PMC8497165_01
Clinical picture of the affected eye. Note the hazy cornea, circumciliary congestion, and the worm along with exudates in the inferior angle.
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fig1
On slit-lamp examination, the conjunctiva was found to be congested with circumciliary congestion and hazy cornea (Figure 1).
(a) Worm in the anterior chamber (marked with asterisk *). (b, c) Clear corneal incisions made at 9 and 2 o'clock. (d) Injecting pilocarpine 0.5% intracamerally. (e) Paralyzed worm which has coiled up. (f) Worm removed in toto with the use of a viscoelastic device from 2 o'clock port and expression from 9 o'clock port.
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fig2
After painting and draping, two 2.8 mm clear corneal incisions were made at 9 o'clock and at 2 o'clock positions (Figures 2(a)-2(c)). Pilocarpine nitrate 0.5% was injected into the anterior chamber (Figure 2(d)). Once the worm was observed to be hypomobile, the anterior chamber was injected with viscoelastic surgical device (VSD) from the corneal port created at 2 o'clock to push the worm and the exudates away from the pupil (Figure 2(e)). The port at 9 o'clock was opened using angled plain forceps (Figure 2(f)).
(a) Anterior segment photograph at 4th postoperative week. A large patch of iris pigment can be observed over the pupillary axis over the anterior capsule. Posterior synechia remained from 2 to 7 clock hours. Opacification of the anterior capsule was also present on the central region. Also, note an anterior synechia at 6 o'clock:where the worm was residing presurgically. (b) Fundus photo of the right eye (normal) and the left eye (affected) at 4th week of follow-up. No obvious vitreous or chorioretinal lesions were seen. Note the hazy fundus picture due to media opacity over the anterior lens capsule.
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fig3
Anterior segment examination revealed iris pigmentary patches over the pupillary axis secondary to medical synecholysis and anterior synechiae at 6 o'clock but without inflammation (Figure 3(a)). Due to media opacity, the posterior segment findings looked hazy but retinal and optic disc structures could be appreciated and appeared normal (Figure 3(b)).
Microbiological assessment of the parasite. Note the refractile cuticle with reticular tissue. The subcuticular layer consisted of aggregated subcuticular cells, small myofiber bundles with scolex, two suckers, and birefringent four hooklets.
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fig4
The subcuticular layer consisted of aggregated subcuticular cells, small myofiber bundles with scolex, two suckers, and birefringent four hooklets consistent with Taenia solium (Figure 4).