Annulated Surprise during Cataract Surgery: A Case Report

We report a pediatric case in which a retrolenticular Armillifer armillatus infestation mimicked a white cataract.

A ten-year-old girl presented with a white cataract of her right eye during a humanitarian mission in the Democratic Republic of Congo. Fundoscopy was inaccessible. During surgery, an annulated worm-like parasite was found in the retrolenticular space. Further anamnesis was remarkable for regular snake and crocodile meat consumption, and a clinical diagnosis of ocular pentastomiasis was made. The parasite was morphologically and molecularly identified as A. armillatus. After surgery, fundoscopy showed diffuse retinal atrophy and the vision did unfortunately not improve. Human pentastomiasis is a rare, yet emerging zoonosis in rural tropical areas. Consumption of undercooked, infected snake (or rarely other reptile) meat may lead to visceral pentastomiasis, with uncommon ophthalmological involvement. Ocular pentastomiasis can be a devastating cause of vision loss in endemic regions.

This case illustrates that a retrolenticular location of the parasite was likely responsible for a white cataract in an otherwise quiet, white eye, highlighting intraocular pentastomiasis as a potentially underdiagnosed cause of vision loss in endemic regions.