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To the Editor.
—The clinicopathologic case report by Patrick R. O'Connor, MD, titled "Visceral Larva Migrans of the Eye" that appeared in the November Archives (88:526, 1972) raises several important issues. The author concludes that his patient, who had the clinical characteristics of Coats disease (peripheral retinal telangiectasia and aneurysms with subretinal yellow exudate and serous retinal detachment), actually harbored a toxocara larva. Although this is an intriguing hypothesis, I do not think that the author provides satisfactory histologic evidence that there was a larval infestation. The photomicrograph (Fig 3) showing cholesterol clefts and adjacent chronic inflammatory change is certainly not pathognomonic for a larval granuloma. In fact, this picture looks more like organized hemorrhage or lipid exudate and is frequently seen in Coats disease. Before this case can be accepted as an example of ocular toxocara infection, stricter histological criteria must be met. One would have to demonstrate classic
Bresnick GH. Visceral Larva Migrans. Arch Ophthalmol. 1973;89(5):439–440. doi:10.1001/archopht.1973.01000040441022
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