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Diffuse Unilateral Subacute Neuroretinitis (DUSN)

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Retinal and Choroidal Manifestations of Selected Systemic Diseases

Abstract

Diffuse unilateral subacute neuroretinitis (DUSN) is a usually unilateral inflammatory disease characterized by an insidious, usually severe, loss of peripheral and central vision. Clinical characteristics are manifested in early and late stages. Parasites of different sizes and several species of nematodes have been reported as the etiology of DUSN without conclusive evidence about the specific agent. Because serologic testing has been variable, the definitive diagnosis is made when the clinical characteristics of DUSN are found in conjunction with an intraocular worm. Laser photocoagulation, pars plana vitrectomy, thiabendazole, and albendazole have been used to treat DUSN with variable success.

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References

  1. Gass JD. Subretinal migration of a nematode in a patient with diffuse unilateral subacute neuroretinitis. Arch Ophthalmol. 1996;114:1526–7.

    Article  PubMed  CAS  Google Scholar 

  2. Gass JD, Scelfo R. Diffuse unilateral subacute neuroretinitis. J R Soc Med. 1978;71:95–111.

    PubMed  CAS  Google Scholar 

  3. Gass JD, Gilbert Jr WR, Guerry RK, et al. Diffuse unilateral subacute neuroretinitis. Ophthalmology. 1978;85:521–45.

    PubMed  CAS  Google Scholar 

  4. Gass JD, Braunstein RA. Further observations concerning the diffuse unilateral subacute neuroretinitis syndrome. Arch Ophthalmol. 1983;101:1689–97.

    Article  PubMed  CAS  Google Scholar 

  5. Parsons HE. Nematode chorioretinitis; report of a case, with photographs of a viable worm. AMA Arch Ophthalmol. 1952;47:799–800.

    Article  PubMed  CAS  Google Scholar 

  6. Nussenblatt RB. Onchocercasis and other parasitic diseases. In: Nussenblatt RB, Whitcup SM, editors. Uveitis. Fundamentals and clinical practice. 3rd ed. St. Louis: CV Mosby; 2004. p. 250–63.

    Google Scholar 

  7. de Souza EC, Abujamra S, Nakashima Y, et al. Diffuse bilateral subacute neuroretinitis: first patient with ­documented nematodes in both eyes. Arch Ophthalmol. 1999;117:1349–51.

    PubMed  Google Scholar 

  8. Cortez R, Denny JP, Muci-Mendoza R, et al. Diffuse unilateral subacute neuroretinitis in Venezuela. Ophthalmology. 2005;112:2110–4.

    Article  PubMed  Google Scholar 

  9. Gass JDM. Stereoscopic atlas of macular diseases: diagnosis and treatment, vol. 2. 3rd ed. St. Louis: CV Mosby; 1987. p. 622–8.

    Google Scholar 

  10. Moraes LR, Cialdini AP, Avila MP, et al. Identifying live nematodes in diffuse unilateral subacute neuroretinitis by using the scanning laser ophthalmoscope. Arch Ophthalmol. 2002;120:135–8.

    Article  PubMed  Google Scholar 

  11. Kazacos KR, Raymond LA, Kazacos EA, et al. The raccoon ascarid. A probable cause of human ocular larva migrans. Ophthalmology. 1985;92:1735–44.

    PubMed  CAS  Google Scholar 

  12. Blumenkranz MS, Culbertton WW. Chorioretinal biopsy: description of a technique. In: Ryan SJ, Dawson AK, Little HL, editors. Retinal Diseases. Orlando: Grune & Stratton; 1985. 46.

    Google Scholar 

  13. de Souza EC, Nakashima Y. Diffuse unilateral subacute neuroretinitis. Report of transvitreal surgical removal of a subretinal nematode. Ophthalmology. 1995;102:1183–6.

    PubMed  Google Scholar 

  14. Gass JDM. Stereoscopic atlas of macular diseases: diagnosis and treatment, vol. 2. 3rd ed. St. Louis: CV Mosby; 1987. p. 470–5.

    Google Scholar 

  15. Goldberg MA, Kazacos KR, Boyce WM, et al. Diffuse unilateral subacute neuroretinitis. Morphometric, serologic, and epidemiologic support for Baylisascarisas a causative agent. Ophthalmology. 1993;100:1695–701.

    PubMed  CAS  Google Scholar 

  16. Gass JDM, Olsen KR. Diffuse unilateral subacute neuroretinitis. In: Ryan SJ, Schachat AP, editors. Retina. 3rd ed. St. Louis: CV Mosby; 2001. p. 1669–78.

    Google Scholar 

  17. Searl SS, Moazed K, Albert DM, et al. Ocular toxocariasis presenting as leukocoria in a patient with low ELISA titer to Toxocara canis. Ophthalmology. 1981;88:1302–6.

    PubMed  CAS  Google Scholar 

  18. Wilson M, Schantz P. Nonmorphologic diagnosis of parasitic infections. In: Balows A, editor. Manual of clinical microbiology. 5th ed. Washington, DC: American Society for Microbiology; 1991. 67:723.

    Google Scholar 

  19. Oppenheim S, Rogell G, Peyser R. Diffuse unilateral subacute neuroretinitis. Ann Ophthalmol. 1985;17:336–8.

    PubMed  CAS  Google Scholar 

  20. Kazacos KR, Vestre WA, Kazacos EA, et al. Diffuse unilateral subacute neuroretinitis syndrome: probable cause. Arch Ophthalmol. 1984;102:967–8.

    Article  PubMed  CAS  Google Scholar 

  21. Kazacos KR, Boyce WM. Baylisascarislarva migrans. J Am Vet Med Assoc. 1989;195:894–903.

    PubMed  CAS  Google Scholar 

  22. Kuchle M, Knorr HL, Medenblik-Frysch S, et al. Diffuse unilateral subacute neuroretinitis syndrome in a German most likely caused by the raccoon roundworm, Baylisascaris procyonis. Graefes Arch Clin Exp Ophthalmol. 1993;231:48–51.

    Article  PubMed  CAS  Google Scholar 

  23. Mets MB, Noble AG, Basti S, et al. Eye findings of diffuse unilateral subacute neuroretinitis and multiple choroidal infiltrates associated with neural larva migrans due to Baylisascaris procyonis. Am J Ophthalmol. 2003;135:888–90.

    Article  PubMed  Google Scholar 

  24. McDonald HR, Kazacos KR, Schatz H, et al. Two cases of intraocular infection with Alaria mesocercaria (Trematoda). Am J Ophthalmol. 1994;117:447–55.

    PubMed  CAS  Google Scholar 

  25. Stokkermans TJ. Diffuse unilateral subacute neuroretinitis. Optom Vis Sci. 1999;76:444–54.

    Article  PubMed  CAS  Google Scholar 

  26. Barney NP. Diffuse unilateral subacute neuroretinitis. In: Foster CS, Vitale AT, editors. Diagnosis and treatment of uveitis. 1st ed. Philadelphia: Saunders; 2002. p. 475–9.

    Google Scholar 

  27. Garcia CA, de Oliveira AG, de Lima CE, et al. Retinal nerve fiber layer analysis using GDx in 49 patients with chronic phase DUSN. Arq Bras Oftalmol. 2006;69:631–5.

    Article  PubMed  Google Scholar 

  28. Oréfice F, Bonfioli AA, Paranhos FRL. Neuroretinite subaguda unilateral difusa. In: Oréfice F, editor. Uveíte: Clinica e Cirúrgica. Rio de Janeiro: Cultura Médica; 1998. p. 733–56.

    Google Scholar 

  29. Vianna RN, Onofre G, Ecard V, et al. Indocyanine green angiography in diffuse unilateral subacute neuroretinitis. Eye. 2006;20:1113–6.

    Article  PubMed  CAS  Google Scholar 

  30. Sabrosa NA, de Souza EC. Nematode infections of the eye: toxocariasis and diffuse unilateral subacute neuroretinitis. Curr Opin Ophthalmol. 2001;12:450–4.

    Article  PubMed  CAS  Google Scholar 

  31. Martidis A, Greenberg PB, Rogers AH, et al. Multifocal electroretinography response after laser photocoagulation of a subretinal nematode. Am J Ophthalmol. 2002;133:417–9.

    Article  PubMed  Google Scholar 

  32. Gomes AH, Garcia CA, Segundo Pde S, et al. Optic coherence tomography in a patient with diffuse unilateral subacute neuroretinitis. Arq Bras Oftalmol. 2009;72:185–8.

    Article  PubMed  Google Scholar 

  33. Garcia CA, Gomes AH, Garcia Filho CA, et al. Early-stage diffuse unilateral subacute neuroretinitis: improvement of vision after photocoagulation of the worm. Eye. 2004;18:624–7.

    Article  PubMed  Google Scholar 

  34. Garcia CA, Gomes AH, Vianna RN, et al. Late-stage diffuse unilateral subacute neuroretinitis: photocoagulation of the worm does not improve the visual acuity of affected patients. Int Ophthalmol. 2005;26:39–42.

    Article  PubMed  Google Scholar 

  35. McDonald HR. Diagnostic and therapeutic challenges. Diffuse unilateral subacute neuroretinitis. Retina. 2003;23:92–6.

    Article  PubMed  Google Scholar 

  36. Souza EC, Casella AM, Nakashima Y, et al. Clinical features and outcomes of patients with diffuse unilateral subacute neuroretinitis treated with oral albendazole. Am J Ophthalmol. 2005;140:437–45.

    Article  PubMed  CAS  Google Scholar 

  37. Meyer-Riemann W, Petersen J, Vogel M. An attempt to extract an intraretinal nematode located in the papillomacular bundle. Klin Monatsbl Augenheilkd. 1999;214:116–9.

    Article  PubMed  CAS  Google Scholar 

  38. Myint K, Sahay R, Mon S, et al. “Worm in the eye”: the rationale for treatment of DUSN in south India. Br J Ophthalmol. 2006;90:1125–7.

    Article  PubMed  CAS  Google Scholar 

  39. Schatz H, McDonald HR, Johnson R. Diagnostic and therapeutic challenges. Retina. 1997;17:440–3.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgment

Supported in part by the Arévalo-Coutinho Foundation for Research in Ophthalmology (FACO), Caracas, Venezuela.

Author information

Authors and Affiliations

  1. Vitreoretinal Division, The King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia

    J. Fernando Arévalo M.D., F.A.C.S. (Chief)

  2. Wilmer Eye Institute, The Johns Hopkins University, Baltimore, MD, USA

    J. Fernando Arévalo M.D., F.A.C.S. (Professor of Ophthalmology)

  3. Retina and Vitreous Department, Clínica Oftalmológica El Viñedo, Av. Andres Eloy Blanco con calle 139. El Viñedo, Valencia, Carabobo, 2001, Venezuela

    Reinaldo A. Garcia M.D.

  4. Vitreoretinal Service, Clínica Oftalmológica El Viñedo, Av. Andrés E. Blanco c/calle 13, Valencia, Carabobo, 2010, Venezuela

    Luis Suarez Tata M.D.

  5. Department of Ophthalmology, Federal University of Rio Grande de Norte, Rua Ceara Mirim 316, Tirol, Natal, Rio Grande do Norte, 590202-240, Brazil

    Carlos Alexandre de Amorim Garcia M.D., Ph.D.

  6. Department of Oftalmologia, Hospital São Geraldo, HC/UFMG, Rua Espirito Santo 1634/102 CEP 30160-031, Belo Horizonte, Minas Gerais, 30160-031, Brazil

    Fernando Orefice

  7. Fundação Oswaldo Cruz - Fiocruz, Instituto de Pesquisa Clínica Evandro Chagas – IPEC, Centro Hospitalar, Av. Brazil 4365 Manguinhos, Rio de Janeiro, 21040900, Brazil

    Andre Luiz Land Curi M.D., Ph.D.

  8. The Uveitis Service, Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA

    Emmett T. Cunningham Jr. M.D., Ph.D., M.P.H.

Authors
  1. J. Fernando Arévalo M.D., F.A.C.S.
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  2. J. Fernando Arévalo M.D., F.A.C.S.
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  3. Reinaldo A. Garcia M.D.
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  4. Luis Suarez Tata M.D.
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  5. Carlos Alexandre de Amorim Garcia M.D., Ph.D.
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  6. Fernando Orefice
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  7. Andre Luiz Land Curi M.D., Ph.D.
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  8. Emmett T. Cunningham Jr. M.D., Ph.D., M.P.H.
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Corresponding author

Correspondence to J. Fernando Arévalo M.D., F.A.C.S. .

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Editors and Affiliations

  1. Johns Hopkins University, School of Medicine, The Retina Division,Wilmer Eye Institute, Al-Oruba Street, PO Box 7191, Riyadh, 1010, Saudi Arabia

    J. Fernando Arévalo

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Arévalo, J.F. et al. (2013). Diffuse Unilateral Subacute Neuroretinitis (DUSN). In: Arévalo, J. (eds) Retinal and Choroidal Manifestations of Selected Systemic Diseases. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3646-1_2

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  • DOI: https://doi.org/10.1007/978-1-4614-3646-1_2

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