Year : 2000 | Volume
: 48 | Issue : 2 | Page : 142--3
Albendazole therapy for a recurrent orbital hydatid cyst
R Sihota, T Sharma
Rajendra Prasad Center for Ophthalmic Sciences, All Institute of Medical Sciences, New Delhi, India
Rajendra Prasad Center for Ophthalmic Sciences, All Institute of Medical Sciences, New Delhi
|How to cite this article:|
Sihota R, Sharma T. Albendazole therapy for a recurrent orbital hydatid cyst.Indian J Ophthalmol 2000;48:142-3
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Sihota R, Sharma T. Albendazole therapy for a recurrent orbital hydatid cyst. Indian J Ophthalmol [serial online] 2000 [cited 2020 Apr 2 ];48:142-3
Available from: http://www.ijo.in/text.asp?2000/48/2/142/14886
We report the follow up of a patient with an orbital hydatid cyst which recurred despite two attempts at surgical excision. Albendazole therapy was given as two different regimes and the patient was reviewed clinically and by B-scan ultrasonography.
A 14-year-old male presented to us in 1992, complaining of a recurrent protrusion of the left eyeball since 1986, despite two previous surgeries for the same, in 1988 and 1990. The proptosis recurred 3-4 months after each surgery. Both histopathogy reports identified the tissue consistent with a hydatid cyst. The patient complained of a ptosis and deviation of the left eyeball downward, following the second attempt at surgical excision.
He suffered a concussion injury with a cricket ball to the left eye a few months after the second surgery, with an immediate and gross loss of vision. He underwent a cataract extraction two months after the injury, but did not recover any useful vision. He did not notice any diplopia subsequently.
On examination, there was a left axial proptosis with a Hertel's exophthalmometry reading of 24 mm in the left eye and 19 mm in the right eye, bar reading 104 mm. There was a left ptosis of 3 mm and the levator palpebrae superioris action was 8 mm. The left eye was also hypotropic 15 degrees. The vision was 6/6 in the right eye and counting fingers at one a meter in the left eye. The left eye was pseudophakic with a posterior chamber intraocular lens in place with a few posterior synechiae and old pigmented keratic precipitates The intraocular pressure was 15 mmHg. There was extensive chorioretinal scarring at the left posterior pole, concentric to the disc temporally. The right eye was essentially normal.
Ultrasonography of the left eye and orbit revealed a multilobulated, cystic swelling filling the entire orbit and pushing forward to deform the globe [Figure:1]. A CT scan confirmed the presence of a well delineated, lobulated cystic mass, both intra and extraconal, confined to the orbit. The center of each lobule had the density of water. IgM Enzyme-linked immunosorbent assay (ELISA) and Indirect Haemagglutination (IHA) were performed with purified Echinococcus antigen and were positive with a titre of more than 1:128. Casoni's dermal test showed a wheal, 22-mm diameter, in 15 minutes. These tests were performed using kits from Behring Diagnostics, Germany and Dialab Diagnostics, Austria.
The patient was started on oral albendazole, 15mg/ kg once a day for one month.[1,5] After 6 weeks there was a significant improvement in the proptosis. Further serial ultrasonography documented the shrinking in size of the cystic areas, and an increase of the surrounding infiltration that led to a thickening of the intervening septae 5-6 months after the course of albendazole was completed. The exophthalmometry readings at this point were 19 and 20 mm respectively in the right and left eye. There was a gradual return of proptosis to an exophthalmometry reading of 19 and 24 mm in the right and left eye respectively within nine months. Ultrasonography of the left orbit revealed a recurrence of the large cystic lesions and thin intercystic septae.
Since the patient did not want further surgery, another similar course of albendazole was given in 1993 with a similar response, [Figure:2], and follow up.
The patient did not return for a year. On review in December 1995, the proptosis was similar to that on the first visit, as was the ultrasonography picture. This time he was given three consecutive courses of albendazole for a month each, with a drug free interval of two weeks between courses, as this had been shown to be successful in systemic echinococcosis. Again, the proptosis reduced, both clinically and on ultrasonography. Examined six months after completing the 3-month course of albendazole, the multiloculated cystic lesions had disappeared on ultrasonography, leaving a few residual linear echodensities [Figure:3]. On a follow up of over 2 years the proptosis has not recurred; ultrasonography has not revealed any further abnormalities.
The treatment of a hydatid cyst in the orbit is never easy. It is especially difficult when previous surgical attempts have failed to excise the cyst completely and have led to ptosis and diplopia. We were therefore looking at more conservative therapeutic measures.
We had previously used albendazole treatment for cysticercosis with good results and used the same protocol, i.e., a one month course of the drug on two occasions. There was an improvement in the clinical and ultrasonographic findings for 6 months, but there was recurrence thereafter on both occasions. The clinical improvement could be correlated to the progressive increase in infiltrative tissue around the cysts and a gradual decrease in the size of the cystic spaces.
A multicentric clinical trial of albendazole and mebendazole in human cystic echinococcosis has demonstrated that albendazole is more effective than mebendazole. It also showed that albendazole for a longer period appeared to lead to greater success.[2, We then gave the patient a three-month course of albendazole, which brought about a complete resolution of the cysts on echography, with no recurrence for over 2 years.
A three-month course of albendazole is effective in the treatment of recurrent orbital hydatid cysts and a long follow up is required to evaluate therapy, because of the sluggish growth of the metacestode.
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