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Vinata Rajendran, Ekta Rishi, Haard Shah; Intraocular Gnathostomiasis : Clinical Profile and Management of Eight Cases.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3890.
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© ARVO (1962-2015); The Authors (2016-present)
To analyse the clinical profile, presentation and management of subjects withintraocular Gnathostomiasis.
This is a retrospective interventional case series. We managed eight cases of intraocular gnathostoma in the study period from 1990 to 2016 at a tertiary eye care centre. Systemic steroids were used to control the intraocular inflammation in most of the cases. The nematodes once identified, were surgically removed either by the anterior (n=5) or the posterior (n=3) route. The anterior route was by visco-expression and pilocarpine with or without using forceps and the posterior route was facilitated by pars plana vitrectomy. All cases underwent photographic or videographic documentation and histopathological confirmation of the nematode.
All eight patients presented with some form of uveitis. The mean presenting age was 34.5 years with a mean duration of symptoms being 36.12 days. Referring diagnosis from the local ophthalmologists included different grades of retinal vasculitis (n=4). Mean presenting best corrected visual acuity (BCVA) was 0.77 LogMar (SD = 0.71), whereas the mean final BCVA was 0.65 LogMar (SD = 0.74). The characteristic clinical features were multiple iris holes (n=7), uveitis (n=8) and secondary glaucoma (n=4). Microscopic study of all the parasites revealed typical head bulb with circumferential rows of hooklets and cuticular spines on the surface of the body.
Intraocular Gnathostomiasis can present in patients with varying grades of uveitis, associated multiple iris holes, secondary glaucoma, subretinal haemorrhage and subretinal tracts. The migratory nature of the live nematode often makes a definitive diagnosis very difficult. Relief of symptoms and a good clinical outcome depends on identification and prompt removal of the parasite.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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