Subretinal Angiostrongyliasis: A Case Report

PURPOSE: To report the patient with subretinal Angiostrongylus larva. METHODS: Retrospective, observational case report. RESULTS: A 47-year-old Thai woman had eosinophilic meningitis. One week after the onset of a headache, blurred vision developed in her right eye. Ocular examination of the right eye showed Angiostrongylus larva in the subretinal space in the inferotemporal quadrant and macular edema. Although serum analysis for Angiostrongylus was negative, the larva can be identified by its characteristic appearance. Blood eosinophilia and cerebrospinal fluid eosinophilia were presented. Focal laser photocoagulation was applied to the retina, and the patient also received anti-helminthic and oral corticosteroid drugs. The vision did not recover. Ultimately, the retina became atrophic. The dead larva remained at the same site at which it was observed. No further larval migration occurred after treatment. CONCLUSION: Angiostrongylus larva can damage the retinal layer despite its eradication and no further migration. After its death, the inflammation persisted either as the result of toxin secretion or an immune responsiveness. Administration of local anti-inflammatory drugs such as corticosteroids or any anti-vascular endothelial growth factor injection should be considered.