Photo Quiz: a Present during Surgery

INTRODUCTION

An 84-year-old male with a senile right eye cataract underwent surgery in March 2021. The patient presented foreign body sensation for over 1 year. The patient lived in an urban area in the north of Madrid, Spain. The patient had no recent history of international travel.

Ophthalmological examination revealed entropion, follicles and microhemorrhages in subtarsal conjunctiva, paracentral corneal leukoma with minimal diffuse keratitis, François dystrophy, and phacosclerosis. There was no inflammation in the anterior chamber or alterations in the fundus, and the intraocular pressure was 14 mm Hg.

During a procedure for cataract phacoemulsification and intraocular lens implantation, a 2-cm structure consistent with a nematode appeared on the surface of the cornea (Fig. 1A) upon placement of a blepharostat. The presence of the parasite interrupted the surgery.

FIG 1.

(A) Specimen on the cornea with hyperemia, approximately 2 cm in length. (B) Presence of larvae in utero and ex vivo. The black arrow indicates the vulval opening anterior to esophageal-intestinal junction (magnification, ×400). (C) Spaced cuticular striations on the body surface (magnification, ×1,000). (D) Anal opening in posterior aspect (magnification, ×1,000).

The specimen was removed with a surgical clamp from the anterior corneal surface of the patient’s right eye. In addition, an EDTA blood collection was drawn.

The parasite possessed female genital organs, including a vulval opening anterior to esophageal-intestinal junction. Upon microscopic examination, ensheathed larvae were seen both in utero and deposited on the slide (Fig. 1B). The specimen appeared as a transparent nematode, presenting spaced striated cuticles on its periphery (Fig. 1C). The anterior aspect demonstrated a wide, straight, and deep buccal cavity without sharp hooks. The anal opening was present in the posterior place of specimen (Fig. 1D).