ESOIRS 2014

6/25/2014
ESOIRS 2014
Dr. Ahmed Elmarsafawy
18/6/2014
Dr. Ahmed El-Marsafawy / ESOIRS 2014
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Special thanks
To
Prof. Dr. Ahmed Shama.
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Prof. Dr. Samir Elbaha.
Dr. Ahmed El-Marsafawy / ESOIRS 2014
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Unilateral vision loss
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• Male patient 35 ys.
• C/O: defect in V/A in right eye since several years in
a gradual course, and asking if there is any way to
improve it.
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Right
Left
BCV/A: 3/60
6/6
Cornea &lens : clear
Tension: 14(OU)
Pupil: RAPD
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• Fundus:
• RT:
Diffuse RPE defects,
Pale disc
Narrow vessels.
Retinal Pigmentation
• Lt:
Normal fundus.
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• F.A.
• OCT (macula).
• OCT (NFL).
• Field.
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Unilateral
vision
loss.
Sub-acute
or
chronic.
Optic n.
affected.
Diffuse
RPE
defect.
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Neuro-retinitis
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•
•
•
•
Diffuse.
Unilateral.
Subacute.
Neuroretinitis.
DUSN
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• 1983, Gass and Braunstein observed a nematode in
two patients with DUSN.
•
Hence, a syndrome of initially unknown cause
found to be related to a nematode in the subretinal
space
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• Different species of nematodes have been
reported as the etiologic agent of DUSN, including
Toxocara canis, Baylisascaris procyonis, and
Ancylostoma caninum
, and most of these reports do not present conclusive
evidence about the specfic agent.
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• Via transvitreal approach, de Souza et al.
recovered the nematode intact and motile
• but because of poor fixation, definitive
identification of the worm was not possible.
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• Prof. Samir Elbaha.
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Wuchereria bancrofti
Human parasitic round worm
Major cause of lymphatic filariasis
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• Mild to moderate vitritis.
• Mild optic disk edema.
• Recurrent crops of evanescent, multifocal, graywhite lesions at the level of the outer retina. These
lesions typically are clustered in only one segment
of the fundus.
• In approximately 25–40% of cases, a worm is
visualized during eye examination.
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• sarcoid, and other entities that cause focal
chorioretinitis,including:
• toxoplasmosis and histoplasmosis.
• multifocal choroiditis, serpiginous choroiditis.
• acute posterior multifocal placoid pigment
epitheliopathy.
• multiple evanescent white dot syndrome.
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• Progressive optic atrophy with the subsequent
afferent pupillary defect.
• Increase in the internal limiting membrane
reflex (Oréfice’s sign).
•
Evidence of tunnels in the subretinal space
(Garcia’s sign).
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• Retinal narrowing of the retinal arteries.
•
Marked diffuse degenerative changes in the RPE
and retina.
•
Severe permanent loss of vision.
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• Post traumatic chorioretinopathy.
• occlusive vascular disease.
• sarcoid .
• toxic retinopathy.
• Unilateral retinitis pigmentosa.
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• Laser Treatment:
• treatment of a visible worm with photocoagulation
seems to offer the best chance for halting worm
motility and resolution of the active gray-white
lesions without causing significant intraocular
inflammation or toxic damage to the eye.
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• Oral Treatment:
Gass et al. reported that thiabendazole could be
effective in some patients when the worm cannot
be found and when DUSN is accompanied by
moderate degrees of vitreous inflammation that is
associated with a breakdown in the blood-retinal
Barrier.
• (400 mg/day)for 30 days.
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• Pars Plana Vitrectomy (PPV):
• Pars plana vitrectomy is not the standard of
treatment for DUSN when the nematode is found.
• However, as previously stated, for recovering
the nematode intact, when a nematode larva is near
the fovea.
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• Please check fundus thouroughly in cases of uveitis
in young adult , and do not jump to steroid and
treatment, because this is the only way to stop
deterioration of vision in cases of DUSN.
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Thank You
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