Spectral domain optical coherence tomography features of subretinal cysticercus cyst

Abstract

A 31-year-old man of Asian descent presented with loss of vision in his right eye from 6 months earlier. Best corrected visual acuity (BCVA) was limited to light perception in the right eye and was 6/6, N6 in the left one. Slit lamp examination revealed normal anterior segments bilaterally. Intraocular pressure was 8 and 14 mmHg in the right and left eyes, respectively. Fundus examination in the right eye showed a large subretinal cysticercus cyst, accompanied by total retinal detachment (RD), severe extensive subretinal fibrosis and membranes (Fig. 1A). B-scan ultrasound (Alcon Ultrascan, Alcon Laboratories, Fort Worth, Texas, USA) images illustrated total RD with a hyperechoic area within the cystic cavity suggestive of cysticercus scolex (Fig. 1B). Spectral domain optical coherence tomography (OCT) (Topcon 3D OCT-2000, Topcon Medical Systems, Oakland, New Jersey, USA) demonstrated a highly reflective cyst wall and a more hyper-reflective dome-shaped structure within the wall suggestive of the scolex (Fig. 1C). The posterior extent of the cyst could not be visualized due to its large size. T1-weighted contrast-enhanced magnetic resonance imaging (MRI) of the brain demonstrated a ring-shaped enhancing lesion in the left cerebellar hemisphere with perilesional brain edema suggestive of neurocysticercosis (Fig. 1D). The patient was referred to a neurophysician and received a three month course of oral albendazole and steroids. Eventually, he was recommended for follow-up care.

Figure 1

(A) Color fundus photograph of the right eye; note total retinal detachment with subretinal fibrosis and membranes, and a large subretinal cysticercus cyst with scolex. (B) B-scan ultrasound image of the same eye demonstrates total retinal detachment with a hyperechoic lesion within the cystic cavity persisting in low gain suggestive of cysticercus scolex. (C) Spectral domain optical coherence tomography image through the cystic cavity showed a hyper-reflective layer suggestive of cyst wall and a highly reflective dome-shaped structure within the cyst suggestive of scolex. (D) T1-weighted contrast-enhanced magnetic resonance image of the brain revealed a ring shaped enhancing lesion in the left cerebellar hemisphere (arrow).