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Post-traumatic intraocular ophthalmomyasis due to Phormia sp.
Oftalmomiasis intraocular postraumática por Phormia sp.
F. Munayco-Guilléna,b,
Corresponding author
fernando.munayco.g@upch.pe

Corresponding author.
, P.A. Muro-Mansillaa,b, L.S. Marroquín-Loayzaa,b, J.A. Zavala-Loayzaa,b, R.R. Cámara-Reyesc, A. Verástegui-Díazd
a Servicio de Retina y Vítreo, Instituto Nacional de Oftalmología, Lima, Peru
b Universidad Peruana Cayetano Heredia, Lima, Peru
c Universidad San Luis Gonzaga de Ica, Sociedad Científica de Estudiantes de Medicina de Ica (SOCEMI), Ica, Peru
d Universidad Ricardo Palma, Sociedad Científica de Estudiantes de Medicina de la Universidad Ricardo Palma (SOCEMURP), Lima, Peru
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    "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&#44; organs or bodily cavities&#46; It can be divided in &#40;a&#41; primary or genuine&#44; which attacks healthy tissues &#40;biontophagous parasites&#41; and &#40;b&#41; secondary myasis&#44; which attacks injured or necrotic tissues &#40;necrobiontophage parasites&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;2</span></a> Ophthalmomyasis is infrequent because&#44; according to literature&#44; it accounts for less than 5&#37; of myasis cases&#46;<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&#58; &#40;a&#41; external&#44; where the larvae infest eyelids on the ocular surface&#59; &#40;b&#41; internal&#44; where the larvae penetrate the ocular globe and can infest the vitreous cavity or subretinal space&#44; and &#40;c&#41; orbitary when they invade orbitary space and tissues&#46;<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&#44; mostly caused by <span class="elsevierStyleItalic">Oestrus ovis</span> &#40;ram fly&#41; found all over the world&#46; Other species such as <span class="elsevierStyleItalic">Cochliomyia hominivorax</span> &#40;drilling worm&#41; are considered endemic in Peru&#46; This species can produce internal ophthalmomyosis without interruption&#46;<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&#44; with <span class="elsevierStyleItalic">Phormia</span> sp&#46; fly larva as infesting parasite&#46; This is the first report of internal ophthalmomyosis with said parasite subsequent to open ocular trauma&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Clinic case</span><p id="par0025" class="elsevierStylePara elsevierViewall">Male patient&#44; 18&#44; injured by a birdshot that penetrated the left hand and face&#44; severely impairing the left eye&#46; The patient remained unconscious for 2 days in an open field in a rural area&#46; After being found unconscious&#44; he was taken to the hospital of Hu&#225;nuco &#40;a province that borders the Andes Mountains and the Peruvian jungle&#41;&#44; where an abundant amount of larvae were removed from the left eye in addition to being treated for the rest of injuries&#46; Due to the complexity thereof&#44; the patient was referred to the National Ophthalmology Institute of Peru&#44; where he arrived 9 days after the event&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Clinical examination showed the left eye with injuries and loss of 50&#37; of substance in the upper eyelid and loss of 30&#37; of substance in the lower eyelid &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In addition&#44; a scleral wound with uveal exposure was identified in zone II&#44; with purulent material and fly larvae&#46; The left eye was hypotonic&#44; with athalamia and corneal edema &#40;&#43;&#43;&#41;&#46; Visual acuity was no perception of light and ocular fundus could not be examined due to opacity&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Left eye echography produced hyperechogenic images suggesting intraocular foreign bodies &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Physical examination in the right eye revealed Tyndall &#40;&#43;&#43;&#41;&#44; flare &#40;&#43;&#43;&#41;&#44; hypo-reactive pupil and ocular fundus with grade II hemovitreous&#44; retinal paleness and diffuse micro-hemorrhages&#46; Medical treatment with oral prednisolone&#44; atropine and ketorolac was initiated&#46;</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 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; It was decided to carry out surgical cleansing&#44; left ocular globe evisceration without implant and suture of palpebral wounds&#46; This decision was taken on the basis of the following criteria&#58; evolution time&#44; high risk of infection and ecographic images suggesting intraocular larvae&#46; During evisceration&#44; the presence of fly larvae was observed&#46; The patient was treated with intravenous ciprofloxacin and clindamycin as well as oxytetracycline cream&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Pathological anatomy reported the presence of larvae adhered to uveal tissue &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; 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&#46;</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&#44; prostration&#44; immunosuppression&#44; dementia&#44; unconsciousness&#44; tumors with necrosis and exposure of open wounds&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In the present case&#44; remaining unconscious in an open field with exposed wounds in eyelids facilitated infestation&#44; giving rise to external ophthalmomyosis&#46; In addition&#44; untreated open ocular globe trauma allowed the entrance of parasites into the eye&#44; producing intraocular ophthalmomyosis&#46; Pathological anatomy demonstrated that the larvae were adhered to the uvea&#44; which proves that intraocular infestation was not recent&#46; In addition to hooks&#44; said parasites utilize proteolytic enzymes &#40;chymotrypsin&#41; to facilitate adherence to tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> This definitively worsens the anatomic and visual prognosis for the patient&#44; involving higher risk of endophthalmitis and other severe complications including meningitis&#44; destruction of the orbit and surrounding tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Extraocular ophthalmomyosis could become intraocular depending&#44; among other factors&#44; on the larva species and host risk factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#44;3</span></a> It is important to identify the larva species because it could also provide information such as exposure time&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Phormia</span> sp&#46; is a member of the Diptera order and the Calliphoridae family and can reside&#44; generally in <span class="elsevierStyleItalic">post mortem</span> tissue&#44; from day 1 to 14&#46; Said dipter deposits eggs in all discontinuous tissues of corpses and is mainly found in damaged tissue&#46; The growth and development of the fly depends on environmental temperature&#44; for which reason it is considered to be a poikilothermic species that is commonly found in corpses left in open-air during warm seasons&#46; At ambient temperature&#44; the stage from egg to pupa occurs in 6&#8211;11<span class="elsevierStyleHsp" style=""></span>h&#46; With increased environmental temperature&#44; the metabolic rates of the fly generally increase&#44; producing increased growth and development rates&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In the case of live subjects&#44; the <span class="elsevierStyleItalic">Phormia</span> sp&#46; larvae could compromise necrotic tissue appearing after 10<span class="elsevierStyleHsp" style=""></span>h&#44; even less if the subject is in open air under warm conditions&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7&#44;8</span></a><span class="elsevierStyleItalic">Phormia</span> sp&#46; is known to have forensic importance because it assists in establishing the <span class="elsevierStyleItalic">post mortem</span> interval&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#44;8</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">As regards treatment&#44; physical extraction of larvae is recommended&#46; In order to avoid relapses&#44; a single dose of ivermectin at 300<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;kg can be utilized&#44; together with broad range antibiotic therapy covering aerobic and anaerobic microorganisms&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#44;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&#44; which would enable the insertion of an implant followed by a prosthesis&#44; thus achieving an improved esthetic result and consequently of patients self-esteem&#46;</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&#44; it can be concluded that untreated open globe traumatisms could facilitate the appearance of internal ophthalmomyosis in a patient under risk conditions&#46;</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&#46;</p></span></span>"
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        "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&#46; He remained unconscious for 2 days in an agricultural area&#44; had a visual acuity of non-perception of light&#44; wounds with loss of substance in upper and lower eyelid&#44; atalamia&#44; hypotonia&#44; corneal edema&#44; wound with uveal exposure and exit of larvae in zone II&#46; He was subjected to evisceration of the left eye&#46;</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&#46;</p></span>"
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        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Caso cl&#237;nico</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Paciente var&#243;n de 18 a&#241;os el cual presentaba lesi&#243;n en el ojo izquierdo por arma de fuego&#46; Permaneci&#243; inconsciente 2 d&#237;as en una zona agr&#237;cola&#44; luego fue llevado a un hospital local donde se le extrajeron larvas&#46; En el ojo izquierdo present&#243; una agudeza visual de no percepci&#243;n de luz&#44; heridas con p&#233;rdida de sustancia en los p&#225;rpados superior e inferior&#44; atalamia&#44; hipoton&#237;a&#44; edema corneal&#44; herida con exposici&#243;n uveal y salida de larvas en zona II&#46; Se le practic&#243; evisceraci&#243;n del ojo izquierdo&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Un traumatismo ocular abierto no tratado adecuadamente es factor de riesgo para la instalaci&#243;n de una oftalmomiasis intraocular&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Munayco-Guill&#233;n F&#44; Muro-Mansilla PA&#44; Marroqu&#237;n-Loayza LS&#44; Zavala-Loayza JA&#44; C&#225;mara-Reyes RR&#44; Ver&#225;stegui-D&#237;az A&#46; Oftalmomiasis intraocular postraum&#225;tica por <span class="elsevierStyleItalic">Phormia</span> sp&#46; Arch Soc Esp Oftalmol&#46; 2019&#59;94&#58;145&#8211;148&#46;</p>"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Left eye B-mode echography&#46; &#40;B&#41; Computerized tomography showing radio-opaque images suggesting a metallic foreign body in the medial wall of the orbit&#46; Lower arrow&#58; intraocular hyper-echogenic images&#46; Upper arrow&#58; interruption in the sclera&#46; &#40;B&#41; Hyperdense image suggesting metallic foreign body in the medial wall of the orbit&#46;</p>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; <span class="elsevierStyleItalic">Phormia</span> sp&#46; larvae extracted after left eye evisceration&#46; &#40;B&#41; <span class="elsevierStyleItalic">Phormia</span> sp&#46; larvae showing multiple hooks along the body&#46; &#40;C&#41; Larva hooks introduced in uveal tissue&#44; also partially showing showing the parasite body adhered to the uvea &#40;HE 400&#215;&#41;&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:9 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Miasis ocular por <span class="elsevierStyleItalic">Oestrus ovis</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "M&#46; Beltr&#225;n"
                            1 => "G&#46; Torres"
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                          ]
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              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Oftalmomiasis post traum&#225;tica&#58; relato de caso y revisi&#243;n de la literatura"
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                          "etal" => false
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                      "titulo" => "Ophthalmomyiasis caused by a <span class="elsevierStyleItalic">Phormia</span> sp&#46; &#40;Diptera&#58; Calliphoridae&#41; larva in an enucleated patient"
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                        0 => array:2 [
                          "etal" => false
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                  "host" => array:1 [
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            3 => array:3 [
              "identificador" => "bib0065"
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                      "titulo" => "Miasis orbital severa causada por <span class="elsevierStyleItalic">Cochliomia hominovorax</span> en la regi&#243;n andina de Ecuador"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Dominguez-Enriquez"
                            1 => "J&#46; Cueva-Rosillo"
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                  ]
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              "identificador" => "bib0070"
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ISSN: 21735794
Original language: English
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