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.
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. 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]. 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]. 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.
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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