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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 1  |  Page : 73-74

Managing caterpillar hair induced posterior segment complications


Vitreoretina Department of Disha Eye Hospitals Private Limited, Kolkata, West Bengal, India

Date of Submission06-Apr-2020
Date of Acceptance14-Jul-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Das Arnab
Disha Eye Hospitals Private Limited, 88 (63A), Ghoshpara Road, Barrackpore, Kolkata - 70 0120, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_860_20

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  Abstract 


Keywords: Caterpillar hair, cystoid macular edema, floaters, parsplana vitrectomy, vitritis


How to cite this article:
Arnab D, Majumdar S, Sourav S. Managing caterpillar hair induced posterior segment complications. Indian J Ophthalmol Case Rep 2021;1:73-4

How to cite this URL:
Arnab D, Majumdar S, Sourav S. Managing caterpillar hair induced posterior segment complications. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Feb 27];1:73-4. Available from: https://www.ijoreports.in/text.asp?2021/1/1/73/305542



A 25-year-old male presented with slight dimness of vision & floaters in the left eye (LE) for last one month with a past history of Caterpillar (CP) hair removal from cornea one year ago. On examination, best corrected visual acuity (BCVA) was 20/25 in LE and Slit lamp examination showed one CP hair with granuloma formation in corneal endothelium [Figure 1]a and one mobile seta with granuloma in the anterior temporal vitreous [Figure 1]b with associated grade 2 vitritis. Fundus examination showed multiple inferior setae embedded in the retina with surrounding inflammatory reaction [Figure 1]c. Following Pars plana vitrectomy (PPV), the patient is asymptomatic with no evidence of active inflammation and maintaining 20/20 vision.
Figure 1: Slit lamp photo showing corneal endothelial caterpillar hair granuloma [solid white arrow] (a). Diffuse slit lamp examination shows a mobile caterpillar setae in anterior vitreous [solid yellow arrow] (b). Ultra wide field Optos showing multiple Caterpillar setae embedded in the inferior retina with surrounding inflammatory reaction[solid red arrows] (c)

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A 20-year-old male patient, lost to follow up following CP hair removal from the right eye (RE) one year ago, presented with waxing and waning anterior uveitis in the RE. A diagnosis of intermediate uveitis with anterior spillover was made. Patient had a BCVA of 20/60 in RE. Slit lamp biomicroscopy revealed cystoid macular edema (CME). On indirect ophthalmoscopy parsplana snowbanking and a linear CP hair was noted at the vitreous base. Total vitrectomy with a thorough base excision with indentation was done and the CP hair at the vitreous base was removed [Figure 2] with cryotherapy over the snowbanks. At 6 months follow-up post PPV, the patient is maintaining a 20/25 vision with complete resolution of CME on OCT.
Figure 2: Intraoperative Superonasal retina with indentation shows a Caterpillar hair at the vitreous base with surrounding inflammation [solid green arrow]

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  Discussion Top


CP hairs with Vitreo-retinal involvement is rare involving 1-2%[1] of cases and may cause permanent loss of the eye due to persistent inflammation of the eye.[2] The vitreoretinal involvement apart from entering through the anterior chamber, can also penetrate trans-sclera through the parsplana route. Surgical removal of setae was imperative to terminate the inflammation in both the cases.[2],[3]

An early diagnosis of posterior segment involvement followed by timely intervention can prevent the loss of the eye. Hence, regular follow-up of these cases is important even after removal of anterior segment hair as they have a risk of delayed onset of inflammation due to migration of the setae.

Acknowledgement

The authors acknowledge the assistance and technical support of Disha Eye Hospitals Pvt Ltd in conducting this case report.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sengupta S, Reddy PR, Gyatsho J, Ravindran RD, Thiruvengadakrishnan K, Vaidee V. Risk factors for intraocular penetration of caterpillar hair in Ophthalmia Nodosa: A retrospective analysis. Indian J Ophthalmol 2010;58:540-3.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Agarwal M, Acharya MC, Majumdar S, Paul L. Managing multiple caterpillar hair in the eye. Indian J Ophthalmol 2017;65:248-50.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Shibui H, Kawashima H, Kamata K, Sasaki H, Inoda S, Shimizu H. Vitrectomy for caterpillar seta-induced endophthalmitis. Arch Ophthalmol 1997;115:555-6.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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