Koohasawad Sugamon
Department of Ophthalmology, Neurological Institute of Thailand, Bangkok, Thailand.
Int Med Case Rep J. 2021 Oct 29;14:757-760. doi: 10.2147/IMCRJ.S324286. eCollection 2021.
To report the patient with subretinal larva.
Retrospective, observational case report.
A 47-year-old Thai woman had eosinophilic meningitis. One week after the onset of a headache, blurred vision developed in her right eye. Ocular examination of the right eye showed larva in the subretinal space in the inferotemporal quadrant and macular edema. Although serum analysis for was negative, the larva can be identified by its characteristic appearance. Blood eosinophilia and cerebrospinal fluid eosinophilia were presented. Focal laser photocoagulation was applied to the retina, and the patient also received anti-helminthic and oral corticosteroid drugs. The vision did not recover. Ultimately, the retina became atrophic. The dead larva remained at the same site at which it was observed. No further larval migration occurred after treatment.
larva can damage the retinal layer despite its eradication and no further migration. After its death, the inflammation persisted either as the result of toxin secretion or an immune responsiveness. Administration of local anti-inflammatory drugs such as corticosteroids or any anti-vascular endothelial growth factor injection should be considered.
报告一例视网膜下幼虫患者。
回顾性观察病例报告。
一名47岁泰国女性患有嗜酸性粒细胞性脑膜炎。头痛发作一周后,其右眼出现视力模糊。右眼眼部检查显示在颞下象限视网膜下间隙有幼虫及黄斑水肿。尽管血清检测呈阴性,但可通过幼虫的特征性外观进行识别。患者出现血液嗜酸性粒细胞增多和脑脊液嗜酸性粒细胞增多。对视网膜进行了局部激光光凝治疗,患者还接受了抗蠕虫药物和口服糖皮质激素治疗。视力未恢复。最终,视网膜萎缩。死亡的幼虫仍留在观察到的同一部位。治疗后未发生进一步的幼虫迁移。
尽管幼虫已被根除且未进一步迁移,但仍可损害视网膜层。幼虫死亡后,炎症持续存在,可能是毒素分泌或免疫反应的结果。应考虑给予局部抗炎药物,如糖皮质激素或任何抗血管内皮生长因子注射剂。