Clinical experience in treatment of diffuse unilateral subretinal neuroretinitis

Abstract

PurposeTo describe the clinical features, management, and outcomes of patients with diffuse unilateral subacute neuroretinitis (DUSN).MethodsA noncomparative, consecutive analysis of case series from two tertiary care campuses of LV Prasad Eye Institute, India, between January 2011 and April 2014 was performed. Medical records of the patients presenting with DUSN (early or late stage) were reviewed.ResultsThe current study included 13 patients. The majority (10/13, 76.92%) of the patients were aged 20 years or less. All patients had unilateral eye involvement. Visual acuity at presentation was 20/200 or worse in 9/13 (69.23%) patients. A delay in diagnosis occurred in 6/13 patients, and initial diagnosis in these patients included retinitis pigmentosa (4 patients) and posterior uveitis (2 patients). Clinical features included early presentation (prominent vitritis, localized retinitis, and vasculitis) in 7/13 (53.85%) patients and late presentation (attenuation of vessels, retinal pigment epithelium atrophic changes, and optic atrophy) in 6/13 (46.15%) patients. Worm could not be identified in any of the cases. All the patients received laser photocoagulation of retina and oral albendazole treatment for a period of 30 days. With treatment, visual acuity improved in seven patients (six early stage, one late stage) and remained unchanged in six patients. Mean follow-up period was 8.69 months (range, 1–21 months). The mean central foveal thickness in the affected eye, done by optical coherence tomography, during the late stage of the disease was 188.20±40 µm (range, 111–242 µm), which was significantly thinner than the fellow eye, 238.70±36.90 µm (range, 186–319 µm), P=0.008.ConclusionDUSN is a serious vision threatening disease, which may progress to profound vision loss in the later stage of the disease. Visualization of subretinal worm is usually not possible. Treatment with high-dose albendazole therapy and laser photocoagulation may alter the blood–retinal barrier and may be useful in achieving visual recovery.

Role of PASCAL and optical coherence tomography angiograpgy in the treatment of diffuse unilateral subacute neuroretinitis caused by large live motile worm

“…As reported earlier,[79] laser photocoagulation required to disrupt the blood retinal barrier allowing better intraocular anthelmintic drug penetration was performed in our patient.…”

“…Laser photocoagulation is the treatment of choice in cases of DUSN where the worm is seen clinically or to the outer retinal crops as the worm might be in the vicinity of these lesions. [7] The worm is identifiable in only 30% of the cases. This case may be an early stage of the disease since no optic atrophy or vascular attenuation was present.…”

Diffuse unilateral subacute neuroretinitis: review article

“…These lesions are thought to be related to possible reactions to the nematode in subretinal space and characteristically migrate and change according to worm's location. It may or may not leave a residual retinal lesion depending on the degree of host immune response against the toxic products of the worm [20,[30][31][32].…”

“…In earlier stages of the disease, DUSN is often mistaken for other entities, including toxoplasmosis, toxocariasis, histoplasmosis, multifocal choroiditis, serpiginous choroiditis, acute posterior multifocal placoid pigment epitheliopathy, multiple evanescent white dot syndrome, and optic neuritis [17] In later stages, it is important to exclude posttraumatic chorioretinopathy, unilateral retinitis pigmentosa, occlusive vascular disease, sarcoidosis, syphilis, and other toxic retinopathies [9,32].…”

Short-term oral albendazole therapy for diffuse unilateral subacute neuroretinitis: A case report

“… 1 Although this disease's pathogenesis remains unclear and a specific causative agent has not been identified, parasitic organisms such as Baylisascaris procyonis, Ancylostoma caninum, and Toxocara canis are thought to be involved in its etiology. 1 , 2 DUSN is more prevalent in young individuals, and most patients present with unilateral disease. 3 , 4 In the early stages of DUSN, patients may present with a mild loss of visual acuity associated with vitritis, optic disc edema, and gray-white retinal lesions.…”