Advertisement

DUSN

  • Shriji Patel
  • Anita Agarwal
Living reference work entry

Abstract

Diffuse unilateral subacute neuroretinitis (DUSN) was first described by Gass and was termed “unilateral wipe out syndrome” (Gass et al. 1978). He observed a subset of young adults and children with rapidly progressive visual loss accompanied by optic atrophy, retinal vascular attenuation, and pigmentary retinopathy in one eye. While reviewing serial photographs of these patients, he noted clusters of gray-white lesions that migrated to different areas of the fundus over time. The keen observer that he is, he found a small curvilinear glistening white structure approximately 400 microns in length with tapered ends in the vicinity of the active lesions. The white worm-like structure moved with the crops of gray-white lesions. This led him to describe DUSN, a condition that is characterized by migrating crops of creamy white retinal lesions caused by a moving tiny larva in the subretinal space.

Suggested Reading

  1. Akao N, Hayashi E, Sato H, Fujita K, Furuoka H. Diffuse retinochoroiditis due to Baylisascaris procyonis in Mongolian gerbils. J Parasitol. 2003;89:174–5.CrossRefPubMedGoogle Scholar
  2. Anshu A, Chee SP. Diffuse unilateral subacute neuroretinitis. Int Ophthalmol. 2008;28:127–9.CrossRefPubMedGoogle Scholar
  3. Carney MD, Combs JL. Diffuse unilateral subacute neuroretinitis. Br J Ophthalmol. 1991;75:633–5.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Casella AM, Farah ME, Souza EC, Belfort Jr R, Oguido AP. Retinal nerve fiber layer atrophy as relevant feature for diffuse unilateral subacute neuroretinitis (DUSN): case series. Arq Bras Oftalmol. 2010;73:182–5.CrossRefPubMedGoogle Scholar
  5. Cortez R, Denny JP, Muci-Mendoza R, Ramirez G, Fuenmayor D, Jaffe GJ. Diffuse unilateral subacute neuroretinitis in Venezuela. Ophthalmology. 2005;112:2110–4.CrossRefPubMedGoogle Scholar
  6. Cunha LP, Costa-Cunha LV, Souza EC, Monteiro ML. Intraretinal worm documented by optical coherence tomography in a patient with diffuse unilateral subacute neuroretinitis: case report. Arq Bras Oftalmol. 2010;73:462–3.CrossRefPubMedGoogle Scholar
  7. de Amorim Garcia Filho CA, Gomes AH, de Amorim Garcia Soares AC, de Amorim Garcia CA. Clinical features of 121 patients with diffuse unilateral subacute neuroretinitis. Am J Ophthalmol. 2012;153:743–9.CrossRefPubMedGoogle Scholar
  8. de Souza EC, Nakashima Y. Diffuse unilateral subacute neuroretinitis. Report of transvitreal surgical removal of a subretinal nematode. Ophthalmology. 1995;102:1183–6.CrossRefPubMedGoogle Scholar
  9. de Souza EC, Abujamra S, Nakashima Y, Gass JD. Diffuse bilateral subacute neuroretinitis: first patient with documented nematodes in both eyes. Arch Ophthalmol. 1999;117:1349–51.CrossRefPubMedGoogle Scholar
  10. Garcia CA, Gomes AH, Garcia Filho CA, Vianna RN. Early-stage diffuse unilateral subacute neuroretinitis: improvement of vision after photocoagulation of the worm. Eye. 2004;18:624–7.CrossRefPubMedGoogle Scholar
  11. Garcia CA, Gomes AH, Vianna RN, Souza Filho JP, Garcia Filho CA, Orefice F. Late-stage diffuse unilateral subacute neuroretinitis: photocoagulation of the worm does not improve the visual acuity of affected patients. Int Ophthalmol. 2005;26:39–42.CrossRefPubMedGoogle Scholar
  12. Garcia CA, Sabrosa NA, Gomes AB, Segundo Pde S, Garcia Filho CA, Sabrosa AS. Diffuse unilateral subacute neuroretinitis – DUSN. Int Ophthalmol Clin. 2008;48:119–29.CrossRefPubMedGoogle Scholar
  13. Gass JD. Acute herpetic thrombotic retinal angiitis and necrotizing neuroretinitis (“acute retinal necrosis syndrome”). Trans New Orleans Acad Ophthalmol. 1983;31:97–107.PubMedGoogle Scholar
  14. Gass JD, Braunstein RA. Further observations concerning the diffuse unilateral subacute neuroretinitis syndrome. Arch Ophthalmol. 1983;101:1689–97.CrossRefPubMedGoogle Scholar
  15. Gass JD, Scelfo R. Diffuse unilateral subacute neuroretinitis. J R Soc Med. 1978;71:95–111.PubMedPubMedCentralGoogle Scholar
  16. Gass JD, Gilbert Jr WR, Guerry RK, Scelfo R. Diffuse unilateral subacute neuroretinitis. Ophthalmology. 1978;85:521–45.CrossRefPubMedGoogle Scholar
  17. Goldberg N, Bhatnagar P. Letter to the editor. Diffuse unilateral subacute neuroretinitis (DUSN). Ocul Immunol Inflamm. 2012;20:139–42.CrossRefPubMedGoogle Scholar
  18. Goldberg MA, Kazacos KR, Boyce WM, Ai E, Katz B. Diffuse unilateral subacute neuroretinitis. Morphometric, serologic, and epidemiologic support for Baylisascaris as a causative agent. Ophthalmology. 1993;100:1695–701.CrossRefPubMedGoogle Scholar
  19. Gomes AH, Garcia CA, Segundo Pde S, Garcia Filho CA, Garcia AC. Optic coherence tomography in a patient with diffuse unilateral subacute neuroretinitis. Arq Bras Oftalmol. 2009;72:185–8.CrossRefPubMedGoogle Scholar
  20. Harto MA, Rodriguez-Salvador V, Avino JA, Duch-Samper AM, Menezo JL. Diffuse unilateral subacute neuroretinitis in Europe. Eur J Ophthalmol. 1999;9:58–62.PubMedGoogle Scholar
  21. Kazacos KR, Raymond LA, Kazacos EA, Vestre WA. The raccoon ascarid. A probable cause of human ocular larva migrans. Ophthalmology. 1985;92:1735–44.CrossRefPubMedGoogle Scholar
  22. Matsumoto BT, Adelberg DA, Del Priore LV. Transretinal membrane formation in diffuse unilateral subacute neuroretinitis. Retina. 1995;15:146–9.CrossRefPubMedGoogle Scholar
  23. Mets MB, Noble AG, Basti S, et al. Eye findings of diffuse unilateral subacute neuroretinitis and multiple choroidal infiltrates associated with neural larva migrans due to Baylisascaris procyonis. Am J Ophthalmol. 2003;135:888–90.CrossRefPubMedGoogle Scholar
  24. Naumann GO, Knorr HL. DUSN occurs in Europe. Ophthalmology. 1994;101:971–2.CrossRefPubMedGoogle Scholar
  25. Sabrosa NA, Zajdenweber M. Nematode infections of the eye: toxocariasis, onchocerciasis, diffuse unilateral subacute neuroretinitis, and cysticercosis. Ophthalmol Clin N Am. 2002;15:351–6.CrossRefGoogle Scholar
  26. Saffra NA, Perlman JE, Desai RU, et al. Baylisascaris procyonis induced diffuse unilateral subacute neuroretinitis in New York City. J Neuro-Oncol. 2010;1(6):1–4.Google Scholar
  27. Salvanet-Bouccara A, Troussier H. Diffuse unilateral subacute neuroretinitis. Apropos of a case. J Fr Ophtalmol. 1987;10:667–72.PubMedGoogle Scholar
  28. Souza EC, Casella AM, Nakashima Y, Monteiro ML. Clinical features and outcomes of patients with diffuse unilateral subacute neuroretinitis treated with oral albendazole. Am J Ophthalmol. 2005;140:437–45.CrossRefPubMedGoogle Scholar
  29. Tarantola RM, Elkins KA, Kay CN, Folk JC. Photoreceptor recovery following laser photocoagulation and albendazole in diffuse unilateral subacute neuroretinitis. Arch Ophthalmol. 2011;129:669–71.CrossRefPubMedGoogle Scholar

Copyright information

© Springer (India) Pvt. Ltd. 2018

Authors and Affiliations

  • Shriji Patel
    • 1
  • Anita Agarwal
    • 1
  1. 1.Department of OphthalmologyVanderbilt University Medical CenterNashvilleUSA

Personalised recommendations