Cutaneous larva migrans with optic disc edema: a case report

<p>Abstract</p> <p>Introduction</p> <p>A rare case of optic disc edema associated with cutaneous larva migrans is presented. To the best of our knowledge, this has not been previously reported in literature. Joint management by ophthalmology and tropical medicine teams proved most beneficial for our patient, facilitating correct diagnosis, appropriate investigations and instigation of suitable treatment.</p> <p>Case presentation</p> <p>A 45-year-old Caucasian man, a naturalist, from the UK developed cutaneous larva migrans while in Kenya and presented to us with visual disturbance secondary to unilateral optic disc edema. This resolved after receiving a single dose of ivermectin and visual acuity reverted to normal.</p> <p>Conclusion</p> <p>To the best of our knowledge, optic disc edema associated with cutaneous larva migrans has not been previously reported. This case highlights the importance of taking relevant history of recent travel to endemic areas affected by the nematodes in patients presenting with optic disc edema, and pertinent questioning regarding non-ocular symptoms, including skin lesions. In this case, a history of recent foreign travel and treatment for skin lesions was crucial.</p

Intraocular nematode with diffuse unilateral subacute neuroretinitis: case report

<p>Abstract</p> <p>Background</p> <p>Live intraocular nematode is a rare occurrence. Nematode can migrate actively within the eye, creating visual symptoms and damaging ocular tissue.</p> <p>Case presentation</p> <p>A 26-year old man presented with painless reduced vision of the left eye for one week duration. It was associated with floaters. Visual acuity on the left eye was hand movement. Anterior segment examination was normal with normal intra-ocular pressure. Fundus examination showed a live nematode lying subretinally at the macular area with macular oedema and multifocal chorioretinal lesions at peripheral retina. There was no vitritis, vasculitis or any retinal hemorrhage. Systemic examination revealed normal findings and laboratory studies only showed leucocytosis with normal eosinophil count and negative serum toxocara antibody. The diagnosis of introcular nematode with diffuse unilateral subacute neuroretinitis was made. He was treated with oral anti-helminths and a course of oral steroid at a reducing dose. The nematode had died evidenced by its immobility during the treatment and finally disintegrated, leaving macular oedema with mottling appearance and mild hyperpigmentation. Multifocal chorioretinal lesions had also resolved. However despite treatment his visual acuity during follow-up had remained poor.</p> <p>Conclusions</p> <p>Cases of intraocular nematode, though not commonly encountered, continue to present the ophthalmologist with the problem of diagnosis and management and hence poorer prognosis to the patient.</p

Comparative evaluation of diode laser versus argon laser photocoagulation in patients with central serous retinopathy: A pilot, randomized controlled trial [ISRCTN84128484]

BACKGROUND: To evaluate the efficacy of diode laser photocoagulation in patients with central serous retinopathy (CSR) and to compare it with the effects of argon green laser. METHODS: Thirty patients with type 1 unilateral CSR were enrolled and evaluated on parameters like best corrected visual acuity (BCVA), direct and indirect ophthalmoscopy, amsler grid for recording scotoma and metamorphopsia, contrast sensitivity using Cambridge low contrast gratings and fluorescein angiography to determine the site of leakage. Patients were randomly assigned into 2 groups according to the statistical random table using sequence generation. In Group 1 (n = 15), diode laser (810 nm) photocoagulation was performed at the site of leakage while in Group 2 (n = 15), eyes were treated with argon green laser (514 nm) using the same laser parameters. Patients were followed up at 4, 8 and 12 weeks after laser. RESULTS: The mean BCVA in group 1 improved from a pre-laser decimal value of 0.29 ± 0.14 to 0.84 ± 0.23 at 4 weeks and 1.06 ± 0.09 at 12 weeks following laser. In group 2, the same improved from 0.32 ± 0.16 to 0.67 ± 0.18 at 4 weeks and 0.98 ± 0.14 at 12 weeks following laser. The improvement in BCVA was significantly better in group 1 (p < 0.0001) at 4 weeks. At 4 weeks following laser, all the patients in group1 were free of scotoma while 6 patients in group 2 had residual scotoma (p < 0.05). The mean contrast sensitivity in group 1 improved from pre-laser value of 98.4 ± 24.77 to 231.33 ± 48.97 at 4 weeks and 306.00 ± 46.57 at 12 weeks following laser. In group 2, the same improved from 130.66 ± 31.95 to 190.66 ± 23.44 at 4 weeks and 215.33 ± 23.25 at 12 weeks. On comparative evaluation, a significantly better (p < 0.001) improvement was noted in group 1. CONCLUSION: Diode laser may be a better alternative to argon green laser whenever laser treatment becomes indicated in patients with central serous retinopathy in terms of faster visual rehabilitation and better contrast sensitivity. In addition, diode laser also has the well-recognized ergonomic and economic advantages

Concentric “microwaves” of Henle's fiber layer: Associated with horizontal folding

Concentric “microwaves” in Henle's fiber layer are found in a case of extensive horizontal folding in the fundus due to tumor pressure on the globe from behind. In addition to horizontal folding of inner choroid and inner retina between disk and fovea, somewhat irregular vertical folds are found next to the fovea in the inner retinal layers. The concentric waves of Henle's fiber layer are a new observation and they are suspected to be a protective adjustment of the central retina to minimize distortion of the foveola. Konzentrische Mikrowellen in Henle's Faserschicht werden in einem Fall von horizontaler Faeltelung im Augenhintergrund bei Tumordruck von hinten dargestellt. Zusätzlich zu horizontalen Falten der Aderhaut und Netzhaut zwischen Sehnerv und Fovea werden leicht unregelmäßige vertikale Falten der inneren Netzhaut im Foveabereich gefunden. Die konzentrischen Mikrowellen in Henle's Faserschicht sind eine neue Beobachtung und dieselben könnten eine mechanische Anpassung der zentralen Netzhaut zur Vermeidung von Verzerrung der Fovea darstellen.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47370/1/417_2004_Article_BF00407774.pd

OCT Angiography (OCTA) in Retinal Diagnostics

Optical coherence tomography angiography (OCTA) is an imaging modality which can be applied in ophthalmology to provide detailed visualization of the perfusion of vascular networks in the eye. Compared to previous state of the art dye-based imaging, such as fluorescein angiography, OCTA is non-invasive, time-efficient, and it allows for the examination of retinal vasculature in 3D. These advantages of the technique combined with the good usability in commercial devices led to a quick adoption of the new modality in the clinical routine. However, the interpretation of OCTA data is not without problems: Commonly observed image artifacts and the quite involved algorithmic details of OCTA signal construction can make the clinical assessment of OCTA exams challenging. In this article we describe the technical background of OCTA and discuss the data acquisition process, common image visualization techniques, as well as limitations and sources of artifacts of the modality. Examples of clinical cases underline the increasing importance of the OCTA technology in ophthalmology and its relation to dye-based angiography

Three-dimensional spectral domain optical coherence tomography and light microscopy of an intravitreal parasite

BACKGROUND: Various imaging modalities play a role in diagnosing parasitic infections of the eye. We describe the spectral domain optical coherence tomography (SD-OCT) findings of an intravitreal parasite with subsequent evaluation by light microscopy. FINDINGS: This is a case report of a 37-year-old Ecuadorian man who presented with uveitic glaucoma and a new floater in his left eye for 1 week’s duration. Full ophthalmic examination revealed an intravitreal parasite. Color fundus photography, fluorescein angiography (FA), ocular ultrasonography (US), and SD-OCT were performed. The parasite was removed via 23-gauge pars plana vitrectomy and sent to pathology for evaluation. Color fundus photography and ocular ultrasonography demonstrated an elongated foreign body within the vitreous above the retina. FA demonstrated minimal vascular changes in the vicinity of the parasite. SD-OCT was utilized to visualize the parasite and to create a three-dimensional (3D) image. The parasite was determined to be most consistent with Gnathostoma spp. by morphologic analysis. CONCLUSIONS: This is the first reported case of SD-OCT of an intravitreal parasite with corresponding evaluation by pathology. SD-OCT allows non-invasive, high-resolution visualization and 3D reconstruction of parasitic anatomy which may help establish tomographic criteria for species identification. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12348-015-0064-x) contains supplementary material, which is available to authorized users