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
Patient's rendition of the scotomata
noted in his left central visual field.
Gray-white curvilinear tracks
crisscross the macula and posterior fundus of the left eye.
Temporal to the macula a 3-mm-long
segmented organism (botfly larva), tapered at both ends, is seen in the subretinal
When the larva had reached a location
6 disc diameters inferior to the optic disc, it was covered with intense green
argon laser burns.
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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