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JP Denny, R Cortez H, G Ramirez C, R Muci-Mendoza, D Fuenmayor R, GJ Jaffe; Diffuse Unilateral Subacute Neuroretinitis in Venezuela . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2248.
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Purpose: Diffuse Unilateral Subacute Neuroretinitis (DUSN) is an inflammatory disorder of the posterior segment that is caused by a subretinal nematode and frequently results in severe visual loss. Here, we describe the clinical features and management of the largest reported series of patients with DUSN to date. Methods: The charts of all patients seen with DUSN in a vitreoretinal clinic in Caracas, Venezuela between July 1979 and August 2000 were retrospectively reviewed. Results: We identified 82 eyes of 78 patients with DUSN. The mean age at diagnosis was 16.7 years. Sixty-five (83.3%) patients were 20 years old or younger. Forty-five (57.7%) patients were males and 33 (42.3%) were females. The presenting visual acuity was 20/400 or worse in 69 eyes (84.1%). The subretinal nematode was identified in 31 cases (37.8%). All nematodes were small, approximately 400µm. Generally, when the nematode was identified, it was killed with laser photocoagulation, however, in 6 cases, the patient was given a 10-day course of albendazole. In 3 of these cases, the nematode became immobile after approximately seven days of therapy. In the other 3 cases, the nematode remained motile and was photocoagulated. In another patient, a subretinal nematode was identified and photocoagulated. One year later, another motile subretinal nematode was identified. Conclusions: In Venezuela, DUSN is seen frequently, particularly in young patients who generally have poor visual acuity at the time of presentation. Early diagnosis and treatment are vital to the prevention of visual loss. Given the high prevalence in the region, screening clinics may substantially decrease morbidity related to DUSN. Based on our observations, we recommend photocoagulation of viable nematodes together with systemic antihelminthic therapy. Additionally, a careful search must be carried out in all patients who demonstrate persistent or recurrent inflammation after photocoagulation of a subretinal nematode given the possibility of additional organisms.
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