Intralenticular gnathostomiasis: A rare parasitic invasion

Intraocular gnathostomiasis is an exceptionally rare manifestation of Gnathostoma spinigerum infection. Ingested larvae from undercooked meat[1] can migrate to various body parts, causing significant morbidity. Intralenticular localization-where the larva is embedded within the crystalline lens-is extremely unique, with this video documenting the first reported global case.

To present the clinical, diagnostic, and surgical aspects of a unique case of intralenticular gnathostomiasis, providing educational value to ophthalmologists, parasitologists, and primary care physicians. This case emphasizes the importance of considering parasitic infections in differential diagnoses, particularly in patients with relevant dietary or travel histories.

A foreign national presented with ocular irritation and gastrointestinal symptoms following the consumption of undercooked meat. Clinical findings included anterior chamber reaction, mild vitritis, optic disc edema, retinal hemorrhages, and curvilinear retinal scars. Endogenous endophthalmitis was initially suspected. On Day 18, a live worm was visualized within the lens on slit-lamp examination and anterior segment-optical coherence tomography (AS-OCT). The video illustrates the diagnostic journey and meticulous surgical extraction of the worm in toto. An animated segment demonstrates the presumed migratory path of the larva. Histopathology confirmed the species as Gnathostoma spinigerum.

• Diagnosis: Emphasizes the importance of detailed history-taking, including dietary habits and travel exposure. • Documentation: High-quality images of the motile worm within the lens aid future recognition and diagnosis. • Surgery: Demonstrates the technique to safely extract the worm, providing insights into managing such rare and delicate cases. • Postoperative Care: Discusses the importance of postoperative monitoring and care for full visual and systemic recovery.

https://youtu.be/VAdj17UZVA0.