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February 1998

Surgical Removal of Subretinal Cysticercus

Arch Ophthalmol. 1998;116(2):261. doi:

We would like to remark on the article by Chuck et al,1 which appeared in the April 1997 issue of ARCHIVES. The authors commented that they were faced with the question of adequate treatment for subretinal cysticercosis: killing the organism in situ with drug therapy or removing it surgically. An infection with Taeniaformis crassiceps is rare in humans. A less uncommon presentation of intraocular cysticercosis is that produced by Taenia solium. Although the efficacy of medical treatment for neurocysticercosis caused by T solium has been proved,2 its use in treating ocular cysticercosis has been disappointing. In an experimental animal model of intraocular cysticercosis, using T crassiceps,3,4 we have not observed an adequate response to medical treatment. We, as well as other authors,5 have also observed this inadequate response to medical treatment in some patients with subretinal cysticercosis caused by T solium. It is possible that drugs used for the treatment of neurocysticercosis either do not cross the ocular barriers or penetrate the ocular barriers at nontherapeutic doses. We applaud the authors' decision to remove the organism surgically. In Mexico, where ocular cysticercosis is unfortunately a condition that is still frequently observed, as is the case in other parts of Central and South America, Africa, India, China, eastern Europe, and Indonesia, we prefer to treat this condition by means of surgical removal, using vitreoretinal techniques. It is important to remove the organism while conserving its wall integrity to avoid the release of the intraocular antigen that might be responsible for the severe postoperative inflammatory response often observed. The removal of the posterior hyaloid in all cases of subretinal and intravitreous cysticercosis should also be emphasized; this will prevent the subsequent contraction of the vitreous cortex that frequently produces a postoperative retinal detachment.