research Articles

Simultaneous Brain and Ocular Cysticercosis in a Five-Year-Old Boy

To the Editors: ysticercosis caused by the parasitic tapeworm Taenia solium is a major public health problem in developing countries and also in developed countries as a result of increasing migration.1,2 The disease occurs when humans become the intermediate host in the life cycle of T. solium by ingesting its eggs from contaminated food.1,2 Neurocysticercosis is the commonest helminthic disease of the human nervous system.1,2 We present a 5-year-old boy who had simultaneous brain and ocular cysticercosis. In September 2005 this child was admitted because of multiple generalized seizures to another hospital near Mumbai. A computed tomography scan of the brain revealed multiple ring-enhancing cystic lesions with perilesional edema. A few cysts had an enhancing nodule suggestive of a scolex. Normal physical and neurologic examination findings, negative Mantoux test, normal chest radiograph, and absence of chronic fever or anorexia excluded central nervous system tuberculosis. Direct ophthalmoscope findings were normal. With a diagnosis of multiple brain cysticercii the child was treated with oral prednisone (2 mg/kg/d) for 3 days, followed by oral albendazole (15 mg/kg/d for 4 weeks) and discharged after a 7-day stay.3 Oral valproic acid was given to prevent recurrent seizures.3 In January 2006, the parents brought the child to our outpatient department for complaints of repetitive closure of the left eye lid and watering from left eye. On enquiry it was found that these symptoms had begun in October 2006, while the child was receiving albendazole therapy. As the child did not complain of pain, the parents completed the albendazole course. On examination it was found that the child had almost no perception of light in his left eye. The remainder of the physical examination was normal. The child was hospitalized. Indirect ophthalmoscopic examination revealed retinal detachment in the left eye. Computed tomography scan of the brain with orbital cuts showed multiple ring-enhancing cystic lesions, some with perilesional edema, and a cystic lesion along the posterior retina in the left eye (Fig. 1). Ultrasonographic examination of the left eye showed a subretinal cyst (9 × 9 mm) with 2 calcified specks with surrounding retinal detachment. The child was treated with oral prednisone (2 mg/kg/d for 3 weeks and then tapered and continued on 1 mg/kg/d). During the next 4 months the child developed inflammatory phthisis and lost all vision in his left eye.FIGURE 1.: Contrast-enhanced CT scan orbit showing cystic lesion along posterior retina in left eye (subretinal cysticercosis).The recommended treatment of intraocular cysticercosis is surgical removal of the intact cyst.4 Larvicidal drugs, such as albendazole, are contraindicated in ocular cysticercosis because the degeneration of the cyst can cause severe inflammation and visual loss.4 Simultaneous occurrence of brain and subretinal cysticercosis is extremely rare.5 We are not aware of any other reports of iatrogenic blindness developing in a child with this clinical condition. This case has important diagnostic and therapeutic implications. Indirect ophthalmologic examination or ultrasonographic examination of the eyes of children with neurocysticercosis should be considered before treatment of neurocysticercosis. Sunil Karande, MD Nilesh Kumbhare, DCH Department of Pediatrics Lokmanya Tilak Municipal Medical College and General Hospital Sion, Mumbai India [email protected]

Changing trends in ocular cysticercosis over two decades: An analysis of 118 surgically excised cysts

To evaluate the frequency of ocular cysticercosis and to demonstrate the changing trends in localisation of ocular cysticercosis along with a brief review of literature. A retrospective analysis of histology proven ocular cysticercosis cases seen over a period of 20 years (1981 through 2000) was done. The pathology record forms were reviewed for demographics, clinical features with specific reference to the location of cysts in four subgroups: subconjunctival; intraocular orbit and eyelid. The distribution of cases in four five-year periods namely group A: 1981-1985, group B: 1986-1990, group C: 1991-1995 and group D: 1996-2000 and the changing trends in the location of cysts was evaluated. One hundred eighteen cysts from 118 patients aged 4-72 (mean 17.1) years were submitted to the pathology service of S D Eye Hospital, Hyderabad. Male to female ratio was 1: 1.2. Total number of cases in groups A, B, C and D were 33, 41, 16 and 25 respectively. Location of cysts was subconjunctival - 74 (62.7%); intraocular-31 (26.3%); orbital-8 (7%) and lid-5 (4%). In last 20 years, significant decrease (P =0.0001) was noted in subconjunctival cases (85% vs. 28%) with a significant rise (P =0.0001) in intraocular cysticercosis (6% vs. 60%). Frequency of surgically excised ocular cysticercosis remained constant over last two decades with an increasing manifestation of intravitreal cysticercosis in the recent years. This could imply either improved diagnostic modalities, available expertise in vitreo-retinal surgery or ineffective medical treatment for intraocular parasitic infection. The relative decrease in extraocular cysticercosis is probably due to the increased preference and success with medical management.

CYSTICERCOSIS OF THE EYE IN SOUTH INDIA – A CASE SERIES

Purpose: To study the clinical presentation and treatment outcome of patients with ocular cysticercosis in southern India. Methods: This study included 10 patients who were diagnosed to have ocular or adnexal cysticercosis over a period of one year in Pondicherry, India. The clinical presentation, results of investigation and treatment outcome of the cases were analysed retrospectively. Results: Age of these patients ranged from 12 to 55 years. Four presented with loss of vision, two with a swelling in the eyelid, one with proptosis, one with diplopia and two with conjunctival involvement. ELISA for cysticercus antibodies in serum was positive in all cases. Albendazole and prednisolone were given for the treatment of these cases. Two patients responded well to treatment and were completely cured of the disease. There was partial improvement in 6 cases. Surgery in the form of excision was performed in two cases following a course of medical therapy. There was no significant change in visual acuity in eyes with intraocular cysticercosis following treatment. Conclusion: Ultrasonography B scan and ELISA for anticysticercal antibodies help to establish the diagnosis of ocular cysticercosis. A combination of oral albendazole and corticosteroids is found to be effective in confirmed cases. Intraocular cysticercosis is associated with a poor prognosis for vision.

MRI in intraocular cysticercosis - A case report

MRI in intraocular cysticercosis - A case report

Intraocular cysticercosis: clinical characteristics and visual outcome after vitreoretinal surgery

Purpose To report the clinical characteristics of, discuss the surgical options for, and analyze the factors affecting the anatomic and visual outcome of intraocular cysticercosis. Design Retrospective, noncomparative, interventional case series. Participants Forty-five eyes of 44 Indian patients with posterior segment intraocular cysticercosis. Methods The charts of 45 eyes, in which intraocular cysticercosis was removed by vitreoretinal surgery (either transscleral or transvitreal), were reviewed. Main outcome measures These included the postoperative retinal status and the best-corrected Snellen visual acuity. Results Intraocular cysticercosis was present in the vitreous cavity of 27 eyes (60%) and in the subretinal space of 18 eyes (40%). Anterior segment inflammation was seen in 13 eyes (28.8%) and vitreous inflammation in 38 eyes (84.4%). Retinal detachment was observed in 22 eyes (48.8%), with proliferative vitreoretinopathy in 13 eyes (59.09%). Subretinal cysts anterior to the equator (4 eyes) were removed transsclerally, whereas subretinal cysts posterior to the equator and intravitreal cysts (41 eyes) were removed transvitreally. The mean follow-up was 10.5 months. At the last follow-up, the retina was attached in 39 eyes (86.6%); visual acuity of ≥5/200 was achieved in 67.5%. Conclusions Current vitreoretinal surgical techniques enable removal of intraocular cysticercosis in all cases, with reattachment of the retina in 86.6% and recovery of ambulatory vision in approximately 67% of cases.

Intraocular cysticercosis simulating retinoblastoma in a 5-year-old child

Several ocular conditions can clinically simulate retinoblastoma by producing either a leucocoria or an ophthalmoscopically visible intraocular mass. In a large series of patients referred with the clinical diagnosis of retinoblastoma, 42% were found to have benign lesions that simulated retinoblastoma.1 The three lesions that most often clinically mimic retinoblastoma are persistent hyperplastic primary vitreous, Coats' disease, and ocular toxocariasis.1 Herein we report a case of intraocular cysticercosis in a 5-year-old child presenting with leucocoria, and simulating retinoblastoma.

Serum and aqueous anticysticercus IgG levels in intraocular cysticercosis

IgG anticysticercus antibody levels were estimated in the aqueous and serum by enzyme-linked immunosorbent assay (ELISA) in 7 patients with ocular cysticercosis and compared with controls with senile cataract. Mean anticystic ercus antibody levels in the aqueous and serum were significantly higher in patients than in controls. Evaluation of antibody levels in the serum or aqueous can play an important role in substantiating the diagnosis in suspected cases of intraocular cysticercosis.

Ultrasonological characteristics of extraocular cysticercosis

Cysticercosis is a common ophthalmic parasitosis wherein humans are the intermediate hosts in the life cycle of the tape worm Taenia solium . While intraocular cysticercosis is more common and is more readily diagnosed clinically, recognition of extraocular cysticercosis needs supplementary imaging. Computed tomography (CT) and magnetic resonance imaging (MRI) have been extensively used to diagnose and characterize neurocysticercosis. Since the orbit is easily accessible to ultrasonography (USG), we evaluated its role in the diagnosis and management of extraocular cysticercosis. Serial A- and B- scan ultrasonograms from 24 patients with extraocular cysticercosis were analyzed to determine features at various stages of evolution of the lesion and an attempt was made to classify the lesion on this basis. Of 24 patients, 23 had a cyst clearly demonstrable by USG: 22 within or attached to an extraocular muscle (with or without myositis) and one free in the orbit. One patient had an optic nerve cyst not detected by USG but by CT scan. Cysts at various stages of evolution were found – viable, degenerating and inactive. The therapeutic response of the cyst to treatment with oral albendazole could be effectively studied and monitored by sequential USG. Orbital ultrasound is a practical, precise and cost-effective imaging modality to diagnose, manage and monitor extraocular cysticercosis, although it can not completely replace CT and MRI.

Taenia crassiceps: Experimental model of intraocular cysticercosis

An experimental model of Taenia crassiceps intraocular cysticercosis was developed in rabbits. The objectives of this study were to analyze the pathophysiology of this parasitic infection and to evaluate the humoral immune response. Cysticerci, inoculated in the anterior chamber of the eye, were able to grow; no inflammatory changes in the eye or anticysticercus antibodies in serum or in aqueous humor were detected during the 12-day period. In contrast, rabbits that had previously been either infected intraperitoneally with living T. crassiceps cysts or immunized intramuscularly with T. crassiceps antigenic extract developed an intense inflammatory reaction in the eye and high levels of antibodies were detected in serum and aqueous humor even before the intraocular inoculation of parasites. Furthermore, intraocular cysticerci showed minimal growth and some were eliminated. These findings support the concept that the eye is an immunologically privileged site in the nonimmunized host and the importance of the immune response in the elimination of this parasitic infection.

Intraocular Cysticercosis

We observed and photographed intraocular cysticercosis in a 50-year-old woman. The subretinal cysticercus in the macular area produced a macular break during its passage from the subretinal space into the vitreous cavity. The parasite was removed by closed vitrectomy, but the macular break was left untreated because there was no vitreous traction to the macula. The patient ultimately developed a subretinal scar in the macular area, and visual acuity improved from hand movements to counting fingers.

Management of Subretinal and Vitreous Cysticercosis: Role of Photocoagulation and Surgery

Treatment of intraocular cysticercosis requires selection of the proper method, prevention of complications, and careful follow-up. Small subretinal cysticercus can be treated with xenon or argon photocoagulation. Macular cysticercus are extracted through a sclerochoroidal incision. Large cysticercus can be removed in selected cases with an outcome probe placed in the subretinal space. Cysticercus in the vitreous should be removed with a suction-cutter probe via the pars plana.