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Subretinal Thelazia-Induced Diffuse Unilateral Subacute Neuroretinitis

Paradee Kunavisarut, MD1; Direk Patikulsila, MD1; Pradya Somboon, PhD2; Kessara Pathanapitoon, MD, PhD1; Aniki Rothova, MD, PhD3
[+] Author Affiliations
1Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
2Department of Parasitology, Chiang Mai University, Chiang Mai, Thailand
3Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
JAMA Ophthalmol. 2014;132(7):896-898. doi:10.1001/jamaophthalmol.2014.346.
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Diffuse unilateral subacute neuroretinitis (DUSN) is a parasitic eye infection with characteristic abnormalities of the outer retina and retinal pigment epithelium and is caused by nematode infection, which can be located in the subretinal space.1 It is a primarily unilateral ocular disorder clinically characterized by a decrease in vision associated with vitritis, papillitis, and recurrent development of white linear lesions in the retina. The gold standard of the diagnosis of DUSN is the visualization of a motile worm. Herein, we report a case of subretinal Thelazia-induced DUSN.

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Figure 1.
Fundus Photographs and Fluorescein Angiograms of the Right Eye Taken 1 Week After Initial Presentation Demonstrated Diffuse Unilateral Subacute Neuroretinitis

A and B, Fundus photographs showed mild vitritis, vascular sheathing, and diverse chorioretinal lesions. B, In the superior part of the retina, a threadlike lesion (arrowhead) beneath the retina was observed. C and D, Fundus fluorescein angiograms demonstrated multiple diffuse curvilinear lesions characterized by leakage in the late frames.

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Figure 2.
An Adult Thelazia in the Subretinal Space Was Discovered 4 Weeks After Initial Presentation

A, Optical coherence tomography revealed a threadlike parasite located in the subretinal space (arrowheads). B, Fundus photograph taken 1 day after optical coherence tomography revealed that the parasite migrated slightly (arrowhead). C, A female Thelazia 6.25 mm long and 0.1 mm wide (measured at the vulva opening area) was extracted from the subretinal space.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Thelazia Removal

Removal of the parasite with an extrusion tube during pars plana vitrectomy.

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