Intraocular cysticercosis: clinical characteristics and visual outcome after vitreoretinal surgery

An Interesting Case Report on a Myocysticercosis Cyst

One of the most dangerous parasite infections, cysticercosis, is found practically everywhere in the world. Cysticercus cellulosae is the larval stage of the swine tapeworm Taenia solium, which causes cysticercosis. Orbital or ocular cysticercosis (OOC) is an avoidable cause of blindness. There are two types of ocular cysticercosis: intraocular (in the anterior chamber, subretinal space, or vitreous) and extraocular (in the orbital tissues or subconjunctival space). Here, we report a rare case of extraocular muscle cysticercosis that presented as a solitary, well-defined lobulated mass near the medial canthus in the right eye and was well managed medically with antihelminthic drugs and corticosteroid therapy. The key to diagnosing myocysticercosis is orbital imaging. Although brain and ocular involvement in cysticercosis is common, extraocular muscle cysticercosis is extremely uncommon and mainly affects young people and children. Orbital pseudotumor, idiopathic myositis, and hydatid cysts are a few differential diagnoses for ocular cysticercosis. It is critical to recognize and treat such illnesses as early as feasible to avoid serious consequences. Public health measures are essential to eradicate this disease in the area.

Worm in the Eye: A Case Report of Ocular Neurocysticercosis With Adherent Retinal Cyst

Neurocysticercosis is caused by cysticercus cellulosae, the larval stage of Taenia solium, commonly referred to as the pork tapeworm. These larvae form cysts in several organs, including the brain, spinal cord, and eye. Neurocysticercosis is recognized by the World Health Organization as a public health issue and stands as the foremost preventable cause of epilepsy worldwide. Ocular neurocysticercosis refers to the concurrent involvement of the eyes and brain with cysticercus lesions. Neurological symptoms include focal deficits, intracranial hypertension, or cognitive decline. In the eye, the orbital type commonly presents with periocular swelling, ptosis, diplopia, restriction of ocular motility, or decreased vision. The ocular type shows signs of retinal detachment, a macular hole, and inflammation. A 45-year-old female presented with pain in his right eye with blurred vision for 15 days. On USG and MRI of the eye, a thin-walled lesion was noted. The brain showed a few calcified granulomas in the right parietal lobe on MRI. The left eye was normal. If left untreated, the cysts can lead to a severe inflammatory reaction in the eye, which may eventually lead to blindness. This blindness caused by cysticercus is preventable, and hence, early diagnosis and prompt medical or surgical treatment are essential.

Intraocular twin cysticercosis

A 20-year-old vegetarian male presented with a history of painful diminution of vision in the right eye for the past month. The patient had dense vitritis. B-scan ultrasonography (USG) revealed two cysts with scolices, one subretinally along with retinal detachment and another one in vitreous cavity. Orbital USG revealed no cystic lesions in the orbit or extraocular muscle. He underwent 23 gauge pars plana vitrectomy. Both intravitreal and subretinal cysts were cut and aspirated using cutter and removed from the eye, and silicon oil was injected. Postoperatively he was started on oral steroids and advised to maintain prone positioning for two weeks. At two months his best corrected visual acuity (BCVA) in the right eye was 20/125 with silicon oil in situ.

Delayed Pediatric Diagnosis of Cysticercosis and Uveitis Presenting as Chronic Multifocal Subretinal Fluid Blebs

Purpose:

To report an unusual case of intraocular cysticercosis in a 11-year-old boy that presented with chronic posterior uveitis and associated recalcitrant subfoveal and multifocal subretinal fluid blebs. The patient was later found to have a subsequent free-floating vitreous cyst that had been concealed from examination for years.

Methods:

Case report.

Results:

A diagnostic and therapeutic vitrectomy and cyst extraction revealed eosinophilic material suggestive of cysticercosis. Brain magnetic resonance imaging revealed suggestive neurocysticercosis and serological titers for cysticercosis immunoglobulin G were positive. After antihelminthic therapy and surgical removal of the cyst, the patient did well with complete resolution of multifocal subretinal fluid blebs and visual acuity improvement to 20/25.

Conclusion:

Ocular cysticercosis is a sight-threatening parasitic disease that can cause visually threatening manifestations if not identified and treated in a timely manner. Awareness of atypical presentations such as seen in this case in a pediatric patient is paramount.

Cysticercosis in ophthalmology

Cysticercosis is caused by Taenia solium, a cestode or tapeworm that preferentially affects the subcutaneous tissue, brain, muscle, and the eye. It is traditionally a disease of low socioeconomic regions, but large-scale population migration has made it a matter of global concern. Its ocular invasion is a potentially blinding disease. In the last two decades, there has been considerable discussion of cysticercosis; however, most comes from a limited number of case observations. Thus, to overcome this limitation, we summarize and analyse twenty years of medical literature (from 2000 to 2020) on cysticercosis in ophthalmology.

Submacular cysticercosis in two cases: Course and outcome

Ocular manifestations due to cysticercosis may involve the vitreous cavity or subretinal space in the posterior segment of the eye. Management of subretinal cysticercosis is challenging, especially if it involves the submacular region. Removal of submacular cysticercosis (SMC) requires utmost care and competent expertise. In recent times, modern vitreo-retinal equipment has improved the outcome of SMC. On the contrary, untreated SMC run a high risk of spontaneous rupture, liberation of toxin from dying worm, and intense intraocular inflammation threatening vision eventually. In the present report, two cases of SMC were discussed who presented to us within a span of 1 week. We described the course of disease and final outcome in these two patients (one underwent surgical removal while other denied surgery) highlighting the urgent need of cyst removal in such scenarios.

Submacular Cysticercosis Successfully Treated through Conservative Management: Case Report

Appropriate medical management can be an alternative in those patients with submacular cysticercosis in whom achieving good visual outcome with vitreoretinal surgery is not possible. We report the case of a 25-year-old female who presented complaining of blurred vision in her left eye associated with photopsias and metamorphopsias of 3 months duration. Initial visual acuity in the right eye was 20/20 and 20/100 in the left eye. Upon indirect ophthalmoscopy in the left eye, a yellow-white, dome-shaped, elevated lesion with foveal involvement was observed. The rest of the ophthalmological examination proved normal. With clinical findings and images, submacular cysticercosis was diagnosed, and vitreoretinal surgery was suggested. Nevertheless, the patient did not accept the treatment; therefore, medical management was initiated. Central nervous system involvement was ruled out, and treatment with praziquantel and systemic prednisolone was initiated. Cysticercosis was resolved with significant improvement of her symptoms and visual acuity.

A rare case of giant subretinal migration of cysticercosis cyst with extensive epiretinal membrane and subretinal fibrosis

Cysticercosis is caused by cysticercus cellulosae, the larval form of pork tapeworm. In intraocular cysticercosis the cyst enters the subretinal space via the choroid and then gains entry into the vitreous cavity by piercing the retina. It is well established that the cyst can incite extensive intraocular inflammation. Other complications such as epiretinal membrane and cataract have been reported in the literature. Thus far, epiretinal membrane in intraocular cysticercosis has been reported at the site of entry of the cyst into the vitreous cavity. The data on the extent of epiretinal membrane is sparse. We report a rare case of migrating subretinal cysticercosis with extensive epiretinal membrane and subretinal fibrosis.

Submacular cysticercosis

Ocular cysticercosis could involve subconjunctival space, anterior chamber, extraocular muscle, subretinal space, or vitreous. The presence of intraocular live cyst is a potential threat to visual acuity. The removal of the cyst in-toto is thus of importance to prevent inflammatory reaction and ocular damage. The presence of cysticercosis underneath the macula makes the management challenging. Herein, we describe the management of a submacular live cysticercus cyst with a good postoperative gain in visual acuity. Also, the swept-source optical coherence tomography changes are described.

Cysticercosis of the eye

Cysticercosis is a preventable and eradicable cause of blindness endemic in the Indian subcontinent, South-East Asia and other developing countries. Ocular and orbital cysticercosis has varied presentations depending upon the site of involvement, number of lesion and the host immune response. In this article we present a review of the various clinical manifestations, diagnosis and management protocol for orbital and ocular cysticercosis. Owing to its varied presentation, cysticercosis may pose a diagnostic challenge to the health professionals. Early diagnosis and management can prevent the vision loss and optimize visual outcomes.

Intravitreal cysticercosis with full thickness macular hole: management outcome and intraoperative optical coherence tomography features

Ocular cysticercosis is a serious condition with a potential for complete vision loss if left untreated. Intravitreal cysticercosis is the most common ocular form of cysticercosis and is associated with retinal detachment, retinal traction, subretinal scarring and vitritis. To the best of our knowledge, there is no report of the occurrence of a live intravitreal cysticercosis with a full thickness macular hole (FTMH) in the literature. We here report a case of live intravitreal cysticercosis with a FTMH along with its management and intraoperative optical coherence tomography features of the live cysticercus.

Characterization of the parasite-induced lesions in the posterior segment of the eye

Ocular lesions are frequently associated with different parasitic infections. The classes of infection include protozoa, nematodes, cestodes, and ectoparasites. Ocular parasitic infections can manifest in any part of the eye; the disease manifestations are frequently characterized as either posterior or anterior eye disease. Parasite-induced lesions may be due to damage directly caused by the parasite, indirect pathology caused by toxic products or the immune response initiated by infectious parasitism. This review characterized the parasite-induced lesions in the posterior segment of the eye. Prompt diagnosis and early treatment of these lesions can reduce ocular morbidity. The method of the literature search was conducted on PubMed, Elsevier Scopus database, and Google Scholar with no limitation on the year of publication databases. It was limited to English articles published for ocular lesions in clinical studies and was focused on parasitic infections of the eye.

Ocular parasitoses: A comprehensive review

Parasitic infections of the eyes are a major cause of ocular diseases across the globe. The causative agents range from simple organisms such as unicellular protozoans to complex metazoan helminths. The disease spectrum varies depending on the geographic location, prevailing hygiene, living and eating habits of the inhabitants, and the type of animals that surround them. They cause enormous ocular morbidity and mortality not because they are untreatable, but largely due to late or misdiagnosis, often from unfamiliarity with the diseases produced. We provide an up-to-date comprehensive overview of the ophthalmic parasitoses. Each section describes the causative agent, mode of transmission, geographic distribution, ocular pathologies, and their management for common parasites with brief mention of the ones that are rare.

Ocular cysticercosis with vitreous hemorrhage: a rare complication of a common disease

Introduction

Cysticercosis, a helminthic infestation caused by Taenia solium, can produce central nervous system, muscles, visceral, subcutaneous tissues and skin manifestations. Ophthalmological involvement can affect eyelids, conjunctiva, anterior chamber, uvea, vitreous, retina, extraocular muscles and optic nerve. Simultaneous co-occurrence of intracranial and intraocular cysticercosis is a common presentation in clinical practice.

Case description

We report a case of young girl who was diagnosed with multiple intracranial neurocysticercosis lesions and was on antiepileptic drugs, following which she presented with progressive painless vision loss from both the eyes. Indirect ophthalmoscopic examination showed evidence of subretinal cysts, retinal hemorrhage and retinal detachment in both the eyes. Surprisingly, bilateral vitreous hemorrhage was also detected. Ocular B-scan ultrasonography, orbital MRI and computed tomography revealed retinal detachment with vitreous hemorrhage in both the eyes. Magnetic resonance imaging (MRI) of brain showed multiple intraparenchymal small cystic lesions in bilateral cerebral and cerebellar hemispheres, basal ganglia, thalami and brainstem.

Conclusions

Vitreous and retinal detachment are well known complications of intraocular cysticercosis, however, vitreous hemorrhage as preoperative feature has never been reported before, although vitreous hemorrhage as postoperative complication is common.

Unusual presentation of subretinal cysticercosis with hypopyon uveitis

Subretinal cysticercosis presenting with anterior uveitis and hypopyon is rare. A 7-year-old boy presented with pain and hypopyon in the right eye. Ultrasonography showed a cystic lesion with scolex. Because visual prognosis was poor, he was treated conservatively. Timely diagnosis would facilitate early therapy and prevent visual loss.

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

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.

Parasitic diseases of zoonotic importance in humans of northeast India, with special reference to ocular involvement

Parasitic zoonotic diseases are prevalent in India, including the northeastern states. Proper epidemiological data are lacking from this part of the country on zoonotic parasitic diseases, and newer diseases are emerging in the current scenario. Systemic manifestation of such diseases as cysticercosis, paragonimiasis, hydatidosis, and toxoplasmosis are fairly common. The incidence of acquired toxoplasmal infection is showing an increasing trend in association with acquired immunodeficiency syndrome. Among the ocular parasitic diseases, toxoplasmosis, cysticercosis, toxocariasis, dirofilariasis, gnathostomiasis, hydatidosis, amebiasis, giardiasis, etc, are the real problems that are seen in this subset of the population. Therefore, proper coordination between various medical specialities, including veterinary science and other governing bodies, is needed for better and more effective strategic planning to control zoonoses.

Ocular cysticercosis in a 32-year-old man in Abuja: ultrasonic features as an aid in diagnosis

We report the case of a 32-year-old man suffering from intraocular cysticercosis, with special emphasis on the use of B-scan ultrasound in the diagnosis and management of the condition. An 8000 B-Scan Scanmate was used to obtain the ultrasound images. The patient had worked on a pig farm a few years before presentation. He presented with shadows seen in the right eye. Binocular indirect ophthalmoscopy revealed that he had a choroidal detachment in the right eye inferotemporally. B-scan ultrasound revealed a subretinal subchoroidal cyst with a thick wall containing well defined intracystic echogenic entities representing scolices, and an associated retinal detachment. These findings appear to be pathognomonic. Excision of the cyst through a trans-scleral approach revealed a yellowish serous fluid, with scolices of cysticercus later confirmed histologically. B-scan ultrasound is extremely useful in the diagnosis of ocular cysticercosis and the findings can be pathognomonic.

Intraocular cysticercosis: case series and comprehensive review of the literature

PURPOSE

To analyze the demographics and clinical characteristics in patients with intraocular cysticercosis.

METHODS

Retrospective case series and comprehensive literature review.

RESULTS

Intraocular cysticercosis was diagnosed in 21 of 21,079 patients (0.10%) seen by the uveitis service at Aravind Eye Hospital. At presentation, visual acuity was 20/200 or worse in 14 eyes (63.6%). Inflammation was unilateral in all but one patient (95.2%). The cyst was located in the vitreous cavity in 36.4% of eyes and in the subretinal space in 63.6% of eyes. In the literature review, most patients were affected unilaterally (98.5%); visual acuity at presentation was 20/200 or worse in 82.3% of eyes; and the cyst was located in the vitreous cavity in 59.5% of eyes.

CONCLUSIONS

Intraocular cysticercosis usually affects young patients unilaterally. The cyst may be in either the vitreous cavity or the subretinal space, and visual acuity at presentation is often poor.

Intravitreal cysticercosis presenting as neovascular glaucoma

We report two cases of intraocular cysticercosis which showed a peculiar presentation of neovascular glaucoma which is hitherto unreported. Two young adults presented with symptoms of raised intraocular pressure due to neovascular glaucoma. On dilated fundus examination both were found to have dead intravitreal cysticercosis. The cysts were removed by a three-port vitrectomy and intracameral injection of bevacizumab was given to help in the regression of rubeosis. Trabeculectomy had to be combined in one case. The intraocular pressure returned to normal. No recurrence of rubeosis was seen even after one year.

Tear IgA-ELISA: a novel and sensitive method for diagnosis of ophthalmic cysticercosis

For the first time, presence of locally secreted specific IgA antibodies in tear specimen from human with ophthalmic cysticercosis is documented in the present study. The ELISA using Taenia solium metacestode excretory secretory (ES) antigen demonstrated a diagnostic level of IgA antibodies in tears with 100% sensitivity (6 out of 6 confirmed cases of ophthalmic cysticercosis) whereas, 25 of 34 (73.52%) clinically suspected cases were diagnosed positive. The ELISA using T. solium metacestode somatic antigen detected a diagnostic titre of IgA antibody in tears with a sensitivity of 50% (3 out of 6 confirmed cases). The specificity of the tear IgAELISA using T. solium metacestode somatic and ES antigens is observed to be 94.87% and 92.3%, respectively. Overall in tears, the ELISA using T. solium metacestode ES antigens for detection of IgA antibodies shows a higher diagnostic efficiency (93.33%) compared to that using T. solium metacestode somatic antigen (88.88%). The sensitivities of the ELISA for detection of IgA antibodies in tears is observed to be higher than that for detection of IgG antibodies in serum using either somatic or ES antigens of the parasite.

Parasites and the eye

Systemic parasitic infections can result in intraocular inflammation. They are a major cause of blindness in many parts of the world. Infection usually results from bloodborne transmission of the organism to the eye or ocular adnexal structures. Diagnosis is often made from clinical patterns of disease in the eye, with laboratory investigations and imaging to support the diagnosis. Various local and systemic therapies are available, but may have limited success in preserving vision.