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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 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...

To study the frequency of ocular lesions in 30 gerbils infected with 100 embryonated eggs of Toxocara canis, indirect binocular ophthalmoscopy was performed 3, 10, 17, 24, 31 and 38 days after infection. All the animals presented larvae in the tissues and 80% presented ocular lesions. Hemorrhagic foci in the choroid and retina were present in 92% of the animals with ocular lesions. Retinal exudative lesions, vitreous lesions, vasculitis and retinal detachment were less frequent. Mobile larvae or larval tracks were observed in four (13.3%) animals. Histological examination confirmed the ophthalmoscopic observations, showing that the lesions were focal and sparse. In one animal, there was a larva in the retina, without inflammatory reaction around it. The results demonstrated that gerbils presented frequent ocular lesions after infection with Toxocara canis, even when infected with a small number of embryonated eggs. The lesions observed were focal, consisting mainly of hemorrhages with signs of reabsorption or inflammation in different segments of eye, and differing from the granulomatous lesions described in ocular larva migrans in humans.

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.

Ocular nematodal infections typically affect children. This article demonstrates the utility of enzyme-linked immunosorbent assay (ELISA) testing of the aqueous humor and vitreous to aid the diagnosis of ocular toxocariasis in adults. A 62-year-old woman presented with a 2-year history of worsening vision in her left eye. Examination of the fundus revealed tractional membranes over the optic nerve and nasal retina. Serologic evaluation was unrevealing. The patient was referred to the Bascom Palmer Eye Institute for an anterior chamber ELISA, which was positive for Toxocara . A vitrectomy and scleral buckling procedure was performed. The patient achieved anatomic success after surgery, but her visual acuity in the left eye remained hand motions. This case highlights the importance and utility of ELISA testing of the anterior chamber fluid and/or vitreous aspirate for ocular toxocarasis. This patient is among the oldest described to have active ocular toxocariasis.

Os autores descrevem um caso no qual o diagnóstico inicial, clínico e laboratorial, era compatível com quadro de toxocaríase ocular. Porém a evolução clínica somada a realização de exame histopatológico revelou diagnóstico diferente, demonstrando à importância do exame histopatológico, principalmente nos quadros em que o diagnóstico é presumido. The Authors describe a case where the initial diagnosis, clinical and laboratorial, was compatible with ocular toxocariasis. Therefore the follow-up added to a histopathologic examination disclosed a different diagnosis, proving the importance of the histopathologic examination, mainly in presumable diagnostics. Universidade Federal de São Paulo (UNIFESP) Universidade Federal do Rio de Janeiro UNIFESP, EPM SciELO

Parasitic infections cause significant ophthalmic disease, both in developing countries and in the Western world. The parasitic infections Acanthamoeba keratitis, ocular toxoplasmosis, and ocular toxocariasis are responsible for a significant proportion of ocular pathology. Especially in light of the recent increase of immunocompromised (i.e. using immunosuppressants or HIV) and aged populations, parasitic infections of the eye are rising in number. This reviews aims to describe the pathogenesis, symptoms, diagnosis and management of infection, as well as preventative measures for these three parasitic ocular diseases.

Purpose TO evaluate the anatomic and functional outcome after surgery in patients with complicated ocular toxocariasis. Methods A retrospective review of the medical records of pediatric patients who underwent a surgical procedure for ocular toxocariasis from July 1990 to January 2005. Patients with postoperative follow-up shorter than 6 months were excluded from the study. Best-corrected visual acuity (BCVA) was arbitrarily divided into 5 groups: 1) no light perception (NLP); 2) light perception (LP) and hand motion (HM); 3) finger counting (FC) to 20/400; 4) 20/300 to 20/60; and 5) 20/50 to 20/20. Results Forty-five patients with a mean age of 8.1 years (range 6–10) were included in the study. The ocular toxocariasis presentation most commonly encountered was peripheral granuloma (38%). Twenty-one eyes presented with BCVA in the LP/HM group, 18 (40%) eyes in the FC to 20/400 group, 5 (12%) eyes in the 20/300 to 20/60 group, and 1 (5%) eye in the 20/50 to 20/20 group. The most common surgical procedure was pars plana vitrectomy (PPV) in 58% of the eyes. Four eyes (9%) presented with postoperative BCVA of NLP, 2 eyes (4%) in the LP/HM group, 12 eyes (27%) in the FC to 20/400 group, 19 eyes (42%) in the 20/300 to 20/60 group, and 8 eyes (18%) in the 20/50 to 20/20 group. Conclusions Surgical treatment of severe ocular complications secondary to toxocara infections results in satisfactory anatomic results and may improve the overall visual outcome of these patients.

To analyze the characteristics and clinical manifestations of clinically diagnosed and serologically confirmed ocular toxocariasis in patients.Thirty-three eyes of 33 patients diagnosed as having ocular toxocariasis at the Hallym University Medical Center between January 1999 and December 2008 were included in the study. The diagnosis of ocular toxocariasis was based on clinical features and confirmed serologically by enzyme-linked immunosorbent assay and immunoblotting. All patients were interviewed by using a structured questionnaire that included risk factors that might account for the introduction of Toxocara larvae. Demographics, social characteristics determined from the questionnaire, and clinical features were evaluated.A total of 33 eyes of 33 patients were enrolled in this study: 24 (73%) patients were men, and mean patient age was 41.6 ± 11.0 years. Ten of 28 patients (36%) who responded to the questionnaire had a history of contact with pets, and 23 (82%) had a history of consuming raw food. The most common symptoms were blurred vision in 22 eyes (67%) and floaters in six eyes (18%). The toxocariasis was unilateral in all patients, and the inflammation was acute in two-thirds of the patients. In 17 eyes (52%), Toxocara granuloma was found in the peripheral retina. Nineteen eyes (58%) had visual acuity of 20/40 or better at presentation and improved significantly after treatment. Final visual acuity was 20/40 or better in 26 eyes (79%).Ocular toxocariasis in Korea usually affects young adults to middle-aged men. The clinical manifestation is unilateral and presents as acute inflammation with a peripheral inflammatory mass. Visual prognosis with appropriate treatment is good.

To study the frequency of ocular lesions in 30 gerbils infected with 100 embryonated eggs of Toxocara canis, indirect binocular ophthalmoscopy was performed 3, 10, 17, 24, 31 and 38 days after infection. All the animals presented larvae in the tissues and 80% presented ocular lesions. Hemorrhagic foci in the choroid and retina were present in 92% of the animals with ocular lesions. Retinal exudative lesions, vitreous lesions, vasculitis and retinal detachment were less frequent. Mobile larvae or larval tracks were observed in four (13.3%) animals. Histological examination confirmed the ophthalmoscopic observations, showing that the lesions were focal and sparse. In one animal, there was a larva in the retina, without inflammatory reaction around it. The results demonstrated that gerbils presented frequent ocular lesions after infection with Toxocara canis, even when infected with a small number of embryonated eggs. The lesions observed were focal, consisting mainly of hemorrhages with signs of reabsorption or inflammation in different segments of eye, and differing from the granulomatous lesions described in ocular larva migrans in humans. Para verificar a freqüência de lesões oculares em 30 gerbils infectados com 100 ovos larvados de Toxocara canis foi realizada a oftalmoscopia binocular indireta nos dias 3, 10, 17, 24, 31 e 38 após a infecção.Todos os animais apresentavam larvas nos tecidos e 80% apresentavam lesões oculares, dos quais 92% tinham lesões hemorrágicas focais na coróide e na retina. Lesões exudativas da retina, lesões do vítreo, vasculite e descolamento da retina foram menos freqüentes. Larva móvel ou traços de larva em quatro (13,3%) animais. O estudo histológico confirmou as observações da oftalmoscopia, mostrando que as lesões eram focais e esparsas. Em um animal havia uma larva na retina, sem reação inflamatória em torno dela. Os resultados demonstraram que os gerbils apresentam freqüentes lesões oculares após infecção com o Toxocara canis mesmo quando infectados com pequeno número de ovos larvados. As lesões observadas eram focais, principalmente focos de hemorragia com sinais de reabsorção ou focos de inflamação nos diferentes segmentos do olho, diferentes das lesões granulomatosas descritas na larva migrans ocular humana.

espanolCaso clinico: Paciente de 7 anos diagnosticado de toxocariasis ocular. El fondo de ojo mostraba una vitritis que no permitia ver la retina. Se instauro tratamiento con corticoides, evolucionando favorablemente, pero existia un granuloma papilar y periferico que levantaba la macula por lo que se realizo una vitrectomia consiguiendose la estabilizacion del proceso. Discusion: La Toxocariasis ocular es rara en los paises desarrollados. El diagnostico esta basado en el aspecto oftalmoscopico, la serologia y la Ig G + en vitreo. En cuanto al tratamiento sigue siendo controvertido el uso de antihelminticos y aceptado el uso de corticoides y la vitrectomia. EnglishCase report: We present the case of a seven-year-old male with ocular toxocariasis. The fundus of the eye showed a vitritis, as a result of which the retina could not be seen. Following treatment with systemic corticosteroids the condition evolved favorably. However, due to a papillary and peripheral granuloma that raised the macula, a vitrectomy was performed which stabilized the process. Discussion: Ocular toxocariasis is not common in developed countries. The diagnosis is based on funduscopic aspects, serology and IgG positivity of the vitreous. In relation to treatment, as the use of anthelminthics therapy is controversial, the use of corticosteroids and vitrectomy is recommended.

We report a case of peripheral Toxocara granuloma in a young boy of 17. Of the 3 forms of ocular toxocariasis, macular granuloma, endophthalmitis and peripheral granuloma, the latter is the least common and is characterized by the retention of relatively good vision. A differential diagnosis was performed between an intraocular foreign body encapsulated in fibroglial tissue, toxoplasmic retinochoroiditis, retinoblastoma, intermediate uveitis and toxocariasis. Fluorescein angiography showed not only some neovascularizations at the level of the peripheral granuloma but also manifestations of inflammatory reactions at the level of the posterior pole, i.e. diffuse leakages from retinal capillaries and parietal staining of some venous segments. Among the various laboratory tests, the most significant are eosinophilia, IgE concentration and detection of specific antibodies in serum as well as in aqueous humour.

Objetivo: Caracterizar las posibles alteraciones histológicas en el globo ocular de ratones infectados masivamente con Toxocara canis, durante los estadios agudos y crónicos de la infección. Método: Se realizó un estudio experimental, prospectivo in vivo, con globos oculares derechos e izquierdos correspondientes a cinco grupos de cuatro ratones cada uno (dos blancos (A/J) y dos negros (C57/BL) infectados por vía endovenosa con 1.000 huevos embrionados de Toxocara canis. Los ratones fueron sacrificados de forma secuencial post infección (3-180 días), se realizó microscópica convencional e histopatología fotografiadas. Resultados: Todos los ratones mostraron algún grado de daño ocular en uno o ambos ojos. La retina era la capa más afectada con edema, hemorragia y cambios degenerativos severos. Otras alteraciones incluyeron reacción inflamatoria de la córnea, obliteración de la cámara anterior con material fibrinoide, asimismo, se evidenció cambios en la histología normal de la uvea y del cristalino. En dos ojos de ratones se encontraron segmentos de larva en la retina, sin reacción inflamatoria alrededor de ellos. Conclusión: La mayoría de las alteraciones no se relacionó a la presencia de formas larvarias, sugiriendo que sean debido al efecto de productos de excreción-secreción durante la infección. Objective: To characterize the histologic alterations in the ocular globe of mice infected with eggs of Toxocara canis, during both the acute and chronic stages of the infection. Method: Performance of an experimental, prospective study in vivo, with right and left ocular globes [using 5 groups of 4 mice in each study; 2 white (A/J) and 2 black (C57/BL)], infected by the intravenous injection of 1000 embrionated Toxocara canis eggs. The mice were sacrificed sequentially post infection (3-180 days), the eyes evaluated by conventional microscopic techniques and the histopathology findings recorded. Results: All the mice revealed some degree of ocular damage in one or both eyes. The retina was the most affected layer with edema, hemorrhage and severe degenerative changes seen. Other alterations included inflammation of the cornea, and obliteration of the anterior chamber with fibrinoid material. We also demonstrated changes in the normal histology of the uvea and lens. In only two eyes were segments of larvae found in the retina, and in each instance there was no evidence of an inflammatory reaction around them. Conclusion: Most of the changes seen were not related to the presence of larval forms, suggesting they were due to the effect of excretion-secretion products during the infective phase.

Summary The report describes the case of an adult patient presenting a severe, serologically proven, Toxocara endophthalmitis, unresponsive to the common surgical and medical approach (vitrectomy, anti-parasitic treatment followed by high-dose corticosteroids). The association of oral cyclosporin A to a lower dose of prednisone was successful in achieving a long-term control of the ocular inflammation without systemic side effects.

Ocular toxocariasis named also ocular larva migrans is caused by larvae of the roundworm Toxocara spp. The purpose of this study was to find out the seroprevalence of Toxocara antibodies in patients suspected of ocular toxocariasis. Between January 2001 and December 2003, sera from 239 ocular patients, aged 3 to 80 years, were examined by ELISA and confirmed by Western blot test. Out of the 239 patients, 172 (72%) were seronegative and 67 (28%) were Toxocara seropositive; 95% CI (22-34%). The median age of Toxocara seropositive patients was 37.6 years. There was no significant difference in the number of Toxocara positive sera between the younger age group (or = 14 years) and the older age group (14 years), p0.05. A high rate of Toxocara seropositivity in ocular patients should alert the ophthalmologists in Slovenia to include toxocariasis in the differential diagnosis of eye diseases more frequently.

The objective of this study is to estimate the prevalence of Ocular Toxocariasis, Diffuse Unilateral Subacute Neuroretinitis (DUSN), Toxoplasma gondii infection and Ocular Toxoplasmosis in a student population in Natal-RN/Brazil and relate it to demographic, epidemiologic and socio-economic risk factors. The incidence of DUSN was observed in patients at the Federal University of Rio Grande do Norte Ophthalmology Service and the Prontoclinica de Olhos Ophthalmology clinic in Natal. In cases where a worm was found in the subretinal space, the result of treatment with photocoagulation using Green Laser (Eye Light ALCON) was evaluated in relation to final visual result. The sample was randomly selected among the schools of the four districts of Natal, according to the type of institution (public or private), its level (elementary or secondary), and study period (morning, afternoon or evening). The school population was studied from March to May, 2001. Initially, the students answered a questionnaire to evaluate demographic, epidemiologic and socio-economic risk factors. Afterwards, the following procedures were carried out: blood samples were taken for Toxoplasmosis (IgG, IgM) serology, hemogram, ophthalmological examination, consisting of clinical history, measurement of visual acuity, refraction under cycloplegia, biomicroscopy of the anterior segment and annexa, funduscopy and examination of extrinsic motility. The prevalence of Toxocariasis was 0.2% or 2 per one thousand students. The sample was insufficient to estimate the prevalence of DUSN. Seventy patients with DUSN diagnosis were examined from January, 2001 to January, 2003. A live worm was found in the subretinal space of all four patients in the acute phase, and these were treated with laser photocoagulation. After follow-up (average = 11.5 months), visual acuity improved in three eyes and remained unaltered in one eye. Worms were found in 22 of the 66 patients in the chronic phase, and these also were treated with laser photocoagulation. After a follow-up period of 13.1 months, on average, visual acuity improved in two of the patients, remained unchanged in 19 and worsened in one. The comparison of visual result before and after treatment was not statistically significant (p = 0.302). The diagnosis of DUSN in the acute phase, followed by prompt localization and destruction of the worm by photocoagulation, can improve the patient s vision. However, destruction of the worm by laser photocoagulation in eyes with DUSN in the chronic phase does not improve visual acuity. Seroprevalence for IgG was 46% (Confidence Interval CI 95%-42.9-49.2%) and for IgM it was 1.4% (CI 95% = 0.8-2.4%). The prevalence of ocular lesion was 1.15% (CI 95% = 0.6 - 2.0%). Socio-economic conditions were determinants in the prevalence of Systemic and Ocular Toxoplasmosis in the bivaried analysis and confirmed in the multivaried analysis (mother s scholarity illiterate/ OR = 2.9 and p < 0.001). The T. gondii infection prevalence, although high, was less than that found in studies performed in the South and Southeast of Brazil and that of Ocular Toxoplasmosis was completely discrepant, varying from 5 to 17 times less. Although important epidemiological variables such as owning a cat, drinking unfiltered water, and coming into contact with rivers or lakes showed an association in the preliminary analysis, they lost their influence when included in the logistic model. Future studies are scheduled to begin in March, 2004, in collaboration with other Brazilian and American universities in an attempt to discover the reason for these findings, as well as identifying the different strains of Toxoplasma gondii, and studying the sources of water utilized by the population of Natal Brazil Esta pesquisa teve como objetivo, estimar a prevalência da Toxocaríase Ocular, Neuroretininte Sub-aguda Difusa Unilateral (DUSN), Infecção pelo Toxoplasma gondii e Toxoplasmose Ocular na população de escolares de Natal-RN/Brasil e relacioná-la aos fatores de risco demográficos, epidemiológicos e socioeconômicos. Estudar a incidência de DUSN em pacientes atendidos no Serviço de Oftalmologia da Universidade Federal do Rio Grande do Norte e Prontoclinica de Olhos, em Natal, bem como, avaliar, nos casos em que foi encontrada larva no espaço sub-retiniano, o resultado do tratamento com fotocoagulação utilizando o Laser Verde (Eye Light ALCON) em relação ao resultado visual. A amostra foi selecionada aleatoriamente e distribuída nas escolas dos quatro distritos da cidade de Natal de acordo com a natureza da instituição (pública ou privada), seu nível (fundamental ou médio) e turno em que o escolar estudava (matutino, vespertino ou noturno). A população de escolares foi estudada no período de março a maio de 2001. Inicialmente, responderam a um questionário para avaliação de fatores de risco demográfico, epidemiológico e socioeconômico. Depois foram feitos os seguintes procedimentos: coleta de sangue para realização de sorologia para Toxoplasmose (IgG, IgM), hemograma, exame oftalmológico constando de história clínica, medida da acuidade visual, refração sob cicloplegia, biomicroscopia do segmento anterior e anexos, fundoscopia e exame da motilidade extrínseca. A prevalência de Toxocaríase foi de 0,2% ou 2 por mil escolares. A amostra não foi suficiente para estimar a prevalência de DUSN. Foram examinados 70 pacientes com diagnóstico de DUSN, no período de janeiro de 2001 a janeiro de 2003. Foi encontrada larva viva no espaço sub-retiniano de todos os quatro que se encontravam na fase aguda, e tratados com fotocoagulação a laser. Após acompanhamento dos pacientes (média = 11,5 meses), a acuidade visual melhorou em três olhos e permaneceu inalterada em um olho. Dos 66 pacientes na fase crônica, foi encontrada larva em 22 deles e tratados com fotocoagulação a laser. Após acompanhamento por um período de 13,1 meses em média, a acuidade visual melhorou em dois, permaneceu a inicial em 19 e diminuiu em um paciente. A comparação do resultado visual antes e após o tratamento, não foi estatisticamente significante (p = 0,302). O diagnóstico de DUSN na fase aguda, seguida por pronta localização e destruição da larva por fotocoagulação, pode melhorar a visão dos pacientes. No entanto, a destruição da larva por fotocoagulação a laser em olhos com DUSN, na fase crônica, não melhora a acuidade visual. A soroprevalência para IgG foi de 46% (Intervalo de Confiança -IC 95% - 42,9-49,2%) e para IgM foi 1,4% (IC 95% = 0,8-2,4%). A prevalência de lesão ocular foi 1,15% (IC 95% = 0,6 2,0%). As condições socioeconômicas foram determinantes na prevalência da Infecção pelo T. gondii e Toxoplasmose Ocular na análise bivariada e confirmada na análise multivariada (escolaridade da mãe não alfabetizada/OR = 2,9 e p< 0,001). A prevalência de Toxoplasmose Sistêmica, embora elevada, foi menor do que a encontrada em estudos realizados no Sul e Sudeste do Brasil e, a da Toxoplasmose Ocular foi totalmente discrepante, variando de 5 a 17 vezes menos. Embora importantes variáveis epidemiológicas, tais como possuir gato, beber água não filtrada, ter contato com lagoas ou rios, tenham mostrado associação na análise preliminar, perderam sua influência quando incluídas no modelo logístico. Estudos futuros já estão planejados para ter inicio em março próximo, em colaboração com outras Universidades do Brasil e dos Estados Unidos com a finalidade de encontrar a razão destes achados, bem como, identificar diferentes tipos de cepas do Toxoplasma gondii, e estudar as fontes de água utilizadas pela população de Natal-RN

In La Reunion island (Indian Ocean) a seroepidemiological survey for toxocariasis was carried out among 387 subjects over 15 years old by Western blotting using Toxocara canis excretory-secretory larval antigens; 92·8% of the sera were positive. Statistical study, including logistic regression analysis, showed a significant correlation of Western blot results with sex, age, and absence of water supply. The final logistic model demonstrated that only the last 2 factors were significant multiplicative rish factors for toxocariasis. Sex was an independent rish factor. With this level of infection, we suggest that further surveys of ocular toxocariasis in children and teenagers of La Reunion would be advisable.

Ocular toxocariasis is prevalent among children. The symptoms and signs may mimic other ocular pathologies such as malignancies and other infectious diseases (such as toxoplasmosis and syphilis). We presented a case of progressive blurring of vision in a single eye of a 9-year-old boy. The presence of anti-toxocara antibody in serum samples helps to confirmation the diagnosis in our patient. Despite of treatment, the boy had lost his vision on the affected eye.

Intravitreal Ranibizumab in the treatment of choroidal neovascularisation secondary to ocular toxocariasis in a 13-year-old boy

This is a case of presumed ocular toxocariasis in a 28-year old woman complaining of a sudden onset of nasal side field defect of the right eye. The patient had been suffering from uveitis for ten months. Fundoscopic examination of the right eye showed a rhegmatogenous retinal detachment. Furthermore, a retinochoroidal granulomatous lesion was observed nearby the tear site. Scleral buckling, cryotherapy, and gas injection(SF6, pure gas, 0.7 cc) were conducted. Mebendazole was prescribed for one month at 25 mg/kg per body weight daily. Even though the interventions resulted in the recovery of the field defect, anti-Toxocara IgG and IgE titer levels did not decrease when checked three months after the treatment ended. This is the first confirmed serological ocular toxocariasis case in Korea. Uveitis may be a clinical presentation prior to retinal detachment of a person with toxocariasis.

Of 500 consecutive patients referred to the Ocular Oncology Service at Wills Eye Hospital with the diagnosis of possible retinoblastoma, 288 (58%) were found on clinical evaluation to have retinoblastoma and 212 (42%) had lesions that simulated retinoblastoma. A total of 23 different conditions accounted for the 212 pseudoretinoblastomas. Three most common pseudoreti noblastomas were: persistent hyperplastic primary vitreous (28%), Coats' disease (16%), and presumed ocular toxocariasis (16%). Congenital cataract and retinopathy of prematurity accounted for a much lower percent of pseudoretinoblastomas in this series as compared to a previously reported series. The pertinent clinical features that serve to differentiate these simulating lesions from retinoblastoma are reviewed.

Article, CANADIAN JOURNAL OF OPHTHALMOLOGY-JOURNAL CANADIEN D OPHTALMOLOGIE. 42(5): 758-759 (2007)

Toxocariasis is an important zoonotic disease caused by the second stage larva of Toxocara canis or Toxocara cati . The typical clinical syndromes of toxocariasis in humans are visceral and ocular toxocariasis. Ocular toxocariasis may presents as peripheral inflammatory mass, posterior pole granuloma and endophthalmitis. We report a serologically confirmed case of ocular toxocariasis in 12-year-old female. The diagnosis was confirmed by detection of anti- Toxocara antibodies in aqueous and vitreous sample by enzyme-linked immunosorbent assay. We suggest that ophthalmologist in this region should include ocular toxocariasis in differential diagnosis particularly in children and young adults.