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Peribulbar triamcinolon acetonide for the management of ocular toxocariasis in a pregnant woman

Poster Details

First Author: A.Dumitrescu ROMANIA

Co Author(s):    A. Dumitrescu   A. Vrapciu   C. Mitulescu   R. Tudosescu   R. Ciuluvica   L. Voinea

Abstract Details

Purpose:

To report a case of a 34-year-old pregnant woman with known eosinophilia who presented in our clinic for sudden vision loss. The patient was diagnosed with ocular toxocariasis and refused antiparasitic therapy because of the side effects on the fetus.

Setting:

Ophthalmology Department of Emergency University Hospital Bucharest

Methods:

A patient with treatment for infertility for 8 years and chronic eosinophilia presented with sudden vision loss, metamorphopsia and ocular pain. BCVA was 20/100 RE and 20/20 LE. Ocular motility, applanation tonometry, exophthalmometry and anterior segment examination were in normal range. Ophthalmoscopy revealed granulomatous inflammation in the interpapilomacular area and retinal oedema. Laboratory tests showed eosinophilia, elevated total IgE and positive toxocara serology (Western Blot). Avidity test for toxocara established that the infection was over 20 weeks old. The teratogenic effect of the antiparasitic therapy determined the patient to refuse it. Topical dexamethasone and peribulbar triamcinolon were administred .

Results:

After peribulbar Triamcinolon acetonide (4 mg/ 0,1 ml) and topical dexamethasone the inflammation was controlled, the granuloma decreased in size and the visual acuity improved to 20/32. No ocular, fetal and systemic side effects were observed. Toxocara is a parasite without vertical transmission and the pregnancy can be continued. The injection was repeated two weeks later. The condition of the patient requires several follow ups in order to monitor the inflammation until child birth. After delivery the patient can be treated with antiparasitic medication but should avoid breastfeeding.

Conclusions:

In many cases, toxocariasis is asymptomatic, with chronic eosinophilia as the only sign. The ocular involvement is unilateral. In ocular toxocariasis combined topical dexamethasone and peribulbar triamcinolon are effective and safe in reducing retinal inflammation when the antiparasitic therapy is contraindicated by the teratogenic and embryocidal effect. NO FINANCIAL DISCLOSURE.

Financial Disclosure:

NONE

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