The authors present an interesting case of a middle-aged woman with fundus features consistent with late-stage diffuse unilateral subacute neuroretinitis (DUSN), characterized by decreased vision to hand motions in the right eye and a live nematode larva that was found moving on the retinal surface. Although initial laser photocoagulation was unsuccessful, the authors were able to remove the motile larva by surgically aspirating into a vitreous cutter. DUSN is typically associated with a subretinal motile nematode larva, with migration to the vitreous being exceedingly rare. Treatment consists of direct laser photocoagulation of the organism when possible, or systemic anti-helminthic therapy such as oral albendazole. The particularly unique aspect of this case is the observation of a live, moving larva within the vitreous months after the subretinal insult that resulted in optic and chorioretinal atrophy as well as subretinal fibrosis. Difficulties with laser photocoagulation of this highly motile intravitreal "target" led the surgeons to an elegant transvitreal approach. Key aspects of the surgery include clamping the infusion line to minimize vitreous turbulence and deferring the lifting of the posterior hyaloid before aspiration of the organism. The initial unsuccessful attempt to aspirate the larva with a soft tip cannula from above was followed by successful aspiration from the side with a vitreous cutter attached to a syringe on manual suction. The authors are to be congratulated for their refined and ingenious technique. This is a rare opportunity to surgically address an intravitreal moving larva that may have caused even more intraocular damage if were not removed in a timely manner.
ASJC Scopus subject areas