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. 2023 Aug;37(11):2299-2304.
doi: 10.1038/s41433-022-02336-4. Epub 2022 Dec 7.

Management of presumed trematode-induced granulomatous intermediate uveitis

Rana Hussein Amin  1 , Abdussalam Mohsen Abdullatif  2
Affiliations

Management of presumed trematode-induced granulomatous intermediate uveitis

Rana Hussein Amin et al. Eye (Lond). 2023 Aug.

Abstract

Purpose: To describe the surgical management of presumed trematode-induced granulomatous intermediate uveitis (PTIGIU) not responding to medical treatment in controlling the inflammation.

Methods: A prospective, interventional, single-center study in which patients with a history of fresh canal water contact and PTIGIU were enrolled. All patients underwent lensectomy-pars plana vitrectomy (PPV) and post-operative control of inflammation, functional and anatomical outcomes were assessed.

Results: Fifteen eyes of 12 patients were included in the study with median age of 11.6 ± 4 yrs. Six months following lensectomy-PPV, inflammation was well controlled in all patients. The eyes were divided into two groups: Group A: 10 patients with an attached retina while Group B: 5 patients who were in the cicatricial stage with tractional retinal detachment. All patients in group A had CDVA of 20/40 or better, unlike patients in group B who failed to achieve a CDVA better than 20/70 throughout their follow-up. In group B, final anatomical success was achieved in only 40% with hypotony occurring in 20%.

Conclusion: PTIGIU is associated with the presence of ciliary body granuloma which, if left untreated, can lead to drastic outcomes. Early lensectomy-PPV represents a viable management option in cases resistant to medical treatment, with a favorable outcome.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Intraoperative picture during the vitrectomy procedure.
A With scleral indentation at the site of ciliary body granuloma showing the latter behind the partially cataractous lens. B During debulking of the ciliary body granuloma using the vitrectomy probe after pars plana lensectomy with preservation of capsular rim for secondary implantation. Iris hooks help improve visualization in poorly dilatable pupils.
Fig. 2
Fig. 2. Anterior segment photo and ultrasound biomicroscopy revealing.
Anterior segment photo showing A Temporal localized cataract (black arrow) corresponding to the site of ciliary body granuloma in a patient with previously healed anterior chamber granuloma (red arrow). B Total lens opacity with localized forward iris bulge (yellow arrow) corresponding to the site of ciliary body granuloma. Ultrasound biomicroscopy revealing C homogenous lesion with medium-reflectivity (ciliary body granuloma) restricted to ciliary body measuring ~1.78 mm thick, D ciliary body granuloma extending in front of the lens and pushing the iris forwards, E healed ciliary body granuloma, 3 months following PPV.
Fig. 3
Fig. 3
Intraoperative fundus photo of a patient in Group B showing tractional retinal detachment, inferior retinal fold, and subretinal bands extending to the optic disc.
See this image and copyright information in PMC

References

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