Year : 1979 | Volume
: 27 | Issue : 4 | Page : 203--205
Intraocular cysticercosis in the non-pork eaters
Bijayananda Patnaik, Rajinder Kalsi
Maulana Azad Med. College New Delhi, India
Associate Prof. of Ophth. Maulana Azad Med. College, New Delhi
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Patnaik B, Kalsi R. Intraocular cysticercosis in the non-pork eaters.Indian J Ophthalmol 1979;27:203-205
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Patnaik B, Kalsi R. Intraocular cysticercosis in the non-pork eaters. Indian J Ophthalmol [serial online] 1979 [cited 2020 Oct 1 ];27:203-205
Available from: http://www.ijo.in/text.asp?1979/27/4/203/32629
Sixteen cases of intraocular cysticercosis have been reported who, except for one were either strict vegeterians or (strict) non-pork eater orthodox muslims. The epidemiological aspect of the problem has been discussed. A presumed clinical course of the cysticercosis of the posterior segment has been constructed. The experience out of successful surgical removal of subretinal cysticercii in 2 cases has been presented.
Materials and Methods
Sixteen cases of intraocular cysticercosis have been received at the Retina Care clinics of this centre since 1970. Relevant clinical data have been tabulated in [Table 1]. All but 2 patients had visual symptoms. One (case 8) had vague visual symptoms and the cyst was detected in the anterior chamber during routine examination by a fellow practitioner (Dr. P.K,J ). The other (case II) an unconscious patient in the neurosurgical ward revealed one cyst in the anterior chamber, one in the vitreous and one in the subretinal space of the right eye. On post-mortem her cause of death was confirmed to be due to the intracranial cysticercosis. There were 12 males and 4 females. The right eye was involved in 6 and the left in 10.
There was only one pork eater out of these 16 patients. The stool examination did not reveal the presence of T. Solium. The cyst was in the vitreous in 13, subretinal in 2 and in the anterior chamber in two. All but 2 of 13 cases with vitreous cyst showed evidence of the parasite passing through the retina.
The majority reached us long after the visual symptoms develored. There were only 2 cases who had consulted us within 1 month.
The subretinal cysts were extracted surgically in 2 cases. The summaries of these are given below:
J.P. 38 yrs. old male patient was admitted with complaints of dimunition of vision in the RE for the last 6 months after a blunt injury to this eye. The eye was red and painful. The patient was a pure vegetarian Brahmin. Examination of ant. segment did not reveal any sign of inflammation. The vision in the RE was H.M. with PR accurate in all quadrants.
The cyst was subretinal in the supero nasal quadrant. The retina was totally detached with extensive gliosis and fixed folds. There were multiple subretinitic precipitates specially near cyst. In the lower quadrant blotches of uveal pigments could be seen under the retina.
Surgery was performed to remove the intraocular cyst by sclerotomy exactly over the subretinal cyst localised by scleral depression under indirect ophthalmoscopy. Heat cautery was applied all round the exposed choroid. The choroid was then incised by light scratch incisions. The cyst wall prolapsed into the wound. Its expulsion was aided by a cryoproble. Post-operatively the retina remained detached. There was no improvement in the vision.
P.S. 25 yrs• old male was admitted on 14.10.77 with history of diminution of vision and seeing black spots in front of left eye for the past 20 days. Patient had never taken pork, but used to eat goat's meat and raw vegetables. There was no evidence of anterior segment inflammation. It was found that he had a retinal detachment with a cyst under the retina in the superior nasal quadrant.The vision was 6/12.
On 19.10.77 surgery was performed to remove the intraocular cyst. The cyst was localized with indirect ophthalmoscopy on the table. A fresh perforation of the retina caused by the evaginating scolex was detected on the talbe. The medial rectus was detached. A 4 mm long scleral incision parallel to the limbus was made across the site of cyst. Choroid was exposed and mild diathermy applied along the periphery of the exposed choroid. On giving an incision o%er the choroid subretinal fuid drained out and the cyst presented over the sclerctomy site from where it was picked up with the freezing tip of a cryo-probe. The wound was closed with mattress suture. The area was frozen for few seconds, and a flat buckle was placed on the sclerotomy site to take care of the small tear noticed in the retina. Medial rectus was sutured back.
During the postoperative period the retina was flat but there was dense white appearance due to exudation in the operated quadrant. Tt,e vision at the time of discharge was 616P in the affected eye.
The cyst from the anterior chamber was extracted through a limbal incision by the refering surgeon himself (P. K. J.).
Since all but one of these patients were either strict vegetarians or muslims who had never eaten pork and stool examination was negative in all, the possibility of internal or external auto-infection can be safely ruled out.
Therefore, the only mode of cystcercosis is through ingestion of contaminated raw food or unfilled water-contaminated by the faeces of low caste Hindus and poor harijans, who do eat pork out of the dirty pigs they kill. Since Yamuna is too dirty and open ditches and ponds are few in number and tube well are many in and around Delhi the possibilities of water being the vehicle is less likely. On the other hand the popular habit of eating raw vegetables, grown in the outskirt of Delhi often irrigated with untreated sewage water, contaminated by the faeces of poor agricultural workers could be the principal mode of parasitic infestation.
Presumed clinical course
The larva enters the globe through the ciliary arteries. Most of them reach the choroid and penetrate into the subretinal space where it grows in size at a variable rate. The cyst shows vigorous undulating movements, specially when disturbed with strong light of examination or photograph. The vitreous overlying the subretinal cyst shows variable degree of haziness -which consists of fine infiltrate to start with. There is usually an. exudative retinal detachment of variable extent. The retina shows progressive pre-retinal gliosis with passage of time with the evagination of the scolex against the retina, the latter is perforated, often in more than one point. Ultimately the cyst through one of these perforations escapes to the vitreous cavity. The detached retina continues to shrink with increasing gliosis and vitreous becomes progressively hazy. Suddenly the vitreous becomes totally impenetrable with massive exudation. The parasite cannot be located. It may be presumed that the sudden advent of massive inflammation is associated with rupture of the cyst or death of the parasite. The eye is lost with massive inflammation. Even the successful removal of the subretinal cyst if not conducted early enough may not prevent the progressive deterioration of the retina and vitreous probably because of continued inflammation (Case 15).
Sixteen cases of intraocular cysticercosis examined in last 7 years have been reported. Making an epidemiological approach it has been pointed out that since fecal contamination of raw food stuff is the most likely source of cysticercosis in these cases a strong case is made out for preventive measures. Successful removal of subretinal cyst have been reported.