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Abstract
Purpose
To investigate the clinical features and treatment outcomes of ocular toxocariasis in Jeju Island using ultra-wide-field fundus photography.
Methods
We retrospectively reviewed the medical records of 40 eyes of 37 patients who were diagnosed with ocular toxocariasis based on clinical aspects and serologic tests. The quality of history-taking was assessed and peripheral blood samples were analyzed. Ocular characteristics were evaluated using ultra-wide-field fundus photography and optical coherence tomography. Changes in visual acuity and funduscopic findings after treatment were also analyzed.
Results
The average age of the patients was 57.9 years and the mean Toxocara canis IgG titer was 1.979 ± 0.486. The most common fundus findings were vitreous opacity (63.6%) and granuloma (60%). Granulomas that were not initially observed within the field of view of conventional fundus photography were found using ultra-wide-field imaging in 15 eyes (62.5%). Ultra-wide-field fluorescein angiography showed peripheral vascular leakage in 16 eyes (69.6%). Treatment with oral prednisolone and albendazole resulted in average vision improvements of 0.19 ± 0.07 logMAR (p = 0.031) as well as significant improvements in anterior chamber inflammation and vitreous opacity. Combination therapy led to a significantly lower recurrence rate than prednisolone monotherapy (p = 0.049).
Conclusions
In Jeju Island, the mean Toxocara canis IgG titer of ocular toxocariasis was high. The incidences of vitreous opacity and granulomas were also high. Ultra-wide-field fundus imaging was useful for finding peripheral retinal lesions and peripheral vascular leakage that were not observed within the field of view of conventional fundus photography. Ultra-wide-field fundus imaging was valuable not only during clinical diagnosis, but also on follow-up evaluations of ocular toxocariasis. Treatment with oral prednisolone and albendazole effectively improved ocular inflammation and visual acuity and helped reduce the recurrence rate.
Figures and Tables
Figure 1
Ultra-wide-field fundus photographs and ultra-wide-field fluorescein angiographic imaging of ocular toxocariasis. (A) A granuloma with mild vitreous opacity. (B) A tractional retinal fold with localized tractional retinal detachment. (C) Diffuse peripheral vascular leakage. (D) A prominent optic disc leakage.
Figure 2
Ultra-wide-field fundus images with overlay of the Early Treatment Diabetic Retinopathy Study (ETDRS) 7-standard 30-degree fields. Small peripheral granuloma in nasal retina (A) and two peripheral granulomas in inferior retina (B) were noted in the image beyond the ETDRS 7 fields.
Figure 3
Ultra-wide-field fundus photographic findings of a patient with ocular toxocariasis before and after treatment of oral prednisolone with albendazole. (A) Severe vitreous opacity and multiple vitreous debris are shown. (B) The vitreous opacity was cleared up after treatment.
Figure 4
Ultra-wide-field fundus photographs of discontinuous migration of granuloma. (A) A round shape granuloma (white arrow) is shown. (B) After 3 months, a new granuloma (white arrow) appeared adjacent to the site of previous granuloma. (C) 1 week later, another novel granuloma (white arrow) was noted. (D) After 3 weeks, the granulomas were decreased in size.
Table 4
Treatment outcomes in patients with ocular toxocariasis
A p-value < 0.05 was considered statically significant.
N/A = not applicable; logMAR = logarithm of the minimum angle of resolution.
*p-values were obtained using the Wilcoxon singled-rank test; †Standardization of uveitis nomenclature (SUN) working group's grading scheme, based on the number of inflammatory cells present in a 1 × 1 mm slit beam of maximal intensity (grade 0: <1 cell, grade 0.5+: 1-5 cells, grade 1+: 6-15 cells, grade 2+: 16-25 cells, grade 4+: >50 cells); ‡National institutes of health (NIH) grading system for vitreous haze (grade 0: no flare, grade 0.5+: flare trace, grade 1+: clear optic disc and vessels, haze nerve fiber layer, grade 2+: hazy optic disc and vessels, grade 3+: optic disc visible, grade 4+: optic disc not visible).
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