Subrenal Filaria with Macular Hole: A Rare Case

Abstract

Introduction: In Indonesia, parasitic infection of the eye is rarely reported, however it can cause blindness. A parasitic disease affecting whole part of eye include retinal layers unilaterally or bilaterally. Onchocercia volvulus, Loa-loa, Brugia malayi and Wuchereria bancrofti have been reported as specific species which can infect retina. The organism can survive up to 4 years in the subretinal space. Objective: To report a rare case of a subretinal worm infection and its management. Case Presentation: A 35-year-old male complaint a sudden loss of vision and felt that something moving within his left eye. He had scotoma and BCVA dropped to 1/60. The anterior segment was normal. Indirect ophthalmoscopy revealed a living worm around the macula and a macular hole. Peripheral retina seen as grayish-white lesion. Pars plana vitrectomy were performed with laser photocoagulation to inactivate the worm. 6 mm worm were evacuated through iatrogenic retinectomy in inferior macula. Continued with ILM peeling and gas tamponade for the macular hole. The parasitologist identified an adult filarial worm and suggested for nocturnal blood smear analysis. Infectious disease specialist suggested diethylcarbamazine citrate (DEC) 6 mg/kg body weight for 28 week. Conclusion: Adult filarial worm in subretinal space can cause severe damage and macular hole by worm motility. However, rapid and right management is the primary choice to inhibit this damage and to detect the species.