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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 165-167

A case of atypical peripheral intraocular cysticercosis: Diagnosed by ultra-wide fundus fluorescein angiography combined with intraocular fluid detection


Renmin Hospital of Wuhan University, Jiefang Road 238#, Hubei Province, People's Republic of China

Date of Submission18-May-2021
Date of Acceptance01-Sep-2021
Date of Web Publication07-Jan-2022

Correspondence Address:
Dr. Anhuai Yang
Eye Center of Renmin Hospital, Wuhan University, Jiefang Road 238#, Hubei Province
People's Republic of China
Dr. Wei Jin
Eye Center of Renmin Hospital, Wuhan University, Jiefang Road 238#, Hubei Province
People's Republic of China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1295_21

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  Abstract 


Intraocular cysticercosis results from the larval of the pork tapeworm, Taenia solium. Diagnosis has traditionally been based on fundus dilation examination, B ultrasonography, and optical coherence tomography. We describe herein a rare case of atypical peripheral intraocular cysticercosis in the calcification stage, which was diagnosed with the help of ultrawide fundus fluorescein angiography and intraocular fluid detection. A relatively conservative surgical plan was performed without removing cyst.

Keywords: Case report, fluorescein angiography, intraocular cysticercosis, intraocular fluid detection, ultrawide fundus imaging


How to cite this article:
Hao X, Yuan M, Chen L, Jin W, Yang A. A case of atypical peripheral intraocular cysticercosis: Diagnosed by ultra-wide fundus fluorescein angiography combined with intraocular fluid detection. Indian J Ophthalmol Case Rep 2022;2:165-7

How to cite this URL:
Hao X, Yuan M, Chen L, Jin W, Yang A. A case of atypical peripheral intraocular cysticercosis: Diagnosed by ultra-wide fundus fluorescein angiography combined with intraocular fluid detection. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 14];2:165-7. Available from: https://www.ijoreports.in/text.asp?2022/2/1/165/334866



Most intraocular cysticercosis can be discovered by clinical examination, ultrasonography, and optical coherence tomography. We reported a case of atypical peripheral subretinal intraocular cysticercosis in the calcification stage, diagnosed by ultrawide fundus fluorescein angiography and intraocular fluid detection.


  Case Report Top


A 10-year-old boy presented with diminution of vision in the right eye for 2 months which was first found during routine checks. He did not complain of pain or redness. There were no systemic complaints. He had a history of pet contact and denied raw meat-eating habit. Best-corrected visual acuity (BCVA) was 20/200 OD and 20/20 OS. OU anterior segments and intraocular pressure were unremarkable. Dilated fundus examination revealed a few inflammatory cells in the vitreous cavity and gold leaf-like reflections in the macula; the peripheral retina could not be observed because of poor cooperation. Ultrawide fundus fluorescein angiography (FFA) showed mass hyperfluorescent foci in the inferior periphery in the early stage and leakage in the late stage, and patchy fluorescent foci around it; fluorescence leakage was seen in the macular in the late stage [Figure 1]. Ultrawide fundus photography exhibited a lesion in the inferior periphery [Figure 2]a. Spectral-domain optical coherence tomography (SD-OCT) showed that the structure of each layer of the macula was disordered and the ellipsoid zone was interrupted discontinuously [Figure 2]c. Fundus examination in the left eye was normal [Figure 2]b and [Figure 2]d. Other eye examinations, such as B ultrasonography and visual field, showed no obvious abnormality. Brain magnetic resonance imaging (MRI) and blood routine examination such as eosinophils were normal. To further clarify the lesion, surgery of lesion extraction and intraocular fluid (IF) detection were recommended. His parents refused surgery. Thus, only vitreous humor and blood sample were obtained. Abnormal IF indexes were as follows: interleukin (IL)-6: 76.7 pg/mL, cysticercosis IgM: 1443.4 ng/mL. Whole data of IF are shown in [Table 1]. The patient refused surgery again and was discharged from the hospital.
Figure 1: Ultrawide fundus fluorescein angiography of the right eye. Showed mass hyperfluorescence foci in the inferior periphery in the early stage and leakage in the late stage, and patchy fluorescent foci around it; fluorescence leakage was seen in the macular in the late stage

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Figure 2: Ultrawide fundus photography and spectral-domain optical coherence tomography of both eyes. Exhibited a lesion in the inferior periphery and showed that the structure of each layer of the macula wasdisordered and the ellipsoid zone was interrupted discontinuously in the right eye (Fig. 2a and c). Fundus examination in the left eye was normal (Fig. 2b and d)

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Table 1: The results of intraocular fluids detection

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The patient returned one month later with no loss of vision and no increase in vitreous inflammatory response. We confirmed the site of the lesion, which was the same as the previous examination without movements. It was thought that intraocular cysticercosis was in the calcification stage. After informing his parents, pars plana vitrectomy (PPV) surgery was performed during which the cyst was found in the subretinal space without ameboid movements. The opaque vitreous and inflammatory factors were cleared, the retinal pull was released, and the area surrounding the cyst was photocoagulated. The patient was required to follow up closely in case of any changes in his condition. At 1 year postoperatively, his BCVA was 20/125 OD, which improved to 20/100 2 years later. There was no evidence of postoperative surgical complications, such as retinal detachment. Further, the fundus condition remained stable [Figure 3].
Figure 3: Ultrawide fundus photography and spectral-domain optical coherence tomography of the right eye 2 years postoperatively. Showed the surrounding area of cyst was photocoagulated (Fig. 3a) and the structure of each layer of the macula was disordered (Fig. 3b)

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  Discussion Top


Intraocular cysticercosis can affect people of any age; adolescents seem to be disproportionately involved.[1] When ophthalmologists use indirect ophthalmoscopy, younger patients may not be able to cooperate with the inspection due to strong light stimulation and poor eye movement, leaving peripheral fundus unexplored. Under the abovementioned circumstances, ultrawide fundus imaging is extremely important for finding the lesion of the peripheral retina.[2] Using ultrawide FFA, we detected the lesion. A diagnosis of intraocular parasitic infection was suspected, with proliferation of the lesion and pulling of the retina.

Translucent cyst and white scolex usually can be observed in the eyeball if infected by cysticercus. B ultrasonography usually detects the presence of a cyst.[2],[3] In our case, these examinations were of no value. Brain MRI and eosinophils were negative, which did not support our suspicious diagnosis. Then, we communicated with the patient's parents about the pros and cons of surgery. Given uncertain diagnosis and high risk of transvitreal/transscleral surgical approaches for removal of lesions in children, his parents firmly refused surgery. They accepted IF detection upon further clarifying the nature of the lesion. The value of cysticercosis IgM was nearly 15 times the normal range, indicating intraocular cysticercosis. IL-6 was higher than normal, indicating intraocular inflammatory reflection.

After 1 month, his fundus was reviewed. No changes were noted in the lesion and no aggravation of intraocular inflammatory reaction was observed. A diagnosis of intraocular cysticercosis in the calcification stage was made.[4] Taking into account the concerns of his parents about the risk of surgical removal of parasites, we proposed a relatively conservative surgical plan, which was accepted by his parents. During PPV, we cleared opaque vitreous and inflammatory factors, released the retinal pull, and photocoagulated the area surrounding the cyst, leaving the cyst untreated. In addition, close follow-up was required to avoid any changes or complications. On the last follow-up 2 years later, his BCVA improved with no complications.

In our case, changes in fundus dilation examination and ultrawide FFA reflected the manifestation of epiretinal membranes, while SD-OCT and surgery found no signs of it. We hypothesize that the structure of each layer of the macular area was disordered, which might be caused by the diffuse inflammatory response of the retina thanks to the cyst, leading to atrophy and thinning of the retina in the macular area.


  Conclusion Top


This article reports a rare case of calcified cysticercosis. Considering the patient's age and various complications caused by surgery, his parents rejected it. Therefore, relatively less traumatic surgery was adopted without retinotomy or sclerotomy, reducing the risk of bleeding and retinal detachment. Although the fundus condition was stable for two years after surgery and no complications occurred, close follow-up is still needed for life.

Acknowledgements

We thank the patient's parents for providing permission to share the patient's information.

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

Funded by Natural Science Foundation of Hubei Province, 2019CFB489, Study on the pathogenesis of diabetic retinopathy by proteomics based on TMT technology.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wender JD, Rathinam SR, Shaw RE, Cunningham ET Jr. Intraocular cysticercosis: Case series and comprehensive review of the literature. Ocul Immunol Inflamm 2011;19:240-5.  Back to cited text no. 1
    
2.
Andreoli MT, Farooq AV, Mieler WF. Asymptomatic intraocular mass. JAMA Ophthalmol 2016;134:105-6.  Back to cited text no. 2
    
3.
Kruger-Leite E, Jalkh AE, Quiroz H, Schepens CL. Intraocular cysticercosis. Am J Ophthalmol 1985;99:252-7.  Back to cited text no. 3
    
4.
Li JJ, Zhang LW, Li H, Hu ZL. Clinical and pathological characteristics of intraocular cysticercosis. Korean J Parasitol 2013;51:223-9.  Back to cited text no. 4
    


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