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Purpose: Ocular toxocariasis (OT) is a zoonotic infection caused by larval stages of Toxocara canis and T. cati. The current review and meta-analysis aimed to evaluate the global prevalence of OT.Methods: Five English (PubMed, Scopus, Science Direct, Web of Science, and Google Scholar) databases were explored and 101 articles met the inclusion criteria.Results: The pooled prevalence (95% confidence interval) of OT was higher in immunological studies (9%. 6-12%) than in studies that applied ophthalmic examination (1%. 1-2%). The lower middle-income level countries had the highest prevalence (6%. 2-12%) as well as the African region (10%. 7-13%). The highest infection rate (4%. 2-7%) was detected in the 1-25 mean age group.Conclusion: Regular anthelminthic treatment of cats and dogs, and removal of animal feces from public places must be considered.

To summarize the clinical features and probable factors associated with recurrence within 6 months in northern Chinese ocular toxocariasis (OT) patients. A retrospective cohort study (38 OT eyes) w...

To report five cases of ocular Toxocariasis (OT) in which ultrawide-field (UWF) imaging was helpful in diagnosis and assessment. OT is an underdiagnosed condition triggered by the ocular invasion of Toxocara larvae. Typical features are peripheral granuloma or endophthalmitis.A retrospective case series of 10 outpatients were studied by complete ophthalmologic examination and complementary tests. UWF retinal imaging, fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SDOCT) were retrospectively analyzed. Five patients with suspected OT were included.UWF imaging and FAF was able to detect all retinal lesions in a single rapid capture. Two patients showed positive serology for Toxocara. An image suggesting the larva in the vitreous cavity was shown in one patient. Antihelmintic 15 treatment along with steroids was prescribed in two patients.UWF imaging and SDOCT provide a more efficient approach and follow-up in OT, raising final standards of care.

To report the epidemiology, clinical characteristics, treatment and outcomes of patients with ocular toxocariasis.Retrospective review of patients diagnosed with ocular toxocariasis at a pediatric ...

We aimed to present a unique case of a child with an optic disc granuloma with exudative retinal detachment as a manifestation of ocular toxocariasis. The response to systemic therapy was assessed using deep range imaging optical coherence tomography. This imaging technique was the most accurate for identification of retinal, macular and vitreous changes associated with this intraocular pathology.

Purpose: To report a case of strabismus in a five-week-old infant, likely secondary to a rare occurrence of congenitally acquired ocular toxocariasis.Methods: Retrospective case report.Results: A five-week-old male infant with left exotropia was referred to pediatric ophthalmology and to a vitreoretinal specialist. Fundoscopic examination revealed a granuloma with associated retinal folds and tractional retinal detachment typical for ocular toxocariasis. Serology revealed positivity for Toxocara antibodies, consistent with the clinical diagnosis of ocular toxocariasis.Conclusion: Ocular toxocariasis is typically thought to be secondary to acquired Toxocara infection secondary to fecal-oral transmission. In this case of early-onset strabismus secondary to ocular toxocariasis, it is hypothesized that this is a presentation of congenitally acquired toxocariasis.

Purpose: This report describes the diagnosis of ocular toxocariasis presenting as endophthalmitis in an adult intravenous drug user. Methods: A case is reported. Results: Fundus imaging showed numerous white opacities obscuring the macula. Toxocara canis serology was reactive with an enzyme immunoassay titer of 1:2 (positive ≥ 1:32). Findings from bacterial and fungal cultures were negative, and vitrectomy cytology revealed no organisms. Postoperatively, serial optical coherence tomography imaging demonstrated a slight decrease in size of an intraretinal hyperreflective lesion in the macula. Conclusions: Owing to a variety of presentations, ocular toxocariasis can be challenging to diagnose. In a patient with a history of intravenous drug use where fungal and bacterial organisms are more common causes of endophthalmitis, it is important to have a wide differential of causative organisms, particularly in the context of negative culture results and a worsening clinical examination.

Purpose: To investigate the outcomes of surgical treatment in patients with ocular toxocariasis and identify prognostic factors.Methods: We retrospectively reviewed the medical records of 56 consec...

A 25-year-old male presented with unilateral panuveitis with multiple voluminous elevated retinal lesions along with subretinal fluid and exudation. An extensive laboratory work-up was done, and a clinical suspicion of viral retinitis was considered. The patient was initiated on antiviral therapy and, subsequently, oral corticosteroids. As the corticosteroids were tapered, the patient developed worsening lesions and vitreous inflammation. Pars plana vitrectomy (diagnostic and therapeutic) was performed and cytology sample revealed a highly eosinophilic infiltrate suggestive of parasitic infection. The real-time polymerase chain reaction was positive for Toxocara cati. The diagnosis of ocular toxocariasis was made. This case highlights a highly unusual presentation where multiple retinal granulomas of ocular toxocariasis were observed in an immunocompetent male.

Ocular toxocariasis can be vision threatening, and is commonly reported from tropical or subtropical regions. Knowledge of clinical manifestations from the United States, particularly in underserved areas such as the American South, is lacking. We report three cases of ocular toxocariasis in individuals from the Mississippi Delta, a rural community with prevalent poverty. Visual acuity was severely affected in two of the three cases. Increased awareness of ocular toxocariasis, which may have under-recognized frequency, will contribute to prompt diagnosis and treatment, which will ultimately improve patient health in the region.

PurposeTo report panuveitis due to Toxocara, with positive Toxoplasma serology. ObservationA nine-year-old boy presented with a panuveitis, intermittent headaches, and a visual acuity of 20/400 in his left eye. Slit lamp examination showed anterior chamber cells and flare without keratic precipitates (KPs), vitreous cells and veils, and optic disc edema with a blurred fundus view. Initial lab values were positive for toxoplasmosis. Topical cycloplegic and steroid eye drops, in addition to trimethoprim/sulfamethoxazole (TMP/SMX) treatment, was initiated. Four days later, oral corticosteroids were started. As inflammation cleared, the fundus examination showed an inferior tractional detachment, leading to an ultimate diagnosis of ocular Toxocariasis.Conclusion and ImportanceHigh false positives on Toxoplasma serology and diffuse vitritis from toxocariasis limiting retinal visualization may confuse the initial diagnosis.

Purpose The purpose of this study is to compare the lesion detection rates of ocular toxocariasis (OT) between ultra-wide-field scanning laser ophthalmoscopy (UWF-SLO) and conventional fundus photography (CFP), and to evaluate the potential diagnostic ability of UWF-SLO in OT. Methods A total of 56 patients with serological/immunological confirmed unilateral OT were enrolled. The presence of OT characteristic features included the posterior granuloma (postG), peripheral granuloma (periG), tractional retinal detachment (TRD), retinal folds (RF), and vitreous strands (VS) and was analyzed in 36 patients with UWF-SLO and 56 patients with CFP. Diagnostic tests were employed using the clinical examination as gold standard. Results In total of the 56 OT eyes, granulomas were identified in 91.1% (51/56) of eyes, including postG in 46.4% (26/56) of eyes, periG in 41.1% (23/56) of eyes, and combined granulomas in 3.6% (2/56) of eyes. TRD, RF, and VS were found in 28.6% (16/56), 51.8% (29/56), and 83.9% (47/56) of patients, respectively. Although the specificities of the diagnosis in clinical features were similar by the diagnostic tests, the sensitivities of postG, periG, TRD, RF, and VS using UWF-SLO were 100%, 100%, 66.7%, 95%, and 81.8%, respectively, which were significantly higher those of CFP (72.2%, 31.3%, 11.1%, 55%, and 48.5%). Additionally, the extent of vitreous haze was milder graded by UWF-SLO compared to CFP (p = 0.0099). Conclusions The diagnostic ability of UWF-SLO was superior to CFP using clinical examination as gold standard for the ascertainment of the characteristic manifestations of OT, especially for granulomas and RF.

Purpose: Ocular toxocariasis (OT) is a vision-threatening disease with a largely unknown intraocular pathogenesis. Herein, we determined the cytokine expression profile in aqueous humor (AH) of patients with OT.Methods: This is a prospective experimental case-control study of cytokine levels in AH of patients with OT and uveitis and control subjects. Thirty samples from eyes with OT, 23 from eyes with uveitis, and 25 from eyes with age-related cataract were analyzed using a multiplexed magnetic bead immunoassay. Thirty-one cytokines were detected and classified into 5 categories: T-helper type 1 (Th1)-associated cytokines, Th2-associated cytokines, Th17 cytokine, proinflammatory mediators, and growth factors.Results: Higher expression in 19 and decreased expression in 3 cytokines in the OT group were identified, compared with controls. Levels of 17 cytokines were increased in the OT group, compared with the non-OT uveitis and control groups. Levels of 3 cytokines were decreased in the OT group compared with controls; no cytokine level was decreased in the OT and non-OT uveitis groups. Interleukin-10 was the only cytokine showing a significant difference in pairwise comparison among all groups. Th17 levels showed no change, while growth factors and proinflammatory mediators showed some significant changes.Conclusions: We believe this is the first analysis of cytokine expression profile in OT. It revealed that Th2-associated cytokines, especially IL-5, IL-10 and IL-13, present a significantly higher concentration in OT compared with the non-OT uveitis and controls. These cytokines may be important for OT pathogenesis and help identify diagnostic markers and develop treatment strategies in future.

We report a case of an asymptomatic Caucasian male who attended our clinic for a routine check-up and macular heterotopia associated with lesions compatible with ocular toxocariasis were found.

We evaluated thirteen eyes of twelve patients diagnosed clinically and serologically with Toxocara optic neuropathy. Eleven patients had unilateral involvement and one patient had bilateral optic neuropathy. Eight patients (66.7%) had a possible infection source to Toxocara. Six patients (50%) had painless acute optic neuropathy. Ten eyes had asymmetric, sectorial optic disc edema with peripapillary infiltration and three eyes had diffuse optic disc edema. Eosinophilia was noted in five patients (41.7%) and optic nerve enhancement was observed in eight of eleven eyes (72.7%) with available orbit magnetic resonance imaging (MRI). Mean visual acuity significantly improved following treatment [mean logarithmic of the minimum angle of resolution (logMAR) 0.94±0.56 at baseline and 0.47±0.59 at the final (P=0.02)]. Asymmetric optic disc edema with a peripapillary lesion and a history of raw meat ingestion were important clues for diagnosing Toxocara optic neuropathy. Additionally, Toxocara IgG enzyme-linked immunosorbent assay (ELISA) test and evaluating eosinophil may be helpful for diagnosis.

Toxocariasis, one of a group of parasitic diseases known as neglected parasitic infections, is a disease caused by the larvae of two species of Toxocara roundworms, Toxocara canis, from dogs, and less commonly Toxocara cati, from cats. Although most infected individuals are asymptomatic, clinical manifestations may include fever, fatigue, coughing, wheezing, or abdominal pain (visceral toxocariasis) or vision loss, retina damage, or eye inflammation (ocular toxocariasis). To assess U.S. pediatrician knowledge of toxocariasis, we conducted an electronic survey of American Academy of Pediatrics members. Of the 2,684 respondents, 1,120 (47%) pediatricians correctly selected toxocariasis as the diagnosis in an unknown case presentation with findings typical for toxocariasis; overall 1,695 (85%) stated they were not confident that their knowledge of toxocariasis was current. This knowledge gap suggests a need for improved toxocariasis awareness and education for U.S. pediatricians, especially those caring for children at risk for infection.

Purpose To report a case of acute endophthalmitis and hyphema mimicking pink hypopyon associated with ocular toxocariasis. Observations An immunocompetent 56-year-old woman presented to our hospital with a sudden onset and a three-day history of decreased visual acuity in her left eye. There were no known inciting factors for her symptoms; however, she had a history of eating undercooked beef five days prior. On examination, the best-corrected visual acuity of her left eye was light perception and the intraocular pressure was 24 mmHg. Hyphema mimicking pink hypopyon and vitreous opacity suggestive of acute endophthalmitis were observed in her left eye. The patient underwent an emergency pars plana vitrectomy. The intraoperative findings included iridodialysis, severe vitritis, multiple whitish spots on the retina, white sheathed retinal vessels, and whitish peripheral granuloma. The aqueous humor tap and vitreous tap cultures were negative. Blood tests showed elevated eosinophil and total immunoglobulin (Ig) E levels. Enzyme-linked immunosorbent assay of her intraocular fluid showed positive anti-Toxocara canis IgG reactions; the patient was therefore diagnosed with ocular toxocariasis. Subsequent treatment with oral albendazole and prednisone resulted in significant improvement and recovery of visual acuity to 20/12.5. Conclusions and Importance Acute endophthalmitis with hyphema mimicking pink hypopyon is a rare clinical presentation of ocular toxocariasis. The findings from this case highlight the importance of suspecting ocular toxocariasis if a patient presents with acute endophthalmitis and hyphema accompanied with peripheral granuloma. Early vitrectomy and subsequent treatment with oral albendazole and prednisone can be effective in visual recovery.

Purpose Ocular toxocariasis (OT) is a worldwide ocular parasitic infection and is especially sight-threatening in children. Because of the clinical manifestation diversity, OT has frequently been misdiagnosed. The purpose of this study was to evaluate the diagnostic value of anti-toxocara immunoglobulin G (IgG) in intraocular fluid (IF) and serum in OT. Methods IF and serum were collected from patients with clinically diagnosed OT and non-OT uveitis. The level of anti-toxocara IgG was detected by enzyme-linked immunosorbent assay. The data were statistically analyzed in anti-toxocara IgG and the Goldmann–Witmer coefficient (GWC) between groups. The area under the receiver operating characteristic curve (AUC ROC) was performed to assess the diagnostic value of serum and IF anti-toxocara IgG and the GWC. Results A total of 290 participants, 128 (44.1%) with OT and 162 (55.9%) with non-OT uveitis, were included in this study. The default serum anti-toxocara IgG cutoff value of 11 U had 72.1% sensitivity and 95.5% specificity. With the optimized cutoff value of 8.2 U, the AUC was 0.886 (95% confidence interval [CI] = 0.830–0.929, P < 0.0001), sensitivity increased to 80.2%, and specificity was 94.0%. With an IF anti-toxocara IgG cutoff value of 1.8 U, the AUC was 0.934 (95% CI = 0.892–0.963, P < 0.0001), sensitivity was as high as 88.4%, and specificity was 96.4%. Conclusions Our study proposes novel diagnostic cutoff values of serum and IF anti-toxocara IgG for OT, which are 8.2 U and 1.8 U, respectively. Translational Relevance This study will improve the accuracy of diagnosis in patients with OT.

Purpose To determine the potential and usefulness of ultrasound biomicroscopy (UBM) as a diagnostic procedure on a larger cohort of paediatric patients with ocular toxocariasis. Methods UBM was performed on 41 eyes of 41 patients with ocular toxocariasis in order to determine configuration of peripheral retina, pars plana and vitreous. Location and range of peripheral pathology using ophthalmoscopy with scleral indentation, UBM and intraoperative confirmation were recorded and compared. Results Pathological structures such as vitreous condensations or membranes of various configuration and extent were identified by UBM. UBM revealed peripheral granuloma and pseudocystic changes in the peripheral vitreous in 15 of 41 eyes. Compared with indirect ophthalmoscope, statistical analysis showed significant differences in the number of clock-hours of peripheral pathology detected by UBM (p=0.015), while statistical differences were not found between UBM and intraoperative peripheral examinations using scleral indentation (p=0.432). Conclusions UBM seems to be a valuable and reliable diagnostic technique for the evaluation of patients with ocular toxocariasis. Longitudinal studies will have to determine the relevance of UBM findings for the individual clinical course and their influence on therapeutic decisions.

To determine the clinical features, treatment, and visual outcome in ocular toxocariasis.A total of 16 cases diagnosed as ocular toxocariasis clinically and/or serologically were analyzed retrospectively.The mean age of the patients was 22.6 years. Cases were categorized into three clinical types with peripheral granuloma (43.7%) as the most common presentation. Of the patients, 10 (62.5%) had positive serum ELISA for T. canis; five (31.2%) received combination treatment with anthelmintic and corticosteroid, and eight (50%) patients had vitreous surgery. The visual outcome in eyes which underwent surgery was better, however the difference in medically and surgically treated groups was insignificant (p = 0.11). There was also no difference in visual outcome among the three clinical groups (p = 0.20).Ocular toxocariasis has a varied presentation spectrum. Serum ELISA for T. canis aids in diagnosis. The difference in visual outcome among clinical and treatment groups was insignificant. However, in general, ocular toxocariasis resulted in a poor visual outcome.

Background Ocular toxocariasis is considered a parasitic disease of major socioeconomic importance. In spite of the high prevalence of human toxocariasis (up to 84%) among Egyptian patients, the incidence of ocular toxocariasis is underestimated. The recognition of this neglected disease would be the initial step to overcome it. Thus, this review gave updated information on the pathogenesis, clinical manifestations, diagnosis, and treatment of ocular toxocariasis. Results Ocular toxocariasis is an important cause of unilateral vision impairment mostly in children and always in the differential diagnosis of retinoblastoma. This disease exhibits various manifestations such as posterior pole granuloma, peripheral granuloma, or chronic endophthalmitis. Diagnosis of ocular toxocariasis can be carried out by the ophthalmic examination and immunodiagnostic methods to reveal the specific antibodies in serum and ocular fluids. In addition, molecular diagnosis, medical imaging techniques, and histopathologic observation of Toxocara larva in the surgically obtained specimens can be performed. Ocular toxocariasis can be treated either medically or surgically. Regarding medical treatment, the ophthalmologists prefer to use steroids and anthelminthic drugs; however, there are no standardized parameters for doses, duration, and route of administration. Conclusion Clinical suspicion plays a leading role in the diagnosis of ocular toxocariasis, but always with other diagnostic methods. Accurate diagnosis and prompt treatment can minimize ocular morbidity.

Copyright © 2016 The korean retina society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 눈 개회충증 환자에서의 혈청 안지오텐신전환효소 수치 상승 Elevation of Serum Angiotensin-Converting Enzyme Level in Patients with Ocular Toxocariasis

Objective: The aim of the study was to analyze the clinical characteristics of pediatric patients with ocular toxocariasis. Methods: Ocular toxocariasis was diagnosed and treated in 46 children from Shanghai and surrounding provinces. The diagnosis of ocular toxocariasis was confirmed immunologically by performing an enzyme-linked immunosorbent assay on serum and/or intraocular fluid. All pediatric patients and their guardians completed a questionnaire concerning their cases and living habits. Results: The mean age of onset was 6 ± 3 years. Most children (85%) resided in rural areas, and 91% of the children had contact with adult dogs or puppies. At the first visit, visual acuity (VA) was Conclusions: Preschool children in China are more often affected by toxocariasis compared with other age groups. The most common signs included unilateral granuloma and ocular inflammation. In our study, clinical manifestations were severe and complicated. At the first visit, VA was

To report a rare case of bilateral granulomatous chorioretinitis complicated by bilateral peripapillary choroidal neovascular membranes. This is the first reported case in Australia where intravitreal injections of anti-vascular endothelial growth factor ranibizumab were used to successfully treat choroidal neovascular membrane caused by granulomatous chorioretinitis. This is also the first reported case in Australia of Toxocara polymerase chain reaction being performed on intraocular fluids.

To investigate the clinical characteristics and treatment results of adult patients with ocular toxocariasis.A total of 54 consecutive patients who were clinically and serologically diagnosed with ocular toxocariasis were retrospectively reviewed.Among patients, 66.7 and 77.3% showed increases in eosinophil cationic protein (ECP) and total Ig E in serum, respectively. Four eyes (7.2%) initially presented as neuroretinitis with subsequent motile retinal lesion. The recurrence rates in the combination treatment group with albendazole and corticosteroids were significantly lower than those in the steroid-alone group during the mean follow-up of 27.6 months (p = 0.001).The adjunctive test of serum total IgE level may be helpful for the diagnosis of ocular toxocariasis. Ocular toxocariasis should be considered in the differential diagnosis of unilateral neuroretinitis with subsequent motile retinal lesion. Combined treatment with albendazole and corticosteroids appeared to be effective for reducing the recurrence of intraocular inflammation.

We present a case of ocular toxocariasis treated successfully with oral albendazole in combination with steroids. A 26-year-old male visited the authors' clinic with the chief complaint of flying flies in his right eye. The fundus photograph showed a whitish epiretinal scar, and the fluorescein angiography revealed a hypofluorescein lesion of the scar and late leakage at the margin. An elevated retinal surface and posterior acoustic shadowing of the scar were observed in the optical coherence tomography, and Toxocara IgG was positive. The patient was diagnosed with toxocariasis, and the condition was treated with albendazole (400 mg twice a day) for a month and oral triamcinolone (16 mg for 2 weeks, once a day, and then 8 mg for 1 week, once a day) from day 13 of the albendazole treatment. The lesions decreased after the treatment. Based on this study, oral albendazole combined with steroids can be a simple and effective regimen for treating ocular toxocariasis.

PurposeTo investigate ultrasound biomicroscopy (UBM) characteristics of patients with ocular toxocariasis (OT) and to explore the role of UBM in the diagnosis and differential diagnosis of OT.DesignCross-sectional study.Methods78 eyes of 77 patients clinically consistent with OT and confirmed by serum and/or intraocular antibodies in a single tertiary centre (Fudan University Eye and ENT Hospital, Shanghai) between July 2009 and July 2016 were included in the study. UBM was performed, and the outcomes were analysed.ResultsMean age of the patients included was 12.8±10.3 years. Positive UBM findings were observed in 72 of 78 eyes (92.3%). The primary imaging feature was peripheral granulomas (66 eyes; 84.6%), of which 78.5% were adjacent to the nasal or temporal side of horizontal meridian and 79.7% located on the surface of the ciliary body, presenting as olivary foci on radical section and botuliform foci on coronal section. Moreover, 12 of the peripherally involved eyes were accompanied with posterior pole granulomas, which could be termed ‘combined type’. Other UBM findings included vitreous strands (53 eyes; 67.9%), peripheral tractional retinal detachment (41 eyes; 52.6%) and tractional cyclodialysis (32 eyes; 41.0%).ConclusionsThe utilisation of UBM verifies the existence of the combined subtype (with both peripheral and posterior pole granulomas) and improves the detection rate of peripheral granulomas, which is of great importance to the diagnosis and differential diagnosis of OT.

Despite being one of the most common zoonotic infections worldwide, human toxocariasis has been one of the neglected tropical diseases. Although most human infections are asymptomatic, two main syndromes of human toxocariasis are classically recognized: systemic toxocariasis, which encompasses diseases in major organs; and ocular toxocariasis (OT), disease in the eye or optic nerve, caused by the migration of Toxocara larvae into the eye. OT is usually a unilateral disease, which typically presents as retinal granuloma, a yellowish or whitish inflammatory mass, in the posterior pole or peripheral retina. Granuloma itself or other comorbid conditions such as epiretinal membrane, macular edema, and retinal detachment can lead to permanent retinal damage and visual loss in eyes with OT. OT is diagnosed clinically by identification of clinical signs on ophthalmologic examination. Serological tests, such as enzyme-linked immunosorbent assay (ELISA) for detection of serum antibody against the Toxocara larvae, can confirm the diagnosis. In addition, serum immunoglobulin E and detection of ocular fluid antitoxocara antibody by ELISA may give additional aid to the diagnosis. Standard treatment of OT is corticosteroid in patients with active intraocular inflammation. Although the role of anthelmintic therapy is unclear, favorable outcome has been reported by combined corticosteroid and albendazole therapy in eyes with active inflammation. Prevention, by increasing public awareness and reducing the risk of infection, is also important. Recently, the association between ingestion of uncooked meat or liver and toxocariasis was reported, especially in adult patients. Future research on the potential source of infection, diagnosis, and treatment should be performed.

To determine the prognosis for ocular toxocariasis (OT) according to the location of the granuloma and to identify factors associated with its recurrence within 1 year.OT patients were classified according to the granuloma lesion. After grouping the patients as posterior or peripheral, we compared sex, age, intraocular pressure, best corrected visual acuity (BCVA), degree of inflammation, immunoglobulin E, eosinophil profiles, recurrence, and complications in each group. We also identified factors associated with recurrence within 1 year.A total of 29 (61.70%) patients had granuloma at the periphery, and 18 (38.30%) patients had granuloma around the posterior pole. There were no significant differences in ocular or systemic evaluations except the initial BCVA. The mean decimal BCVA of the posterior pole granuloma group was worse than that of the peripheral granuloma group (p = 0.042). After treatment, the mean BCVA of the posterior pole granuloma group improved significantly (p = 0.019), and the final mean BCVA was not significantly different between the groups (p = 0.673). Multiple logistic regression analyses revealed that recurrence within a year was associated with age at diagnosis (p = 0.007).The initial BCVA of OT patients differed according to the location of the granuloma, but the BCVA after treatment was not significantly different between the groups. Younger age was associated with recurrence within 1 year.

Purpose To report the clinical features of cataracts in eyes with ocular toxocariasis. Setting Department of Ophthalmology, Seoul National University Bundang Hosptal, Seongnam, South Korea. Design Retrospective observational case series. Methods The clinical diagnosis of ocular toxocariasis was based on the following characteristic features: retinal granuloma with or without ocular inflammation and positive results in serum antibody enzyme-linked immunosorbent assay. Patients younger than 60 years who presented with a unilateral cataract and were diagnosed with ocular toxocariasis between January 2009 and January 2012 were included. Demographic and ocular examination data for all patients showing atypical cataract features were collected. All cataracts were documented with anterior segment photography. Results Seven of 83 patients (8.4%) presented with an atypical cataract in the eye with ocular toxocariasis only. The mean patient age was 49.7 years ± 8.3 (SD) (range 38 to 59 years). All patients had small, round, white lens opacities resembling retinal granulomas. The granuloma-like opacities were located primarily in the lens midperiphery and in the subcapsular level. The lens opacity migrated in 1 patient. Conclusions Ocular toxocariasis can cause a cataract with distinctive clinical features. These cataracts show a granuloma-like opacity primarily in the posterior subcapsular level; the opacity can migrate. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Purpose To assess the current burden of ocular toxocariasis (OT) and to gain knowledge regarding the diagnostic and treatment practices used in the ophthalmologic community in the United States. Design Web-based, cross-sectional survey. Participants Subspecialty ophthalmologists who are currently practicing in the United States. Methods An electronic survey was sent to 3020 ophthalmologic subspecialists belonging to the American Uveitis Society (AUS), the American Society of Retina Specialists (ASRS), or the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) to capture demographic, clinical, diagnostic, and treatment data on patients with OT seen in their practices between September 2009 and September 2010. Main Outcome Measures The demographic, epidemiologic, and clinical characteristics of each reported patient with OT. Results A total of 159 patients with OT were reported by 559 respondents (19%). The median patient age was 11.5 years (range, 1–66 years). Seventy-two patients (45%) with OT lived in the Southern region of the United States. Thirty-one (69%) of 45 patients with OT owned a dog or cat. Vision loss was reported in 46 (85%) of 54 patients with OT; 32 (71%) of 45 patients had permanent vision loss, 13 patients (29%) had temporary vision loss, and duration of vision loss was unreported for 1 patient. Of the 32 patients with OT with permanent vision loss, 30 (94%) had a subretinal granulomatous mass/scar, peripheral granuloma with traction bands, or posterior pole granuloma noted on ophthalmologic examination. Subretinal granulomatous mass/scar, vitritis, and scotoma were the most common ophthalmologic signs found on examination of patients with OT. Conclusions Ocular toxocariasis continues to occur in the United States, where it affects mainly children and causes permanent vision loss in many patients. Healthcare professionals should counsel patients and their family members about prevention strategies in an effort to decrease infection rates and morbidity due to Toxocara . Further improvement of diagnostic and treatment tools is needed to assist ophthalmologists in treating patients with OT. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

PURPOSE To document the intraretinal migration of presumed toxocara larvae mimicking punctate inner choroidopathy, idiopathic choroidal neovascularization, and diffuse unilateral subacute neuroretinitis. METHODS Sequential color photographs, fluorescein angiograms, and optical coherence tomography were performed in three unrelated adult patients with presumed ocular toxocariasis. RESULTS Characteristic fundoscopic manifestations simulating punctate inner choroidopathy, idiopathic choroidal neovascularization, and diffuse unilateral subacute neuroretinitis were reported in these patients, respectively. CONCLUSION Presumed toxocara larvae must be included as a potential cause of different inflammatory diseases as a result of its migration through the retinal layers.

Purpose To determine the prognosis for ocular toxocariasis (OT) according to the location of the granuloma and to identify factors associated with its recurrence within 1 year. Methods OT patients were classified according to the granuloma lesion. After grouping the patients as posterior or peripheral, we compared sex, age, intraocular pressure, best corrected visual acuity (BCVA), degree of inflammation, immunoglobulin E, eosinophil profiles, recurrence, and complications in each group. We also identified factors associated with recurrence within 1 year. Results A total of 29 (61.70%) patients had granuloma at the periphery, and 18 (38.30%) patients had granuloma around the posterior pole. There were no significant differences in ocular or systemic evaluations except the initial BCVA. The mean decimal BCVA of the posterior pole granuloma group was worse than that of the peripheral granuloma group (p = 0.042). After treatment, the mean BCVA of the posterior pole granuloma group improved significantly (p = 0.019), and the final mean BCVA was not significantly different between the groups (p = 0.673). Multiple logistic regression analyses revealed that recurrence within a year was associated with age at diagnosis (p = 0.007). Conclusions The initial BCVA of OT patients differed according to the location of the granuloma, but the BCVA after treatment was not significantly different between the groups. Younger age was associated with recurrence within 1 year.

Background Toxocara canis is a parasite that can infect the eye and create a significant inflammatory response that can be detrimental to the patient's vision. Its clinical presentation can mimic other causes of uveitis, and its diagnosis and treatment can be challenging. Prompt and accurate diagnosis of ocular toxocariasis is essential to prevent permanent visual loss. Case Report A 7-year-old Hispanic boy presented to the clinic with complaints of reduced visual acuity in the left eye. After a careful evaluation of his ocular health, he had ocular toxocariasis diagnosed and confirmed by enzyme-linked immunosorbent assay testing. Treatment with the anthelmintic, albendazole, and oral steroids was initiated. There was initial improvement of the vitritis with significant vitreous debris. However, 2 years later, reactivation occurred, and a vitrectomy was required. This case report reviews the management of a patient with active ocular toxocariasis, including clinical findings and treatment options. Conclusions The differential diagnosis of ocular toxocariasis and review of the available treatments are presented.

Toxocariasis was first reported in the early 1950s.1 Distribution is worldwide but the incidence is highest in the south‐eastern United States, Puerto Rico and the West Indies.2 Serological surveys...

Toxoplasmosis and toxocariasis are parasitic infections that are transmitted by cats and dogs, respectively, to humans, and which may induce posterior uveitis already in childhood. Toxoplasmosis presents as a congenitally or postnatally contracted infection whereas toxocariasis is always an acquired disease. The typical ocular sign of toxoplasmosis is retinochoroiditis, occurring as an active lesion, in most instances, associated with an inactive pigmented scar. In contrast, toxocariasis leads to a choroidal granuloma secondarily involving the retina or an endophthalmitis-like picture. Although toxoplasmosis represents the most common cause of posterior uveitis, there are uncertainties regarding the timing and specificity of the diagnosis, namely in atypical cases and those at risk of permanent severe loss of function. Antiparasitic treatment should be tailored to the severity of the inflammation and the risk of visual function loss. Concomitant steroids may be used to control the sequelae of unspecific inflammation, but should be used with caution and must be combined with an antimicrobial regimen. Because it is a rare disorder, one may not be familiar with the clinical presentation and suggested therapy for ocular toxocariasis. With this survey we, therefore, wish to provide a current, practice-oriented overview on the infection, ocular manifestations, diagnosis and treatment of ocular toxoplasmosis and toxocariasis in childhood.

Ocular toxocariasis (OT) is a zoonotic parasitic infection mainly caused by the intraocular tissue invasion of second-stage Toxocara canis or Toxocara cati larva. Measuring specific anti-T. canis antibodies in the intraocular fluid (IF) can increase OT diagnosis accuracy using Goldmann-Witmer coefficient (GWC). However, there is no systemic evaluation of GWC application in the immunological diagnosis of OT. To assess GWC for the immunodiagnosis of ocular toxocariasis, paired IF and serum samples from 72 patients diagnosed with OT were retrospectively analyzed for specific anti-T. canis IgG by enzyme linked immunosorbent assay (ELISA). GWC values were calculated to determine intraocular specific IgG production. Clinical features and other laboratory data were recorded, and their correlations with GWC evaluated. Of the 72 OT patients, 60 (83.33%) showed intraocular specific IgG production confirmed by GWC, while intraocular nonspecific IgE production was found in 64/69 (92.75%) cases. No significant correlation was found among clinical features and IF specific IgG production. Values for peripheral blood samples were lower than those of intraocular fluid regarding OT screening, and vitreous humor samples showed increased local specific IgG and nonspecific IgE production compared with aqueous humor samples. Overall, our results indicate that GWC and intraocular IgE production have referential values in diagnosing ocular toxocariasis.

To describe the prevalence, clinical features, and causes of vision loss among patients with ocular toxocariasis seen at a uveitis referral center.A review was completed of the charts of patients with ocular toxocariasis who were examined between 1977 and 1996 at the Francis I. Proctor Foundation of the University of California at San Francisco. The prevalence of ocular toxocariasis among all uveitis patients seen at the center was determined. Demographic features, symptoms, and signs in all patients were evaluated.Ocular toxocariasis occurred in 22 (1.0%) of 2,185 uveitis patients. The mean patient age was 16.5 years. Inflammation was usually unilateral (90.9%). Toxocara uveitis presented as a granuloma in the peripheral retina in 50% of cases, as a granuloma in the macula in 25% of cases, and as a moderate to severe vitreous inflammation mimicking endophthalmitis in 25% cases. The primary causes of vision loss were vitritis (52.6%), cystoid macular edema (47.4%), and traction retinal detachment (36.8%).Ocular toxocariasis is an uncommon cause of uveitis that mainly affects younger patients. Inflammation is typically unilateral and presents as either a granuloma in the peripheral or posterior retina or a moderate to severe vitreous inflammation mimicking endophthalmitis.

Norman Ashton, the first ophthalmic pathologist in the UK, spent his career furthering the understanding and treatment of eye disease and exercising the political acumen to garner the funding necessary to advance this new field. His demonstration of the obliteration of growing retinal endothelial cells caused by the excessive administration of oxygen in premature infants is perhaps his best–known work. Apart from this, his casts of the choroidal and trabecular meshwork circulation and Schlemm's canal were the first to display the exact anatomy of these structures to the ophthalmic community. Studies of the pathogenesis of cotton wool spots, neovascularization and microaneurysms and the behaviour of retinal vessels contributed lastingly to the understanding of retinal vascular disease. With associates he demonstrated the role of the endothelium in the blood–retina barrier. Investigation of diabetic, hypertensive and other retinopathies provided fundamental contributions to the comprehension of these conditions. Original studies established an insight into amoebic ocular infections, ocular toxocariasis, nosematosis and a collection of eye diseases in animals and fish. Fight for Sight and the European Ophthalmic Pathological Society owe their beginnings, in large part, to his foresight and energy. He is remembered as a worthy researcher, a witty speaker, a respected supervisor and a kind man.

To characterize the clinical features of ocular toxocariasis and to describe the unique aspects of the disease in Japan.Thirty-six cases diagnosed as ocular toxocariasis at the uveitis clinic of Tokyo Medical University Hospital were analyzed retrospectively.Thirty-six cases comprised 34 adults (average age: 39 +/- 10 years) and two nine-year-old boys. All cases were classified into two clinical types: posterior pole type (13 cases) and peripheral type (23 cases). Visual acuity was maintained over 20/20 in 50% and less than 20/200 in 14% of the cases. The peripheral type had worse outcomes than the posterior pole type in all of the endpoints examined: final visual outcome, frequency of ocular complications, and effectiveness of vitreous surgery. Antibody titers in intraocular fluids led to a diagnosis of ocular toxocariasis in eight seronegative cases of 33 cases examined for antibodies in both serum and intraocular fluid samples.The peripheral type had a worse prognosis than the posterior pole type. However, in general, ocular toxocariasis resulted in fair visual outcomes. The antibody titer in intraocular fluid was helpful in the diagnosis.

The aim of the study was to investigate the characteristics of ocular toxocariasis (OT) presenting with intermediate uveitis in the Korean population. We studied intermediate uveitis patients using ocular and systemic evaluations and a Toxocara IgG serology test. Of 50 intermediate uveitis patients, 19 were seropositive for Toxocara IgG. Of the 19 OT patients, 4 presented with recurrence within 6 months and were significantly younger than nonrecurrence patients (P = 0.009). Thirteen patients had a history of eating raw cow liver. There were 14 males and 5 females in the OT group, and 11 males and 20 females in the non-OT group (P = 0.009). There was bilateral involvement in 7 out of 19 patients in the OT group, and 20 out of 31 patients in non-OT group (P = 0.033). Intermediate uveitis patients in OT were predominately male and had more unilateral presentation than non-OT patients.

La toxocarose oculaire est une parasitose liee a l'infection des tissus oculaires par la larve d'un nematode de la famille des Ascarides: Toxocara canis ou plus rarement Toxocara catis, egalement responsable du syndrome de larva migrans visceral. Cette pathologie transmise par les jeunes animaux est le plus souvent rencontree chez les jeunes enfants. Ils existent trois formes cliniques principales: la pan uveite, le granulome posterieur et le granulome peripherique. Il faut savoir y penser devant tout “foyer chorioretinien blanchâtre a type de granulome“. Le diagnostic de certitude repose sur l’etude immunologique des liquides intraoculaires. Nous rapportons deux cas de toxocarose oculaire a forme de granulome posterieur chez deux enfants seronegatifs pour cette helminthiase.