J Korean Ophthalmol Soc.  2017 Feb;58(2):156-164. 10.3341/jkos.2017.58.2.156.

Clinical Manifestation and Outcomes of Neuroretinitis in Korea

• Jang SG
• Pak KY
• Kwon HJ
• Lee SM
• Park SW
• Byon IS
• Lee JE

• KMID: 2369462
• DOI: http://doi.org/10.3341/jkos.2017.58.2.156

Abstract

PURPOSE
In the present study, the clinical characteristics and outcomes of neuroretinitis in Korea were investigated.
METHODS
Seven consecutive patients with neuroretinitis from 2012 to 2015 were retrospectively reviewed.
RESULTS
The present study included 9 eyes of 7 patients. The subjects consisted of 5 males and 2 females and the mean age was 45.1 ± 13.2 years. Two patients had Influenza-like symptoms and the others had no specific general symptoms. The mean best corrected visual acuity was logMAR 0.48 ± 0.55 (0-1.6) on the initial visit. Four patients 40 years of age or under had no abnormal findings in laboratory work-up. Conversely, 3 patients over 40 years of age were positive for Toxocara based on enzyme-linked immunosorbent assay (ELISA). Two of 3 patients positive for Toxocara were treated with albendazole and 1was not. Eight eyes had good visual recovery over 20/30 except for 1 patient who did not take the albendazole despite being positive for Toxocara detected using ELISA.
CONCLUSIONS
Three of 7 patients with neuroretinitis in Korea showed positive results for Toxocara based on ELISA. In cases with seropositive Toxocara ELISA results, albendazole treatment should be considered.

Keyword

Neuroretinitis; Ocular toxocariasis; Optic neuritis; Toxocara; Toxocariasis

MeSH Terms

Albendazole
Enzyme-Linked Immunosorbent Assay
Female
Humans
Korea*
Male
Optic Neuritis
Retinitis*
Retrospective Studies
Toxocara
Toxocariasis
Visual Acuity
Albendazole

Figure

• 

  Figure 1. Fundus photos of nine patients with neuroretinitis at the initial presentation. Patient 1 had bilateral diffuse optic disc swel-ling with macular edema (A, B). Patient 2 had focal optic disc swelling and stellate hard exudate in the right eye (C). Patient 3 had diffuse optic disc swelling and macular edema in the left eye (D). Patient 4 and 6 had optic disc swelling and stellate hard exudate in the right eyes (E, G). Patient 5 had diffuse optic disc swelling with subfoveal fluid in the right eye (F). Patient 7 had bilateral optic disc swelling and macular edema in consecutive (H, I).

• 

  Figure 2. Clinical manifestation of an old patient with albendazole treatment (patient 1). Fundus photos showed optic disc swelling with macular edema of both eyes in initial visit (A, B). Hyperfluorescence was noticed at optic disc in late phase fluorescein angiog-raphy, and there was no distinct inflammation focus in macula (C, D). Optical coherence tomography showed subretinal fluid in both eyes (E, F). Subretinal fluid and optic disc swelling were disappeared at 2 months after taking Albendazole (G-J).

• 

  Figure 3. Clinical manifestation of an old patient without Albendazole treatment (patient 3). Fundus photos and optical coherence tomography showed optic disc swelling and subretinal fluid (A, B). At 3 months later, optic disc swelling and subretinal fluid dis-appeared (C, D) after intravitreal bevacizumab injection. But best corrected visual acuity was still 0.04 and outer retinal degener-ation was noticed in fundus photo and optical coherence tomography (white arrows).

• 

  Figure 4. Clinical manifestation of a young patient without Toxocara antibody (patient 5). A fundus photo showed optic disc swelling and disc hemorrhage (A). Optical coherence tomography showed subfoveal fluid (C). Subfoveal fluid and optic disc swelling dis-appeared without any treatment at three months later (B, D).

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  Figure 5. Consecutive involving of both eyes in patients 7. Neuroretinitis was not noticed in right eye (A, C) but in left eye (B, D) at the initial visit. At 20 days later, new optic disc swelling stellate hard exudate were noticed in right eye (E) and stellate hard exudate was also observed in left eye (F). Four months later, macular stellate hard exudate and optic disc swelling were gone in the both eyes (G, H).

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