A rare case of intraocular communicating cysticercosis
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A 59-year-old female presented with a gradual diminution of vision in the left eye for 3 months associated with pain and redness. The best-corrected visual acuity (BCVA) in the right eye was 20/20 and counting fingers close to the face in the left eye. The examination of the right eye was unremarkable. The left eye showed a sluggishly reacting pupil, partial posterior vitreous detachment (PVD) and two well-defined overlapping translucent cysts just below the inferior arcade, the larger one in the retro-hyaloid space demonstrating the typical undulating movement and the smaller one in the sub retinal space harboring the scolex. CT brain showed features suggestive of neuro-cysticercosis.

After obtaining neurologist opinion and initiation of oral steroids, through 25-gauge pars plana vitrectomy, the retro-hyaloid space was entered through the area of partial PVD. The cyst capsule was firmly adherent to the hyaloid, which was gently separated using a soft-tipped cannula when it was still found adherent to the underlying structures. After meticulous dissection, this cyst was found communicating to the sub retinal cyst through the posterior hyaloid. Chandelier-assisted bimanual dissection was then performed to open up the 'hyaloid tunnel' that enveloped its connection to the subretinal component of the cyst, which was subsequently teased out into the vitreous cavity in toto with passive suction revealing its dumbbell shape. It was then removed completely with a high-speed vitrectomy cutter. The bed of the cyst with surrounding fibrosis was lasered. At one-week follow up, her BCVA had improved to 20/120 and her retina was attached. Anticonvulsant and antiparasitic therapy were initiated.

Chandelier-assisted bimanual dissection helps achieve meticulous dissection and isolation of the cyst in toto prior to its removal with a high-speed vitreous cutter, thus ensuring its complete removal and good postoperative visual recovery.

Source: http://www.ijo.in/article.asp?issn=0301-4738;year=2020;volume=68;issue=8;spage=1654;epage=1655;aulast=Dhevi