Recurrent vitreous opacity caused by intraocular Toxocara larva: a case report and literature review

Abstract

Background Toxocara larva entity has seldom been reported on the surface of the retina. We report on an unusual case of recurrent vitreous opacity caused by intraocular Toxocara larva after vitrectomy. Case presentation A 34-year-old male was referred to our clinic with a 6-month history of decreased visual acuity in the right eye characterized as red, painless, and progressive. Optos fundus photograph showed optic disc elevation with granuloma, and proliferative membrane starting from the optic disc and running towards the superior temporal retina due to the movement of a Toxocara larva, which was covered by the proliferative membrane in the superior temporal retina. Since it adhered closely to the retina, the lesion in the superior temporal retina was not removed to avoid induction of an iatrogenic retinal break and the larva was not found during the first diagnostic pars plana vitrectomy. Intraocular Anti-Toxocara IgG was 45.53U (< 3, enzyme-linked immunosorbent assay (ELISA)), and the Goldmann-Witmer coefficient was 8.55, confirming the diagnosis of ocular toxocariasis. After this operation, visual acuity improved to 20/200. However, vitreous opacity worsened again, and the proliferative membrane expanded around the Toxocara larva three weeks after the operation. Toxocara larva was found and removed in the superior temporal region during the second operation. His visual acuity improved to 20/100, vitreous opacity disappeared, and the retina was stable two months after the second operation. Conclusion It is advisable to remove suspected Toxocara larva to prevent the reoccurrence of ocular toxocariasis.

Case report: Ultrasound biomicroscopy as a guide for the selection of injection sites for dexamethasone intravitreal implant (Ozurdex) for peripheral granulomatous ocular toxocariasis in children

“…Lesion characteristics include dense granulomas or snowbank-like changes visible in the pars plana of the retina. Common clinical manifestations are posterior corneal deposits, iris adhesion, strabismus, moderate-to-severe vitreous inflammation, vitreous strands, tractional retinal detachment, and epiretinal membranes ( 12 ). Given the high prevalence of peripheral granulomatous OT and its impact on patients' visual acuity, we should pay more attention to this type of OT, strengthening diagnostic and therapeutic strategies to improve patients' visual acuity and quality of life.…”