Year : 2002 | Volume
: 50 | Issue : 2 | Page : 133--135
Viscoexpression of anterior chamber cysticercus cellulosae
Jaya Chandra Das, Z Chaudhuri, Raj L Bansal, S Bhomaj, P Sharma, D Chauhan
Department of Ophthalmology, Guru Nanak Eye Centre, New Delhi, India
Jaya Chandra Das
Department of Ophthalmology, Guru Nanak Eye Centre, New Delhi
We report a case of anterior chamber Cysticercus cellulosae that was removed by viscoexpression
|How to cite this article:|
Das JC, Chaudhuri Z, Bansal RL, Bhomaj S, Sharma P, Chauhan D. Viscoexpression of anterior chamber cysticercus cellulosae.Indian J Ophthalmol 2002;50:133-135
|How to cite this URL:|
Das JC, Chaudhuri Z, Bansal RL, Bhomaj S, Sharma P, Chauhan D. Viscoexpression of anterior chamber cysticercus cellulosae. Indian J Ophthalmol [serial online] 2002 [cited 2020 Jun 3 ];50:133-135
Available from: http://www.ijo.in/text.asp?2002/50/2/133/14806
Cysticercus cellulosae is the larval form of the tapeworm Taenia solium. Man occasionally serves as the larval host of the worm, getting infected either by drinking contaminated water or eating uncooked vegetables infested with eggs of the worm or rarely by autoinfection due to reverse peristalsis whereby the eggs reach the portal system in a retrograde manner from the intestines.
Ocular cysticercosis can involve the ocular adnexa, the subconjunctival space and both the anterior and posterior segments of the eye. The subretinal space is considered to be the most common site of ocular cysticercosis by most authors, though some others have reported the subconjunctival space to be the most common site. Anterior chamber cysticercosis is unusual.. The management of the condition has been essentially surgical. The different modalities employed to remove the cyst include paracentesis, extraction with capsule forceps, cryoextraction, erysiphake extraction and viscoexpression.
We report a case of cysticercus in the anterior chamber, which we removed by viscoexpression.
A 74-year-old male patient presented to us in January 1999 with a history of decrease in vision associated with the appearance of an occasional floater in front of his right eye for 3 months. He had no history of pain, watering, discharge, protrusion of eye or double vision. No history of fever, headache or seizures was elicited. The patient was a bilateral aphake, and had undergone intracapsular cataract extraction in 1980. His medical records showed that the right eye best corrected visual acuity was 6/12. The visual acuity was unchanged for 18 years. The patient was vegetarian and did not raise any pets.
On general, systemic and neurological examination no abnormalities were detected. The patient had a corrected visual acuity of 6/60 in the right eye and 6/12 in the left eye at the time of examination. Slitlamp examination of the right eye showed a translucent cyst with undulating movements in the anterior chamber [Figure:1]. The cyst appeared partly in the anterior chamber and partly in the posterior chamber. There was no active iridocyclitis. However, the iris pattern was grossly distorted with patches of atrophy. Fibrosis of the pupillary margin as well as the margins of the superiorly placed peripheral iridectomy was noted. The pupil was distorted in shape. Fundus evaluation of the right eye was not possible through the pupil as the cyst appeared adherent to the pupillary margin. The fundus viewed through the peripheral iridectomy appeared a normal. Ultrasonography (A and B Scan) of the right eye revealed a dumbbell like cystic structure extending between the anterior and posterior chambers with a hyperechoic focus present posteriorly suggestive of the scolex of cysticercus cellulosae [Figure:2]. The scolex was not visible in the anterior chamber on slitlamp examination. CT scan of the head was normal. The anterior and posterior segments of the left eye were unremarkable.
Intraocular cysticercosis of the right eye was diagnosed. The patient was started on oral prednisolone (0.75mg/kg/ day) and oral albendazole (15 mg/kg/day) and early surgery was planned. A topical antibiotic steroid combination (fluoromethalone and neomycin) and 2% pilocarpine nitrate 4-hourly was started in the right eye simultaneously.
The patient was operated on the second day after starting treatment when the pupil was relatively constricted. A 0.5 mm beveled limbal incision was made at the 7 o' clock position in the right eye with a diamond knife. A 3-mm clear corneal incision was made in the superotemporal quadrant of the eye thus avoiding the area of the previous cataract incision. The surgical assistant injected 2% methylcellulose through the inferior opening with a 26-gauge canula while simultaneously the surgeon inserted a plastic 2.5 mm wide glide through the superior incision. The pupillary margin was freed of adhesions with the cyst and the glide was inserted beneath the cyst such that the pupillary area and the area of peripheral iridectomy were mechanically covered. The surgeon subsequently gently depressed the posterior lip of the incision with the glide. This resulted in extrusion of the intact cyst along with methylcellulose [Figure:3]. The anterior chamber was washed with balanced salt solution and both the incisions were sutured with 10-0 monofilament nylon sutures. Topical antibiotic-steroid combination and oral albendazole were continued for a month after surgery. Systemic prednisolone was gradually tapered over the same period.
The cyst was fixed in 10% formalin and stained with hematoxylin and eosin. Histopathological analysis showed a scolex with double rows of hooklets and a membranous cyst wall suggestive of cysticercus cellulosae, confirming our clinical diagnosis.
Detailed fundus examination after dilatation was normal. On follow-up examination at 6 months, the patient had a corrected visual acuity of 6/18 in the right eye. No other anterior or posterior segment abnormalities were detected.
Anterior chamber cysticercosis is a rare condition. This may be associated with iridocyclitis. The possible pathomechanism in the present case was probably an anterior migration of the parasite from the posterior ciliary arteries to the subretinal space, and thence to the vitreous cavity and the anterior chamber. Absence of a posterior capsule in the right eye may have facilitated this migration.
Surgical removal of the parasite is the treatment of choice, as the cyst is known to increase in size resulting finally in profound inflammatory reaction and eventual destruction of the eye. The efficacy of medical treatment in anterior chamber cysticercosis is not well established.,
The different modalities of surgical removal of anterior chamber cysticercus include paracentesis, cryoextraction, erysiphake extraction, extraction with capsule forceps and viscoexpression. In all the above modalities except the last, chances of anterior chamber and cyst manipulations are high, potentially leading to complications. Viscoexpression as described in one previous report does not appear to be a controlled procedure because of the fact that only one superior surgical incision was made and the injected viscoelastic could displace the cyst inferiorly into the vitreous cavity. This would necessitate further manipulations. Injection of the viscoelastic in the required superior direction through an inferior opening and introduction of a glide obviates these problems and makes the procedure safe.
|1||Shekhar CG, Lemke BN. Orbital Cysticercosis. Ophthalmology 1997;104:1599-1604.|
|2||Malik SRK, Gupta AK, Chaudhry S. Ocular Cysticercosis. Am J Ophthalmol 1968;66:1168-71.|
|3||Bartholomew RS. Subretinal Cysticercosis. Am J Ophthalmol 1975;79:670-73.|
|4||Kapoor S, Sood GC, Aurora AC, Sood M. Ocular Cysticercosis: report of a free floating cysticercus in the anterior chamber. Acta Ophthalmol 1977;55:927-30.|
|5||Mathur RN, Abraham L. Cysticercosis of the eye: a case of a plastic iridocyclitis due to cysticercus cyst in the anterior chamber. Arch Ophthalmol 1962;67:562-63.|
|6||Wood TR, Binder PS. Intravitreal and intracameral cysticercus. Ann Ophthalmol 1979;11:1033-036.|
|7||Beri S, Vajpayee RB, Dhingra N, Ghose S. Managing anterior chamber cysticercosis by viscoexpression: A new surgical technique. Arch Ophthalmol 1994;112:1279-80.|
|8||Santos R, Chavarria M, Aguirre AE, Failure of medical treatment in 2 cases of intraocular cysticercosis. Am J Ophthalmol 1984;97:249-50.|