• Courtesy of Artidtaya Denwattana, MD, FICO. Submitted by Jakkrit Juhong, MD.
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    Retina/Vitreous

    A 31-year-old woman presented to the ophthalmology clinic with a 3-day history of progressive vision loss of the right eye. She had a history of regularly consuming fresh vegetables and raw seafoods. The best-corrected visual acuity of her right eye was 20/200. Fundus examination of the right eye revealed mild vitritis, diffused granular appearance of subretinal and a glistening white, non-segmented motile worm approximately 2 disc diameter (~3000 μm) with tapered ends at inferotemporal quadrant within temporal arcade [Panel A, asterisk] with faint linear tracks of the parasite at inferior to the macula area [Panel A, arrow]. Spectral-domain optical coherence tomography (Spectralis; Heidelberg Engineering) of the right eye showed multiple hyper-reflectivity dots in the vitreous cavity [Panel B, asterisk] and fluid accumulation in subfoveal area with diffuse disruption of the external limiting membrane and ellipsoidal layer [Panel B, arrow]. The diagnosis of diffuse unilateral subacute neuroretinitis (DUSN) was made. Focal laser photocoagulation (Ellex Inc.; 25 spots, 150 mW, 200 μ, 200 ms) of 532 nm was performed around, and over, the parasite in an attempt to restrict mobility and to kill the worm directly. Oral albendazole 400 mg daily with a tapered dose of oral prednisolone (starting from 40 mg/day) were given for 4 weeks. One day after laser treatment, a static worm was confirmed without any more movements surrounding with a whitish laser reaction [Panel C, arrow]. The patient was referred for surgical removal of parasite. At a follow-up visit 1 month later, the BCVA of her right eye was 20/100 and no ocular inflammation was seen.