University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (KM, KL,GTK).
University of Hawai'i John A. Burns School of Medicine, Department of Surgery, Honolulu, HI (GTK).
Hawaii J Health Soc Welf. 2021 Nov;80(11 Suppl 3):40-44.
Angiostrongylus cantonensis, commonly known as the rat lungworm, is mostly found in Asia, the Pacific Basin, and the Caribbean, but is also endemic in Hawai'i, especially on the Island of Hawai'i. Ocular angiostrongyliasis is an uncommon but previously reported complication associated with permanent vision loss. This is the first reported case of ocular angiostrongyliasis involving the retina or posterior segment of the eye in the US. A 24-year-old male from Chicago visited the Island of Hawai'i, where he worked on a farm and ate a vegetarian diet. When he returned to Chicago, he became sick and was hospitalized for eosinophilic meningitis. One month later, he developed a retinal detachment which required surgical repair involving a pars plana vitrectomy. During the reattachment of the retina during surgery, a live motile was identified nematode in the subretinal space. An endolaser probe immobilized and killed the nematode, and it was subsequently extracted through the sclerotomy. Thermal scars around all retinal holes including the retinotomy site were made to stabilize the retina, and perfluoropropane gas was injected to achieve temporary tamponade. Thereafter, the patient's cerebrospinal fluid returned positive for angiostrongylus cantonensis antibodies. During extended follow-up, the patient eventually lost all vision in the affected eye due to recurrent retinal detachment. This case of ocular angiostrongyliasis demonstrates the importance of obtaining travel history from endemic areas, knowing the risk of developing eosinophilic meningitis, and understanding the risk of permanent vision loss in cases involving the retina.
广州管圆线虫，俗称鼠肺线虫，主要分布在亚洲、太平洋盆地和加勒比海地区，但也存在于夏威夷，特别是夏威夷岛。眼内广州管圆线虫病是一种罕见但以前有报道的并发症，可导致永久性视力丧失。这是美国首例报道的涉及视网膜或眼球后段的眼内广州管圆线虫病。一名来自芝加哥的 24 岁男性前往夏威夷岛，在那里他在一个农场工作并吃素。当他回到芝加哥时，他生病了并因嗜酸性粒细胞性脑膜炎住院。一个月后，他出现视网膜脱离，需要手术修复，包括玻璃体切除术。在手术中视网膜复位时，在视网膜下间隙发现了一条活体活动的线虫。通过内激光探头固定并杀死线虫，然后通过巩膜切开术提取线虫。在包括视网膜切开部位在内的所有视网膜裂孔周围制作热疤痕以稳定视网膜，并注入全氟丙烷气体以实现暂时的填塞。此后，患者的脑脊液对广州管圆线虫抗体呈阳性。在长期随访中，由于复发性视网膜脱离，该患者最终失去了受影响眼中的所有视力。该例眼内广州管圆线虫病表明，从流行地区获取旅行史、了解发生嗜酸性粒细胞性脑膜炎的风险以及了解涉及视网膜的情况下永久性视力丧失的风险非常重要。
