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Posters

A successful management of diffuse unilateral subacute neuroretinitis with intravitreal triamcinolone followed by laser photocoagulation

Poster Details

First Author: A.Ramezani IRAN

Co Author(s):    B. Safarpour Lima   M. Soheilian   A. Rastegarpoor   D. Roshandel   S. Sayanjali      0   0 0   0 0   0 0   0 0

Abstract Details



Purpose:

DUSN is a cause of posterior uveitis secondary to the presence of a highly motile nematode in the intraretinal or subretinal space. Direct laser photocoagulation of the worm is the treatment of choice. However, oral antihelminthics and steroids have also been used by many authors. Herein, we report a case of diffuse unilateral subacute neuroretinitis (DUSN) that was successfully managed by an intravitreal injection of triamcinolone and laser therapy.

Setting:

Ophthalmology department of a university hospital. Ophthalmic Research Center of Shahid Beheshti University of Medical Sciences and Imam Hossein Medical Center.

Methods:

In this case report, a middle-aged man who complained of decreased vision and marked unilateral vitritis and neuroretinitis, is presented. Fleurescein angiography was performed. The patient received oral thiabendazole and an intravitreal injection of triamcinolone acetonide. Optical coherence tomography was done after initial treatment. The patient underwent laser photocoagulation. Color fundus photography was performed at the different stages of the management.

Results:

Fluorescein angiography revealed hypofluorescence due to blockage by vitreous opacities, disc leakage, vessel wall staining, and track like transmission defects of RPE all over the fundus. After 10 days following treatment with oral thiabendazole and intravitreal injection of triamcinolone acetonide, he reported a subjective improvement in vision. Media haziness decreased and a live motile subretinal worm was identified. Optical coherence tomography confirmed the subretinal location of the worm. The worm changed its location from time to time and made the precise localization and treatment difficult. Finally, the patient was scheduled for direct laser photocoagulation (spot size 200 micron, duration 200 ms, power 220 mW, number: 22) to destroy the worm. Two months after laser photocoagulation, a localized chorioretinal scar developed at the place and no further active inflammation and subretinal worm were detected.

Conclusions:

Our study showed that intravitreal steroids can be used safely in cases with DUSN and may help detect the causative worm for applying laser photocoagulation.

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