Diffuse unilateral subacute neuroretinitis: report of a case from the Indian subcontinent and the importance of immediate photocoagulation

Venkatesh, Pradeep; Sarkar, Sujoy; Garg, Satpal

doi:10.1007/s10792-007-9045-x

Cited by 13 publications

(5 citation statements)

References 12 publications

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“…In addition, laser treatment should be performed as soon as the worm is identified, because they are motile and may be difficult to locate it if the procedure is delayed. Clinical treatment is limited to cases in which no worm is found despite repeated examinations [19,34,47,48].…”

Section: Laser Treatmentmentioning

confidence: 99%

Diffuse unilateral subacute neuroretinitis: review article

Mazzeo

Motta

Curi

2019

J Ophthal Inflamm Infect

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Diffuse unilateral subacute neuroretinitis (DUSN) is an ocular infectious disease that can lead to severe visual impairment and blindness. It usually occurs in healthy young individuals and depending on the stage of the disease, it may present as vitritis, multifocal gray-white lesions in the outer retina, and derangement of the retinal pigment epithelium, narrowing of the retinal vessels and optic atrophy. Parasites of different sizes and species have been proposed as the etiologic agent of DUSN, including Ancylostoma caninum, Toxocara canis, and others. Thus, it is hypothesized that different infectious worms may be considered as the likely cause of both an autoimmune and toxic form of nematode retinopathy. Because serologic testing is variable, the definitive diagnosis is made when clinical characteristics of DUSN are found in conjunction with an intraocular worm. Ancillary tests can assist in the differential diagnosis when the nematode cannot be visualized, such as fluorescein and indocyanine green angiography, electrophysiological tests, visual field studies, and more recently, optical coherence tomography angiography. Cases in which the worm can be identified, it is defined as confirmed DUSN, and eyes with the typical clinical features but without identification of the worm should be classified as presumed DUSN. In confirmed DUSN, the classic treatment is directly photocoagulation of the worm; however, it can only be visualized in 30% (to 40%) of cases. Treatment of presumed DUSN cases with high-dose oral albendazole has shown encouraging results. However, perhaps due to the disease's rarity or its underdiagnosis, there are no studies comparing current treatment modalities in both presumed and confirmed DUSN. Due to the possibility of this disease being, in part, autoimmune nematode retinopathy, corticosteroids associated with both albendazole or laser therapy, could be in any way beneficial. Thus, further comparative studies are necessary to elucidate the best treatment for this potentially blinding disease.

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Section: Laser Treatmentmentioning

confidence: 99%

Diffuse unilateral subacute neuroretinitis: review article

Mazzeo

Motta

Curi

2019

J Ophthal Inflamm Infect

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“…The diagnosis is primarily clinical, and other investigations like angiography, electrophysiology, serology and optical coherence tomography are only ancillary 1–3. As the worm is known to be migratory and invades the peripheral retinal space frequently, meticulous assessment of the peripheral fundus is mandatory for localisation of the parasite in suspected cases 2. In this regard, UWFI proved to be a very useful tool for diagnosing DUSN in this case, which had presented very late.…”

Section: Descriptionmentioning

confidence: 81%

Ultrawide field imaging with navigable magnifier for diagnosis of diffuse unilateral subacute neuroretinitis

et al. 2017

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“…Therefore, it is very important to perform laser photocoagulation immediately after localization of the nematode, since migration of the worm and worsening of the condition can make relocalization of the worm impossible. [ 7 ]…”

Section: Discussionmentioning

confidence: 99%

Successful management of diffuse unilateral subacute neuroretinitis with anthelmintics, and intravitreal triamcinolone followed by laser photocoagulation

Lima

Ramezani

Soheilian

et al. 2016

J Ophthalmic Vis Res

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Purpose:Diffuse unilateral subacute neuroretinitis (DUSN), a form of posterior uveitis, is secondary to the presence of a highly motile nematode in the intraretinal or subretinal space. Herein, we report a case of DUSN that was successfully managed by an intravitreal injection of triamcinolone and laser therapy.Case Report:A middle-aged man with complaint of decreased vision and marked unilateral vitritis and neuroretinitis. Fluorescein angiography revealed disc leakage, vessel wall staining, and diffuse track-like transmission defects of the RPE. Optical coherence tomography confirmed the subretinal location of the worm. The patient received oral thiabendazole and an intravitreal injection of triamcinolone acetonide. After 10 days, media haziness decreased, and a live motile subretinal worm was identified. Direct laser photocoagulation was performed to destroy the worm. After two months, a localized chorioretinal scar developed and no further active inflammation and subretinal worms were detected.Conclusion:Intravitreal steroids can be used safely in cases with DUSN and may help detect the causative worm for applying laser photocoagulation.

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Diffuse unilateral subacute neuroretinitis: report of a case from the Indian subcontinent and the importance of immediate photocoagulation

Abstract: Whenever the nematode is detected, immediate laser photocoagulation of the worm is necessary as the migratory worm may be difficult to identify later on. This is necessary to prevent the otherwise natural decline in vision.

Cited by 13 publications

References 12 publications

Diffuse unilateral subacute neuroretinitis: review article

Diffuse unilateral subacute neuroretinitis: review article

Ultrawide field imaging with navigable magnifier for diagnosis of diffuse unilateral subacute neuroretinitis

Successful management of diffuse unilateral subacute neuroretinitis with anthelmintics, and intravitreal triamcinolone followed by laser photocoagulation

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