Management of presumed trematode-induced granulomatous intermediate uveitis

Rana Hussein Amin, Abdussalam Mohsen Abdullatif, Rana Hussein Amin, Abdussalam Mohsen Abdullatif

Abstract

Purpose: To describe the surgical management of presumed trematode-induced granulomatous intermediate uveitis (PTIGIU) not responding to medical treatment in controlling the inflammation.

Methods: A prospective, interventional, single-center study in which patients with a history of fresh canal water contact and PTIGIU were enrolled. All patients underwent lensectomy-pars plana vitrectomy (PPV) and post-operative control of inflammation, functional and anatomical outcomes were assessed.

Results: Fifteen eyes of 12 patients were included in the study with median age of 11.6 ± 4 yrs. Six months following lensectomy-PPV, inflammation was well controlled in all patients. The eyes were divided into two groups: Group A: 10 patients with an attached retina while Group B: 5 patients who were in the cicatricial stage with tractional retinal detachment. All patients in group A had CDVA of 20/40 or better, unlike patients in group B who failed to achieve a CDVA better than 20/70 throughout their follow-up. In group B, final anatomical success was achieved in only 40% with hypotony occurring in 20%.

Conclusion: PTIGIU is associated with the presence of ciliary body granuloma which, if left untreated, can lead to drastic outcomes. Early lensectomy-PPV represents a viable management option in cases resistant to medical treatment, with a favorable outcome.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1. Intraoperative picture during the vitrectomy…
Fig. 1. Intraoperative picture during the vitrectomy procedure.
A With scleral indentation at the site of ciliary body granuloma showing the latter behind the partially cataractous lens. B During debulking of the ciliary body granuloma using the vitrectomy probe after pars plana lensectomy with preservation of capsular rim for secondary implantation. Iris hooks help improve visualization in poorly dilatable pupils.
Fig. 2. Anterior segment photo and ultrasound…
Fig. 2. Anterior segment photo and ultrasound biomicroscopy revealing.
Anterior segment photo showing A Temporal localized cataract (black arrow) corresponding to the site of ciliary body granuloma in a patient with previously healed anterior chamber granuloma (red arrow). B Total lens opacity with localized forward iris bulge (yellow arrow) corresponding to the site of ciliary body granuloma. Ultrasound biomicroscopy revealing C homogenous lesion with medium-reflectivity (ciliary body granuloma) restricted to ciliary body measuring ~1.78 mm thick, D ciliary body granuloma extending in front of the lens and pushing the iris forwards, E healed ciliary body granuloma, 3 months following PPV.
Fig. 3
Fig. 3
Intraoperative fundus photo of a patient in Group B showing tractional retinal detachment, inferior retinal fold, and subretinal bands extending to the optic disc.

References

    1. Rathinam SR, Usha KR, Rao NA. Presumed trematode-induced granulomatous anterior uveitis: a newly recognized cause of intraocular inflammation in children from south India. Am J Ophthalmol. 2002;133:773–9. doi: 10.1016/S0002-9394(02)01435-6.
    1. Rathinam S, Fritsche TR, Srinivasan M, Vijayalakshmi P, Read RW, Gautom R, et al. An outbreak of trematode-induced granulomas of the conjunctiva. Ophthalmology. 2001;108:1223–9. doi: 10.1016/S0161-6420(01)00604-2.
    1. Amin RM, Goweida MB, El Goweini HF, Bedda AM, Lotfy WM, Gaballah AH, et al. Trematodal granulomatous uveitis in paediatric Egyptian patients: a case series. Br J Ophthalmol. 2017;101:999–1002. doi: 10.1136/bjophthalmol-2017-310259.
    1. Amin RM, Goweida M, Bedda A, Kamel A, Radwan A. Clinical patterns and causes of intraocular inflammation in a uveitis patient cohort from Egypt. Ocul Immunol Inflamm. 2016;26:1–9.
    1. Arya LK, Rathinam SR, Lalitha P, Kim UR, Ghatani S, Tandon V. Trematode fluke procerovum varium as cause of ocular inflammation in Children, South India. Emerg Infect Dis. 2016;22:192–200. doi: 10.3201/eid2202.150051.
    1. Rathinam SR, Arya LK, Usha KR, Prajna L, Tandon V. Novel etiological agent: molecular evidence for trematode-induced anterior uveitis in children. Arch Ophthalmol. 2012;130:1481–4. doi: 10.1001/archophthalmol.2012.729.
    1. Rodríguez A. Early pars plana vitrectomy in chronic endophthalmitis of toxocariasis. Graefe’s Arch Clin Exp Ophthalmol. 1986;224:218–20. doi: 10.1007/BF02143057.
    1. Amin RM, Radwan AE, Goweida MB, El Goweini HF, Bedda AM, Lotfy WM, et al. Management of presumed trematode induced granulomatous uveitis in pediatric patients. Jpn J Ophthalmol. 2019;63:119–25. doi: 10.1007/s10384-018-0632-3.
    1. El Nokrashy A, Abou Samra W, Sobeih D, Lamin A, Hashish A, Tarshouby S, et al. Treatment of presumed trematode-induced granulomatous anterior uveitis among children in rural areas of Egypt. Eye. 2019;33:1525–33. doi: 10.1038/s41433-019-0428-9.
    1. Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140:509–16. doi: 10.1016/j.ajo.2005.03.057.
    1. Das D, Ramachandra V, Islam S, Bhattacharjee H, Biswas J, Koul A, et al. Update on pathology of ocular parasitic disease. Indian J Ophthalmol. 2016;64:794–802. doi: 10.4103/0301-4738.195590.
    1. Rojas D, Soto C, Rojas A. Pathology and first report of natural eye infection with the trematode Philophthalmus gralli (Digenea, Philophthalmidae) in Tinamus major (Tinamiformes, Tinamidae), Costa Rica. Parasitol Int. 2013;62:571–4. doi: 10.1016/j.parint.2013.08.006.
    1. Read RW, Zhang JI, Albini T, Evans M, Rao NA. Splendore-Hoeppli phenomenon in the conjunctiva: immunohistochemical analysis. Am J Ophthalmol. 2005;140:262–e1. doi: 10.1016/j.ajo.2005.03.023.
    1. Vedhanayaki R, Rathinam SR. Trematode granuloma in children. J Ophthalmol Relat Sci. 2020;4:1–5.
    1. El Hefny E, Sabry D, Sewelam A, El Nokrashy A. Characteristics of childhood presumed trematode-induced granulomatous anterior uveitis using ultrasound biomicroscopy. Ocul Immunol Inflamm. 2021;1–5.
    1. Chen Q, Gu J, Jiang R, Zhou M, Chang Q. Role of ultrasound biomicroscopy in diagnosis of ocular toxocariasis. Br J Ophthalmol. 2018;102:642–6. doi: 10.1136/bjophthalmol-2017-310583.
    1. Alexander JL, Wei L, Palmer J, Darras A, Levin MR, Berry JL, et al. A systematic review of ultrasound biomicroscopy use in pediatric ophthalmology. Eye. 2021;35:265–76. doi: 10.1038/s41433-020-01184-4.
    1. Tran VT, LeHoang P, Herbort CP. Value of high-frequency ultrasound biomicroscopy in uveitis. Eye. 2001;15:23–30. doi: 10.1038/eye.2001.7.
    1. Zhou M, Chang Q, Gonzales JA, Chen Q, Zhang Y, Huang X, et al. Clinical characteristics of ocular toxocariasis in Eastern China. Graefe’s Arch Clin Exp Ophthalmol. 2012;250:1373–8. doi: 10.1007/s00417-012-1971-2.
    1. Alsmman AH, Abdalla A, Ezzeldawla M, Mossa EA, Abozaid M. Argon laser photocoagulation for treatment of presumed trematode-induced granulomatous anterior uveitis in children. Br J Ophthalmol. 2021;106:1667–1671.
    1. Zhang T, Guo D, Xu G, Jiang R. Ocular toxocariasis: long-term follow-up and prognosis of patients following vitrectomy. Ocul Immunol Inflamm. 2020;28:517–23. doi: 10.1080/09273948.2019.1597897.
    1. Shalaby O, Saeed A, Elmohamady MN. Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical study. Arq Bras Oftalmol. 2020;83:402–9. doi: 10.5935/0004-2749.20200079.
    1. Sato T, Kinoshita R, Taguchi M, Sugita S, Kaburaki T, Sakurai Y, et al. Assessment of diagnostic and therapeutic vitrectomy for vitreous opacity associated with uveitis with various etiologies. Medicine. 2018;97:e9491. doi: 10.1097/MD.0000000000009491.
    1. Darsová D, Pochop P, Štěpánková J, Dotřelová D. Long-term results of pars plana vitrectomy as an anti-inflammatory therapy of pediatric intermediate uveitis resistant to standard medical treatment. Eur J Ophthalmol. 2018;28:98–102. doi: 10.5301/ejo.5001020.
    1. Shin YU, Shin JY, Ma DJ, Cho H, Yu HG. Preoperative inflammatory control and surgical outcome of vitrectomy in intermediate uveitis. J Ophthalmol. 2017;2017:5946240. doi: 10.1155/2017/5946240.
    1. Giuliari GP, Ramirez G, Cortez RT. Surgical treatment of ocular toxocariasis: anatomic and functional results in 45 patients. Eur J Ophthalmol. 2011;21:490–4. doi: 10.5301/EJO.2010.6118.
    1. Ahn SJ, Ryoo NK, Woo SJ. Ocular toxocariasis: clinical features, diagnosis, treatment, and prevention. Asia Pac Allergy. 2014;4:134–41. doi: 10.5415/apallergy.2014.4.3.134.
    1. Liu Y, Zhang Q, Li J, Ji X, Xu Y, Zhao P. Clinical characteristics of pediatric patients with ocular toxocariasis in China. Ophthalmologica. 2016;235:97–105. doi: 10.1159/000443215.
    1. Faridi A, Yeh S, Suhler EB, Smith JR, Flaxel CJ. Retinal detachment associated with ocular toxoplasmosis. Retina. 2015;35:358–63. doi: 10.1097/IAE.0000000000000279.

Source: PubMed

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