What challenges have you faced professionally that are specific to your being a woman?Īmy C. An edited version of their conversation is shared below. But are these changes enough? Retina Today gathered a panel of respected female retina specialists and asked them to discuss their thoughts and experiences. Berrocal, MD, recalls, women were commonly told when hired that they would be paid less than their male colleagues because they didn’t have to support a family. 1 Women are increasingly visible in practices, at the podium, and in academia. In fact, women now make up more than 20% of ophthalmologists, and nearly half of US medical students and residents are women. Werner, MD, Associated Retinal Consultants, Reichert Bldg, 5333 McAuley Dr, Ypsilanti, MI 48197.There are more women in ophthalmology-and medicine in general-than ever before. Removal of all components of a Toxocaragranuloma can be successful in treating ocular toxocariasis and is possible with pars plana vitrectomy and subretinal surgical techniques.Īccepted for publication November 9, 1998. Histopathologically, the specimen was consistent with toxocariasis. This prompted a retinotomy and intact removal of the entire dumbbell-shaped granuloma. During membrane stripping, a firm stalk was encountered connected to the subretinal mass. Intraoperatively, the vitreous bands inserted into a macular epiretinal membrane. To clear vitreous debris, relieve vitreomacular traction, and remove the posterior hyaloid required vitrectomy. Vision began to deteriorate because of a combination of inflammation, macular traction, and the development of a macular granuloma. However, the parasite may persist despite anthelmintic treatment. Anthelminthics have been used to destroy viable nematodes and eliminate further migration of the larvae. The rationale for the use of corticosteroids involves suppression of the destructive inflammatory response to the parasite. Subsequently, the patient was managed with oral prednisone and thiabendazole. The diagnosis of toxocariasis, supported by a positive titer, was made later in this patient's course as the retinal lesions evolved into granulomas and vitreous bands formed. The initial clinical appearance was reminiscent of toxoplasmosis in the way it exhibited multiple satellite lesions with vitreous inflammation. The clinician must differentiate toxocariasis from other causes of uveitis, particularly retinoblastoma, 6 reduce ocular inflammation, and prevent loss of vision and amblyopia. A degenerated structure compatible in size with a larva was found ( Figure 5). The subretinal fibrocellular tissue had a granulomatous infiltrate composed of plasma cells, lymphocytes, epithelioid cells, eosinophils, multinucleated giant cells, and hyperplastic retinal pigment epithelium. Surrounding this was a zone of epithelioid histiocytes and multinucleated giant cells and an outer zone of plasma cells, lymphocytes, and eosinophils. Eosinophilic material encapsulating the structure may represent antigen-antibody precipitate (Splendore-Hoeppli phenomenon) ( Figure 4). An encapsulated eosinophilic cystic structure measuring 22.5 µm with an amorphous core of 10.5 µm within a central area of necrosis was consistent with a degenerated Toxocara canislarva. The epiretinal component of the dumbbell-shaped lesion was fibrocellular tissue with a granuloma ( Figure 3). Histopathologic examination findings for the fibrocellular membrane revealed plasma cells, lymphocytes, and eosinophils. Adjacent fluffy infiltrate in papillomacular bundle. Intraretinal macular lesion with epiretinal membrane (black arrow) and subretinal granuloma (white arrow). During membrane stripping the nasal white nodules peeled off the retinal surface. A pars plana vitrectomy, membrane stripping, retinotomy, and removal of the epiretinal, retinal, and subretinal granuloma were done.Īt vitrectomy, the macular lesion was dumbbell shaped: an intraretinal core connected a round epiretinal component and subretinal component ( Figure 2). He improved until macular traction developed in July 1996. The clinical presentation was now consistent with toxocariasis. A partial posterior vitreous detachment was noted over the nasal retina with vitreous inflammation. The macular lesion enlarged into a solid, elevated mass with subretinal hyperpigmentation.
A chalky appearing intraretinal lesion appeared preretinal and temporal to the fovea. The nasal retinal lesion was now raised and its surface was contiguous with a band of vitreous inflammatory membranes. One month later, the visual acuity OS dropped to 20/80. Nasal intraretinal infiltrate with adjacent satellite lesions.
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