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Ophthalmomyiasis Interna

Helmut Buettner, MD
Arch Ophthalmol. 2002;120(11):1598-1599. doi:10.1001/archopht.120.11.1598.
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A 41-YEAR-OLD herdsman noted sudden onset of blurred vision with pale, off-yellow–colored lines crisscrossing his left central visual field (Figure 1). Faint curvilinear gray-white lines at the level of the retinal pigment epithelium crisscrossed the left posterior pole (Figure 2). Temporal to the macula a 3-mm-long segmented organism, tapered at both ends, was seen in the subretinal space (Figure 3). The organism was tentatively identified as the larval form (maggot) of a fly belonging to the species Cuterebra (C. Lamar Meek, PhD, oral communication, May 3, 2000). After several hours the larva had moved, seemingly by reversing its direction, inferior to the optic disc, where it was destroyed by laser photocoagulation (Figure 4). An intraocular inflammatory reaction developed but subsided quickly with the topical administration of steroids and cycloplegics. As the posterior tracks disappeared giving way to macular pigment mottling, the vision gradually improved but did not return to normal. More peripheral tracks remained and became partially pigmented (Figure 5). Several of the tracks converged toward a chorioretinal scar near the temporal ora serrata.

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Figures

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Figure 1.

Patient's rendition of the scotomata noted in his left central visual field.

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Figure 2.

Gray-white curvilinear tracks crisscross the macula and posterior fundus of the left eye.

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Figure 3.

Temporal to the macula a 3-mm-long segmented organism (botfly larva), tapered at both ends, is seen in the subretinal space.

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Figure 4.

When the larva had reached a location 6 disc diameters inferior to the optic disc, it was covered with intense green argon laser burns.

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Figure 5.

One year later a scar marks the location where the larva had been destroyed with photocoagulation. Many subretinal tracks have disappeared; others have become depigmented with focal areas of pigment proliferation. Pigment mottling is present in the macula.

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