TRANSRETINAL MEMBRANE FORMATION IN DIFFUSE UNILATERAL SUBACUTE NEURORETINITIS

Background: Diffuse unilateral subacute neuroretinitis (DUSN) is chara cterized by unilateral visual loss with vitreous inflammation, optic d isc swelling, and the presence of gray-white lesions in the deep retin a, and can be associated with intraocular nematode infection. To date, no cases of transretinal membrane formation in DUSN have been reporte d. Methods: A 22-year-old woman was examined for a 2-week history of u nilateral decreased vision and neuroretinitis. A subretinal nematode w as identified and a diagnosis of DUSN was made. The nematode was destr oyed with laser photocoagulation. An epiretinal membrane and traction retinal detachment persisted and the membrane was removed surgically, at which time it was noted to be transretinal, passing through a full- thickness retinal defect into the subretinal space. Laser photocoagula tion was performed with the argon green laser (400 mW, 400 mu m, 100 m sec). Subsequent removal of the epiretinal portion of the transretinal membrane was performed via a pars plana approach. The membrane was st udied by transmission electron microscopy (TEM). Results: The laser ph otocoagulation was successful in destroying the nematode. Partial reso lution of the neurosensory detachment resulted in marked improvement i n visual acuity. The membrane consisted of a pauicellular collagenous stroma with scattered fibroblasts and mononuclear inflammatory cells. Conclusion: Removal of membranes affecting the macula may be of benefi t in selected patients with DUSN.