Retinal Granuloma Progression After Scleral Buckling in Ocular Toxocariasis: A Case Report

BACKGROUND Toxocariasis has a wide geographic distribution, with high prevalence in tropical and subtropical regions. Ocular larva migrans is one of the most common manifestations in China and classically presents with peripheral granuloma, posterior granuloma, and chronic endophthalmitis. This report describes an atypical case of ocular toxocariasis in an adolescent male patient, initially misdiagnosed as chronic rhegmatogenous retinal detachment. CASE REPORT A 17-year-old male patient presented to our hospital with a 4-month history of progressive vision loss in his right eye, initially misdiagnosed as chronic rhegmatogenous retinal detachment, at a nearby facility. Scanning laser ophthalmoscopy identified a tractional retinal detachment accompanied by a granulomatous tubercle above the temporal peripheral retina in his right eye. The diagnosis of ocular toxocariasis was established by aqueous humor analysis, which revealed markedly elevated intraocular anti-Toxocara IgG levels and a significantly increased Goldmann-Witmer coefficient. The patient subsequently underwent scleral buckling, and 532 nm retinal laser photocoagulation 1 day after scleral buckling, resulting in successful anatomical reattachment. However, he developed retinal granulomatous lesions and vitritis 5 months following the surgery. Oral prednisone and albendazole effectively controlled intraocular inflammation and prevented further granulomatous progression. CONCLUSIONS Ocular toxocariasis may present with nonspecific findings, and serology and the Goldmann-Witmer coefficient are crucial for diagnosis. Scleral buckling is recommended for proliferative retinal changes, with adjunctive systemic therapy and long-term follow-up to prevent recurrence and preserve vision.