A case of submacular cysticercosis treated by pars plana vitrectomy in Kuwait

Abstract

We report a case of submacular cysticercosis in the left eye of an Indian patient living in Kuwait. Though he was systemically asymptomatic, his magnetic resonance imaging showed multiple cysts in the brain. The patient underwent pars plana vitrectomy (PPV), and the cyst was removed in total through a retinotomy over the cyst. He had another small cyst in the periphery that was also removed. He was treated with oral albendazole and systemic steroids after the surgery to treat his neurocysticercosis. He developed rhegmatogenous retinal detachment after the surgery, and the retina was successfully reattached with scleral buckling and PPV procedure. His final best corrected visual acuity improved from counting fingers at 1/2 m at presentation to 20/400. This case report shows that the ocular cysticercosis may be seen among expatriates working in the Middle East. It is important to rule out the presence of neurocysticercosis in such patients as well as multiple cysts in the affected eye. However, the functional outcome of surgical treatment of submacular cysticercosis can be disappointing.

Submacular cysticercosis

“…The chemical toxins released are known to cause inflammatory damage and is accentuated on its death. 4 In our case, the visual acuity improved to 6/24. The thick, tough, and molding characteristic of the cyst allows it to be aspirated through a small retinotomy.…”

“…Scolex was seen as a comet-shaped echo with anterior hyper-reflectivity and posterior hypo-reflectivity, as described previously in the literature. 4,7…”

“…In spite of all these, poor visual outcomes have been described in the literature. 3,4 We herein present a case with submacular live cysticercosis managed with vitreoretinal surgery.…”

Infectious Uveitis

“…When a cysticercus cyst is present under the retina, pars plana vitrectomy with retinotomy, with engagement of the vesicle using a soft-tipped cannula, and extraction through an enlarged sclerotomy wound, can avoid rupture and the subsequent inflammatory reaction. [ 72 ]…”

Submacular cysticercosis in two cases: Course and outcome

“…The submacular cysts carry a worse prognosis as compared to other subretinal locations, which can be attributed to physical damage of photoreceptors, underlying RPE atrophy or inflammatory effects from liberated toxins. [ 6 9 ] Poor functional outcome has also been reported in eyes with RD more than two quadrants and preoperative vision of <5/200. [ 3 ] In a large series of intraocular cysticercosis cases, retinal reattachment was seen in 86.6% cases and ambulatory vision (>5/200) was regained in 67.5% cases.…”