Clinical experience in treatment of diffuse unilateral subretinal neuroretinitis

Figures & data

Figure 1 Fundus pictures of the left eye of an 11-year-old child who presented with blurred vision.

Notes: (A) At presentation, multiple subretinal yellow–white lesions were seen superiorly and at the superotemporal periphery and treated with antitubercular drugs and oral steroids (tapered over 2 months). (B) 1 month after stopping oral steroids, recurrent crops of multiple yellow–white subretinal lesions appeared at macula, which were treated with laser photocoagulation to the inferior retina and high-dose oral albendazole therapy. (C) Complete resolution of lesions was observed at 2 months. The child remains recurrence free 2 years after treatment.
Abbreviations: 20/20, Snellen visual acuity equivalent to 20/20; CFCF, visual acuity counting fingers close to face; 20/40, Snellen visual acuity equivalent to 20/40.

Table 1 Clinical features of patients presenting with presumed diffuse unilateral subacute neuroretinitis (DUSN)

Patient	Age (years)/sex	Duration of symptoms	Visual acuity (presentation)	Clinical presentation	Vitreous cells	RAPD	Follow-up (months)	Visual acuity (final)
1	11/M	15 days	20/40, N6	Recurrent crops of migrating evanescent yellow–white subretinal lesions, RPE mottling	1+	+	14	20/20, N6
2	10/F	1 day	20/100, N24	Anterior chamber cell 2+, yellow subretinal lesions, RPE mottling	2+	−	19	20/20, N6
3	12/F	1 year	20/320, N36	RPE mottling, optic disc pallor	1+	+	11	20/320, N36
4	55/F	4 months	3/200, N36	Anterior chamber cell 1+, subretinal track lesions, optic disc pallor, RPE changes	1+	+	11	3/200, N36
5	29/M	1 month	3/200, N36	ERM with fibrosis, optic disc pallor, RPE changes	2+	−	19	3/200, N36
6	10/M	1 week	1/200, N36	Subretinal lesions, RPE changes	1+	+	2	20/160, N18
7	20/M	1 week	20/200, N18	Subretinal lesions, RPE changes	2+	+	2	20/60, N36
8	8/F	6 months	3/200, N36	Subretinal lesions, optic disc pallor, RPE changes	2+	+	4	20/400, N36
9	15/M	6 months	1/200, N36	Subretinal lesions, optic disc pallor, RPE changes	1+	+	21	20/400, N36
10	20/M	6 months	1/200, N36	Subretinal lesions, optic disc pallor, RPE changes	1+	+	1	3/200, N36
11	20/M	7 months	3/200, N36	Subretinal lesions, RPE changes	1+	+	1	3/200, N36
12	62/F	4 months	20/40, N6	Linear subretinal track lesions, RPE changes	1+	−	5	20/40, N6
13	20/M	1 year	3/200, N36	Chorioretinal scars, optic disc pallor, RPE changes	1+	+	3	3/200, N36

Notes: All patients were given oral high-dose antihelminthic treatment (albendazole 15 mg/kg body weight/day, once daily, for 30 days), and all patients received laser photocoagulation to break blood–retina barrier to increase the ocular penetration of albendazole. Duration of symptoms for the early group was <6 months and for the late group it was ≥6 months.

Abbreviations: +, with; −, without; M, male; F, female; RPE, retinal pigment epithelium; RAPD, relative afferent papillary defect; ERM, epiretinal membrane.

Table 2 Age distribution of patients with DUSN

Age at presentation	Number of patients
≤20 years	10 (76.92%)
>20 years	3 (23.07%)

Abbreviation: DUSN, diffuse unilateral subacute neuroretinitis.

Table 3 Visual acuity at presentation

Visual acuity	Number of patients
Better than or equal to 20/40	2 (15.38%)
20/40 to 20/200	2 (15.38%)
Worse than 20/200	9 (69.23%)

Table 4 Posterior segment findings in patients with presumed DUSN

Clinical finding	Number of patients, (both groups) n (%) (N=13)	Number of patients – early group (N=7), n/N*	Number of patients – late group (N=6), n/N*
Focal RPE alterations	13 (100%)	7/7	6/6
Vitritis	13 (100%)	7/7	6/6
Narrowing of retinal vessels	13 (100%)	7/7	6/6
Optic disc pallor	7 (53.85%)	2/7	5/6
Yellow–white subretinal lesions	7 (53.85%)	3/7	4/6
Subretinal track lesions	2 (15.38%)	2/7	0/6
Vasculitis	3 (23.07%)	3/7	0/6
Fibrosis over disc	2 (15.38%)	2/7	0/6
Retinal edema	Nil	Nil	Nil
Live worm	Nil	Nil	Nil

Notes: Duration of symptoms for the early group was <6 months and for the late group it was ≥6 months.

* n is the number of patients with the finding, and N is the total number of patients in the group.

Abbreviations: DUSN, diffuse unilateral subacute neuroretinitis; RPE, retinal pigment epithelium.

Figure 2 Fundus pictures and OCT images of early stage and chronic stage of the disease.

Notes: Fundus picture (A) and OCT (B) of right eye of a patient in the early stage of the disease showing hazy view due to vitritis, blurred disc margin, loss of foveal reflex, and macular thickening (central macular thickness =315 µm). Fundus picture (C) and OCT (D) of the same eye in the chronic stage of the disease showing resolved vitreous haze, disc pallor, and decreased macular thickening (central macular thickness =240 µm). OCT machine used was Cirrus 4000 SW version: 5.2.0.210, Carl Zeiss Meditec, Jena, Germany.
Abbreviation: OCT, optical coherence tomography.