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Live Larva in Ocular Toxocariasis

To identify the key insights or developments described in this article
1 Credit CME

A 23-year-old man presented for follow-up of ocular toxocariasis (OT), diagnosed 5 years prior during an evaluation for vitritis and chorioretinal granuloma. Diagnosis was confirmed through serum and aqueous humor Toxocara canis antibodies, and treatment with albendazole and oral steroids was instituted. Treatment resulted in inflammation improvement; however, macular scarring led to permanent vision loss. Ultra-widefield color fundus photographs taken at consecutive 4-month intervals revealed a linear image (Figure, A) compatible with a live larva. This was corroborated by optical coherence tomography as a hyperreflective element in the subretinal space of the detached retina (Figure, B). Diagnosis of OT is generally presumptive, with larva demonstration occurring only in rare cases.1,2 Treatment remains controversial; options include albendazole with adjunctive photocoagulation (impossible in this case due to detached retina) or vitrectomy.3,4 Considering the stable cicatricial findings and the poor visual prognosis, it was decided to withhold any course of treatment and closely monitor the patient for recurrence.

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Article Information

Corresponding Author: Sara Geada, MD, Department of Ophthalmology, Centro Hospitalar e Universitario de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal (sarageadabatista@gmail.com).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Fonseca  C , Silva  AM , Freire  S , Proença  R .  Ocular toxocariasis: atypical clinical course.   BMJ Case Rep. 2019;12(4):e228717. doi:10.1136/bcr-2018-228717PubMedGoogle ScholarCrossref
2.
Hernanz  I , Moll-Udina  A , Llorenç  BV , Adan  CA .  Ocular toxocariasis: beyond typical patterns through the new imaging technologies.   Ocul Immunol Inflamm. 2021;29(7-8):1252-1258. doi:10.1080/09273948.2020.1793370PubMedGoogle ScholarCrossref
3.
Ahn  SJ , Ryoo  NK , Woo  SJ .  Ocular toxocariasis: clinical features, diagnosis, treatment, and prevention.   Asia Pac Allergy. 2014;4(3):134-141. doi:10.5415/apallergy.2014.4.3.134PubMedGoogle ScholarCrossref
4.
Despreaux  R , Fardeau  C , Touhami  S ,  et al.  Ocular toxocariasis: clinical features and long-term visual outcomes in adult patients.   Am J Ophthalmol. 2016;166:162-168. doi:10.1016/j.ajo.2016.03.050PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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