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PHOTO ESSAY
Year : 2020  |  Volume : 68  |  Issue : 8  |  Page : 1654-1655

A rare case of intraocular communicating cysticercosis


Sankara Eye Hospital, Coimbatore, Tamil Nadu, India

Date of Submission05-Feb-2019
Date of Acceptance13-Feb-2020
Date of Web Publication24-Jul-2020

Correspondence Address:
Dr. V Anusha
Consultant, Vitreo Retina, Sankara Eye Hospital, Sathy Road, Sivanandapuram, Coimbatore - 35, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1939_19

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  Abstract 


Keywords: Communicating cysticercosis, chandelier assisted vitrectomy, hyaloid tunnel


How to cite this article:
Dhevi R S, Anusha V, Shanker M P, Geetha G. A rare case of intraocular communicating cysticercosis. Indian J Ophthalmol 2020;68:1654-5

How to cite this URL:
Dhevi R S, Anusha V, Shanker M P, Geetha G. A rare case of intraocular communicating cysticercosis. Indian J Ophthalmol [serial online] 2020 [cited 2020 Aug 12];68:1654-5. Available from: http://www.ijo.in/text.asp?2020/68/8/1654/290405



A 59-year-old female presented with gradual diminution of vision in the left eye for 3 months associated with pain and redness. The best-corrected visual acuity (BCVA) in the right eye was 20/20 and counting fingers close to face in the left eye. The examination of the right eye was unremarkable. The left eye showed a sluggishly reacting pupil, partial posterior vitreous detachment (PVD) and two well-defined overlapping translucent cysts just below the inferior arcade, the larger one in the retro-hyaloid space demonstrating the typical undulating movement and the smaller one in the sub retinal space harboring the scolex [Figure 1]. CT brain showed features suggestive of neuro-cysticercosis.
Figure 1: (a) Fundus photo of the left eye revealing two well defined overlapping translucent cysts, one large in the retro-hyaloid space (b) and one small in the sub retinal space (c) just below the inferior arcade

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After obtaining neurologist opinion and initiation of oral steroids, through 25-gauge pars plana vitrectomy, the retro-hyaloid space was entered through the area of partial PVD.[1] The cyst capsule was firmly adherent to the hyaloid, which was gently separated using a soft-tipped cannula when it was still found adherent to the underlying structures. After meticulous dissection, this cyst was found communicating to the sub retinal cyst through the posterior hyaloid [Figure 2]a.[2] Chandelier-assisted bimanual dissection was then performed to open up the 'hyaloid tunnel' [Figure 2]b that enveloped its connection to the sub retinal component of the cyst, which was subsequently teased out into the vitreous cavity in toto with passive suction revealing its dumbbell shape [Figure 2]c.[3] It was then removed completely with a high-speed vitrectomy cutter. The bed of the cyst with surrounding fibrosis was lasered. At one-week follow up, her BCVA had improved to 20/120 and her retina was attached [Figure 3]. Anticonvulsant and antiparasitic therapy were initiated.
Figure 2: (a) Intra operative photo showing the communicating cyst in situ. (b and c) showing the ‘hyaloid tunnel’ (black arrow) and the dumbbell shaped cyst in toto

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Figure 3: (a) Post operative fundus photo at 2 weeks follow up. (b and c) demonstrating the bed of the cyst

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  Discussion Top


Chandelier-assisted bimanual dissection helps achieve meticulous dissection and isolation of the cyst in toto prior to its removal with a high-speed vitreous cutter, thus ensuring its complete removal and good post operative visual recovery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gemolotto G. A contribution to surgical treatment of intraocular cysticercosis. Arch Ophthalmol 1955;59:365-8.  Back to cited text no. 1
    
2.
Kumar A, Verma L, Khosla PK, Tewari HK, Jha SN. Communicating intravitreal cysticercosis. Ophthalmic Surgery, Lasers and Imaging Retina 1989;20:424-6.  Back to cited text no. 2
    
3.
Astir S, Shroff DN, Gupta C, Shroff CM, Saha I, Dutta R. Bimanual 25-gauge chandelier technique for direct perfluorocarbon liquid-silicone oil exchange in retinal detachments associated with giant retinal tear. Indian J Ophthalmol 2018;66:1849.  Back to cited text no. 3
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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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