A rare case of intraocular communicating cysticercosis : Indian Journal of Ophthalmology

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A rare case of intraocular communicating cysticercosis

Dhevi, R S Keerthhi; Anusha, V; Shanker, M Prabhu; Geetha, G

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Indian Journal of Ophthalmology: August 2020 - Volume 68 - Issue 8 - p 1654-1655
doi: 10.4103/ijo.IJO_1939_19
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A 59-year-old female presented with gradual diminution of vision in the left eye for 3 months associated with pain and redness. The best-corrected visual acuity (BCVA) in the right eye was 20/20 and counting fingers close to face in the left eye. The examination of the right eye was unremarkable. The left eye showed a sluggishly reacting pupil, partial posterior vitreous detachment (PVD) and two well-defined overlapping translucent cysts just below the inferior arcade, the larger one in the retro-hyaloid space demonstrating the typical undulating movement and the smaller one in the sub retinal space harboring the scolex [Fig. 1]. CT brain showed features suggestive of neuro-cysticercosis.

Figure 1:
(a) Fundus photo of the left eye revealing two well defined overlapping translucent cysts, one large in the retro-hyaloid space (b) and one small in the sub retinal space (c) just below the inferior arcade

After obtaining neurologist opinion and initiation of oral steroids, through 25-gauge pars plana vitrectomy, the retro-hyaloid space was entered through the area of partial PVD.[1] The cyst capsule was firmly adherent to the hyaloid, which was gently separated using a soft-tipped cannula when it was still found adherent to the underlying structures. After meticulous dissection, this cyst was found communicating to the sub retinal cyst through the posterior hyaloid [Fig. 2a].[2] Chandelier-assisted bimanual dissection was then performed to open up the 'hyaloid tunnel' [Fig. 2b] that enveloped its connection to the sub retinal component of the cyst, which was subsequently teased out into the vitreous cavity in toto with passive suction revealing its dumbbell shape [Fig. 2c].[3] It was then removed completely with a high-speed vitrectomy cutter. The bed of the cyst with surrounding fibrosis was lasered. At one-week follow up, her BCVA had improved to 20/120 and her retina was attached [Fig. 3]. Anticonvulsant and antiparasitic therapy were initiated.

Figure 2:
(a) Intra operative photo showing the communicating cyst in situ. (b and c) showing the ‘hyaloid tunnel’ (black arrow) and the dumbbell shaped cyst in toto
Figure 3:
(a) Post operative fundus photo at 2 weeks follow up. (b and c) demonstrating the bed of the cyst


Chandelier-assisted bimanual dissection helps achieve meticulous dissection and isolation of the cyst in toto prior to its removal with a high-speed vitreous cutter, thus ensuring its complete removal and good post operative visual recovery.

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Conflicts of interest

There are no conflicts of interest.

1. Gemolotto G. A contribution to surgical treatment of intraocular cysticercosis Arch Ophthalmol. 1955;59:365–8
2. Kumar A, Verma L, Khosla PK, Tewari HK, Jha SN. Communicating intravitreal cysticercosis Ophthalmic Surgery, Lasers and Imaging Retina. 1989;20:424–6
3. Astir S, Shroff DN, Gupta C, Shroff CM, Saha I, Dutta R. Bimanual 25-gauge chandelier technique for direct perfluorocarbon liquid-silicone oil exchange in retinal detachments associated with giant retinal tear Indian J Ophthalmol. 2018;66:1849

Communicating cysticercosis; chandelier assisted vitrectomy; hyaloid tunnel

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