Diffuse Unilateral Subacute Neuroretinitis Medication

Updated: Dec 14, 2015
  • Author: Lakshmana M Kooragayala, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

Medication Summary

Antihelminthic treatment is for patients with moderate-to-severe vitreous inflammation or when it is not possible to locate and treat the nematode with photocoagulation. However, it is not effective in destroying the organism in all patients, especially in those with minimal vitreous inflammation where the drug has low ocular penetration. [25]

Thiabendazole is the drug of choice for initial medical therapy. Successful treatment is characterized by the development of a localized area of intense retinitis and fading of the grayish-white retinal lesions within 10 days after completion of therapy.

Ivermectin may be considered if thiabendazole is not effective or cannot be tolerated.

High-dose oral albendazole seems to be safe and beneficial for patients with active DUSN in the early or late clinical stage. [26]

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Anthelmintics

Class Summary

Vermicidal drugs that kill the organism by various antihelminthic actions.

Thiabendazole (Mintezol)

An antihelminthic agent. Probably acts by inhibiting the helminth-specific enzyme fumarate reductase. Vermicidal and/or vermifugal.

Ivermectin (Stromectol)

A semisynthetic, anthelmintic agent mainly used for filarial worms. Effectiveness in the treatment of DUSN is unclear.

Albendazole (Albenza)

A benzimidazole carbamate drug that inhibits tubulin polymerization, resulting in degeneration of cytoplasmic microtubules. Decreases ATP production in the worm, causing energy depletion, immobilization, and finally death. Converted in the liver to its primary metabolite, albendazole sulfoxide. Less than 1% of the primary metabolite is excreted in the urine. Plasma level is noted to rise significantly (as much as 5-fold) when ingested after high-fat meal. Experience with patients < 6 y is limited. To avoid inflammatory response in CNS, patient must also be started on anticonvulsants and high-dose glucocorticoids.

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