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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "145" "paginaFinal" => "148" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Munayco-Guillén, P.A. Muro-Mansilla, L.S. Marroquín-Loayza, J.A. Zavala-Loayza, R.R. Cámara-Reyes, A. Verástegui-Díaz" "autores" => array:6 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Munayco-Guillén" "email" => array:1 [ 0 => "fernando.munayco.g@upch.pe" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "P.A." "apellidos" => "Muro-Mansilla" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L.S." "apellidos" => "Marroquín-Loayza" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J.A." "apellidos" => "Zavala-Loayza" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "R.R." "apellidos" => "Cámara-Reyes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "A." "apellidos" => "Verástegui-Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Retina y Vítreo, Instituto Nacional de Oftalmología, Lima, Peru" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad Peruana Cayetano Heredia, Lima, Peru" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad San Luis Gonzaga de Ica, Sociedad Científica de Estudiantes de Medicina de Ica (SOCEMI), Ica, Peru" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Universidad Ricardo Palma, Sociedad Científica de Estudiantes de Medicina de la Universidad Ricardo Palma (SOCEMURP), Lima, Peru" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Oftalmomiasis intraocular postraumática por <span class="elsevierStyleItalic">Phormia</span> sp." ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 439 "Ancho" => 900 "Tamanyo" => 50216 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Left eye wound with 50% substance loss in upper eyelid and 30% lower eyelid.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Myasis is an infection caused by the invasion of fly larvae in tissues, organs or bodily cavities. It can be divided in (a) primary or genuine, which attacks healthy tissues (biontophagous parasites) and (b) secondary myasis, which attacks injured or necrotic tissues (necrobiontophage parasites).<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,2</span></a> Ophthalmomyasis is infrequent because, according to literature, it accounts for less than 5% of myasis cases.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Ophthalmomyasis is classified in 3 clinic forms: (a) external, where the larvae infest eyelids on the ocular surface; (b) internal, where the larvae penetrate the ocular globe and can infest the vitreous cavity or subretinal space, and (c) orbitary when they invade orbitary space and tissues.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The most frequent ophthalmomyosis in humans is external, mostly caused by <span class="elsevierStyleItalic">Oestrus ovis</span> (ram fly) found all over the world. Other species such as <span class="elsevierStyleItalic">Cochliomyia hominivorax</span> (drilling worm) are considered endemic in Peru. This species can produce internal ophthalmomyosis without interruption.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The case of a patient with open globe treatment who exhibited external ophthalmomyosis which later became internal is presented, with <span class="elsevierStyleItalic">Phormia</span> sp. fly larva as infesting parasite. This is the first report of internal ophthalmomyosis with said parasite subsequent to open ocular trauma.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Clinic case</span><p id="par0025" class="elsevierStylePara elsevierViewall">Male patient, 18, injured by a birdshot that penetrated the left hand and face, severely impairing the left eye. The patient remained unconscious for 2 days in an open field in a rural area. After being found unconscious, he was taken to the hospital of Huánuco (a province that borders the Andes Mountains and the Peruvian jungle), where an abundant amount of larvae were removed from the left eye in addition to being treated for the rest of injuries. Due to the complexity thereof, the patient was referred to the National Ophthalmology Institute of Peru, where he arrived 9 days after the event.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Clinical examination showed the left eye with injuries and loss of 50% of substance in the upper eyelid and loss of 30% of substance in the lower eyelid (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In addition, a scleral wound with uveal exposure was identified in zone II, with purulent material and fly larvae. The left eye was hypotonic, with athalamia and corneal edema (++). Visual acuity was no perception of light and ocular fundus could not be examined due to opacity.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Left eye echography produced hyperechogenic images suggesting intraocular foreign bodies (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Physical examination in the right eye revealed Tyndall (++), flare (++), hypo-reactive pupil and ocular fundus with grade II hemovitreous, retinal paleness and diffuse micro-hemorrhages. Medical treatment with oral prednisolone, atropine and ketorolac was initiated.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Orbitary tomography showed the presence of a metal foreign body that was trapped in the medial wall of the orbit (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). It was decided to carry out surgical cleansing, left ocular globe evisceration without implant and suture of palpebral wounds. This decision was taken on the basis of the following criteria: evolution time, high risk of infection and ecographic images suggesting intraocular larvae. During evisceration, the presence of fly larvae was observed. The patient was treated with intravenous ciprofloxacin and clindamycin as well as oxytetracycline cream.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Pathological anatomy reported the presence of larvae adhered to uveal tissue (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Specimens were taken immediately and sent to the National Health Institute of Peru to be processed in the enteroparasitology lab in order to identify the species.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Literature describes that the risk of ophthalmomyosis increases in vulnerable conditions such as alcoholism, prostration, immunosuppression, dementia, unconsciousness, tumors with necrosis and exposure of open wounds.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In the present case, remaining unconscious in an open field with exposed wounds in eyelids facilitated infestation, giving rise to external ophthalmomyosis. In addition, untreated open ocular globe trauma allowed the entrance of parasites into the eye, producing intraocular ophthalmomyosis. Pathological anatomy demonstrated that the larvae were adhered to the uvea, which proves that intraocular infestation was not recent. In addition to hooks, said parasites utilize proteolytic enzymes (chymotrypsin) to facilitate adherence to tissue.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> This definitively worsens the anatomic and visual prognosis for the patient, involving higher risk of endophthalmitis and other severe complications including meningitis, destruction of the orbit and surrounding tissue.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Extraocular ophthalmomyosis could become intraocular depending, among other factors, on the larva species and host risk factors.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,3</span></a> It is important to identify the larva species because it could also provide information such as exposure time.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Phormia</span> sp. is a member of the Diptera order and the Calliphoridae family and can reside, generally in <span class="elsevierStyleItalic">post mortem</span> tissue, from day 1 to 14. Said dipter deposits eggs in all discontinuous tissues of corpses and is mainly found in damaged tissue. The growth and development of the fly depends on environmental temperature, for which reason it is considered to be a poikilothermic species that is commonly found in corpses left in open-air during warm seasons. At ambient temperature, the stage from egg to pupa occurs in 6–11<span class="elsevierStyleHsp" style=""></span>h. With increased environmental temperature, the metabolic rates of the fly generally increase, producing increased growth and development rates.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In the case of live subjects, the <span class="elsevierStyleItalic">Phormia</span> sp. larvae could compromise necrotic tissue appearing after 10<span class="elsevierStyleHsp" style=""></span>h, even less if the subject is in open air under warm conditions.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7,8</span></a><span class="elsevierStyleItalic">Phormia</span> sp. is known to have forensic importance because it assists in establishing the <span class="elsevierStyleItalic">post mortem</span> interval.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3,8</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">As regards treatment, physical extraction of larvae is recommended. In order to avoid relapses, a single dose of ivermectin at 300<span class="elsevierStyleHsp" style=""></span>μg/kg can be utilized, together with broad range antibiotic therapy covering aerobic and anaerobic microorganisms.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Evisceration instead of enucleation was decided in the present patient due to the absence of necrosis signs in the sclera, which would enable the insertion of an implant followed by a prosthesis, thus achieving an improved esthetic result and consequently of patients self-esteem.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="par0090" class="elsevierStylePara elsevierViewall">On the basis of the above clinic case report, it can be concluded that untreated open globe traumatisms could facilitate the appearance of internal ophthalmomyosis in a patient under risk conditions.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of interests</span><p id="par0095" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1157262" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Clinical case" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1084478" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1157261" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1084479" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-02-28" "fechaAceptado" => "2018-08-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1084478" "palabras" => array:5 [ 0 => "Intraocular ophthalmomyiasis" 1 => "Larvae" 2 => "Evisceration" 3 => "Open globe injury" 4 => "Fly" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1084479" "palabras" => array:5 [ 0 => "Oftalmomiasis intraocular" 1 => "Larva" 2 => "Evisceración" 3 => "Traumatismo a globo abierto" 4 => "Mosca" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Clinical case</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">An 18 year-old male patient presented with an injury to the left eye caused by a firearm. He remained unconscious for 2 days in an agricultural area, had a visual acuity of non-perception of light, wounds with loss of substance in upper and lower eyelid, atalamia, hypotonia, corneal edema, wound with uveal exposure and exit of larvae in zone II. He was subjected to evisceration of the left eye.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An untreated open ocular traumatism is a risk factor for intraocular ophthalmomyiasis.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Clinical case" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Caso clínico</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Paciente varón de 18 años el cual presentaba lesión en el ojo izquierdo por arma de fuego. Permaneció inconsciente 2 días en una zona agrícola, luego fue llevado a un hospital local donde se le extrajeron larvas. En el ojo izquierdo presentó una agudeza visual de no percepción de luz, heridas con pérdida de sustancia en los párpados superior e inferior, atalamia, hipotonía, edema corneal, herida con exposición uveal y salida de larvas en zona II. Se le practicó evisceración del ojo izquierdo.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Un traumatismo ocular abierto no tratado adecuadamente es factor de riesgo para la instalación de una oftalmomiasis intraocular.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Munayco-Guillén F, Muro-Mansilla PA, Marroquín-Loayza LS, Zavala-Loayza JA, Cámara-Reyes RR, Verástegui-Díaz A. Oftalmomiasis intraocular postraumática por <span class="elsevierStyleItalic">Phormia</span> sp. Arch Soc Esp Oftalmol. 2019;94:145–148.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 439 "Ancho" => 900 "Tamanyo" => 50216 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Left eye wound with 50% substance loss in upper eyelid and 30% lower eyelid.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 967 "Ancho" => 2083 "Tamanyo" => 201322 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">(A) Left eye B-mode echography. (B) Computerized tomography showing radio-opaque images suggesting a metallic foreign body in the medial wall of the orbit. Lower arrow: intraocular hyper-echogenic images. Upper arrow: interruption in the sclera. (B) Hyperdense image suggesting metallic foreign body in the medial wall of the orbit.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 681 "Ancho" => 2083 "Tamanyo" => 246156 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">(A) <span class="elsevierStyleItalic">Phormia</span> sp. larvae extracted after left eye evisceration. (B) <span class="elsevierStyleItalic">Phormia</span> sp. larvae showing multiple hooks along the body. 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