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Letters to the Editor.

Surgically removed submacular nematode EDITOR,—Intraocular filariasis is an uncommon disease in civilised countries. In only a few cases has the worm been surgically removed from the posterior portion of the eye and identified. 1 In this report we describe a patient who had a filaria-like worm in an epi-macular and/or submacular lesion, which was successfully removed surgically. A 38 year old woman complained of decreased visual acuity in her left eye of 5 days' duration. Her medical history was unremark-able. The patient had two pet dogs, and she had not travelled to foreign countries in recent years. On examination, her corrected visual acuity was 20/20 in the right eye and 20/100 in the left. No inflammation was present in the anterior segment or vitreous cavity bilaterally. Ophthalmoscopic examination disclosed a white worm, approximately 3 disc diameters in length, equivalent to about 4.5 mm, moving slowly in the macula at the epiretina. Epireti-nal and intraretinal haemorrhages were observed in and around the macular region. The body of the worm was tapered at one end and slightly rounded at the other (Fig 1). A round, preretinal haemorrhage was observed on a branch of the superonasal retinal artery, which could have been the route of entry into the eye. Numerous subretinal hypopigmented tracks with small haemorrhages were noted in the superior retina, and perivascular haemorrhages were observed around the inferior branch of the central retinal vein (Fig 2). Fluorescein angiography showed numerous hyperfluorescent tracks without dye leakage. The patient's blood test revealed a slightly elevated white blood cell count (10 200 ×10 6 /l; normal <9000) and elevated IgE in the serum (680 U/ml; normal <250). On the following day pars plana vitrectomy was performed and the worm was found partially migrated into the subretinal space of the macula. The worm was aspirated successfully through a 20 gauge silicone tipped needle and submitted for parasitological study; however, it was lost during transportation to a diVerent laboratory. Parasitological study of the pa-tient's serum detected an antibody to Diro-filaria. Six months after surgery, the patient's visual acuity was still 20/50. Ophthalmoscopi-cally the hypopigmented tracks had faded, and mildly irregular pigment was observed at the deep retina in the macular lesion. Cone and rod electroretinograms to full field stimuli were normal bilaterally. COMMENT Our patient owned two dogs, and her ocular findings could be diVerentiated from toxo-cariasis, in which only larvae of Toxocara canis can infect …