Changing trends in ocular cysticercosis over two decades: An analysis of 118 surgically excised cysts

Abstract

Purpose: To evaluate the frequency of ocular cysticercosis and to demonstrate the changing trends in localisation of ocular cysticercosis along with a brief review of literature. Methods: A retrospective analysis of histology proven ocular cysticercosis cases seen over a period of 20 years (1981 through 2000) was done. The pathology record forms were reviewed for demographics, clinical features with speciÞ c reference to the location of cysts in four subgroups: subconjunctival; intraocular orbit and eyelid. The distribution of cases in four Þ ve-year periods namely group A: 1981-1985, group B: 1986-1990, group C: 1991-1995 and group D: 1996-2000 and the changing trends in the location of cysts was evaluated. Results: One hundred eighteen cysts from 118 patients aged 4-72 (mean 17.1) years were submitted to the pathology service of S D Eye Hospital, Hyderabad. Male to female ratio was 1: 1.2. Total number of cases in groups A, B, C and D were 33, 41, 16 and 25 respectively. Location of cysts was subconjunctival -74 (62.7%); intraocular-31 (26.3%); orbital-8 (7%) and lid-5 (4%). In last 20 years, signiÞ cant decrease (P=0.0001) was noted in subconjunctival cases (85% vs. 28%) with a signiÞ cant rise (P=0.0001) in intraocular cysticercosis (6% vs. 60%). Conclusions: Frequency of surgically excised ocular cysticercosis remained constant over last two decades with an increasing manifestation of intravitreal cysticercosis in the recent years. This could imply either improved diagnostic modalities, available expertise in vitreo-retinal surgery or ineffective medical treatment for intraocular parasitic infection. The relative decrease in extraocular cysticercosis is probably due to the increased preference and success with medical management.

Intrascleral with Intracorneal Cysticercosis: An Unusual Presentation

“…The case seen by us presented at 15 years of age though his mother gave a history of presence of this swelling in the eye for 11 years. In our patient, the lesion being intrascleral and intracorneal, presented with diminution of vision, a symptom commonly found in patients who have intraocular cysts [3,6]. This was possibly due to its intracorneal nature which caused astigmatism and a refractive error as vision improved with pinhole.…”

“…A distinct change in the presentation of ocular cysticercus has been noted in a study from South India, where presentations of subconjunctival lesions have decreased significantly whereas intraocular lesions have shown significant increase in number [3]. One of the reasons for this change is possibly improved medical treatment for lesions in the anterior segment or orbit and adnexa [3]. It has been postulated that the cysts are brought via the posterior ciliary arteries to the subretinal space usually in the region of the posterior pole [9].…”

“…Western literature has reported a greater involvement of the posterior segment with cysticercosis while Indian literature has reported higher numbers in the ocular adnexa [3]. A distinct change in the presentation of ocular cysticercus has been noted in a study from South India, where presentations of subconjunctival lesions have decreased significantly whereas intraocular lesions have shown significant increase in number [3]. One of the reasons for this change is possibly improved medical treatment for lesions in the anterior segment or orbit and adnexa [3].…”

“…Clinical manifestations of ocular cysticercosis depend upon location inside the eye, size, host's immune status and inflammatory reactions [3]. It is believed that degenerating cysts rapidly increase in size due to osmosis, cause compression of surrounding tissues and release antigens into surrounding tissues resulting in an inflammatory response.…”

“…The first case of ocular cysticercosis was reported by Sommerring in 1830 and the larva was demonstrated and extracted by Schott in 1836. Cysticercus may be found in various ocular tissues (13-46%) with highest frequency in the subretinal tissues (35%) followed by vitreous (22%), conjunctiva (22%), anterior segment (5%), and orbit (1%) [3,4]. In a recent case report, ocular cysticercosis presented as neovascular glaucoma [5].…”