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Open Access Highly Accessed Case report

Intraocular nematode with diffuse unilateral subacute neuroretinitis: case report

Munira Yusoff12, Azma-Azalina Ahmad Alwi1, Mariyani Mad Said1, Sakinah Zakariah1, Zulkifli Abdul Ghani1 and Embong Zunaina2*

Author Affiliations

1 Department of Ophthalmology, Hospital Raja Perempuan Zainab II, 15886 Kota Bharu, Kelantan, Malaysia

2 Department of Ophthalmology, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia

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BMC Ophthalmology 2011, 11:15  doi:10.1186/1471-2415-11-15

Published: 16 June 2011

Abstract

Background

Live intraocular nematode is a rare occurrence. Nematode can migrate actively within the eye, creating visual symptoms and damaging ocular tissue.

Case presentation

A 26-year old man presented with painless reduced vision of the left eye for one week duration. It was associated with floaters. Visual acuity on the left eye was hand movement. Anterior segment examination was normal with normal intra-ocular pressure. Fundus examination showed a live nematode lying subretinally at the macular area with macular oedema and multifocal chorioretinal lesions at peripheral retina. There was no vitritis, vasculitis or any retinal hemorrhage. Systemic examination revealed normal findings and laboratory studies only showed leucocytosis with normal eosinophil count and negative serum toxocara antibody. The diagnosis of introcular nematode with diffuse unilateral subacute neuroretinitis was made. He was treated with oral anti-helminths and a course of oral steroid at a reducing dose. The nematode had died evidenced by its immobility during the treatment and finally disintegrated, leaving macular oedema with mottling appearance and mild hyperpigmentation. Multifocal chorioretinal lesions had also resolved. However despite treatment his visual acuity during follow-up had remained poor.

Conclusions

Cases of intraocular nematode, though not commonly encountered, continue to present the ophthalmologist with the problem of diagnosis and management and hence poorer prognosis to the patient.