Results of treatment of ocular toxoplasmosis with injectable corticosteroids

Sixty-seven patients with toxoplasmic retinochoroiditis who were treated with periocular injections of depot forms of corticosteroids were studied in an attempt to determine (1) whether patients who did poorly on this regimen could be differentiated predictively from those who responded in a more favorable fashion, and (2) whether a treatment regimen that would allow the safe use of periocular depot corticosteroids in patients with toxoplasmic retinochoroiditis could be delineated. The study did not reveal any reliable way of predicting which patients would be good risks for the use of periocular injections of depot corticosteroids. It does suggest that the concurrent use of antitoxoplasma agents might protect patients in such a way that periocular depot corticosteroids would not worsen their disease. For the reasons outlined, the use of periocular injections of depot corticosteroids in toxoplasmic uveitis must be approached with great caution in the future.

Clindamycin in the treatment of human ocular toxoplasmosis

Clindamycin was used systemically and periocularly to treat six patients with ocular toxoplasmosis who had a total of eight attacks. Although it appeared to quiet the attack promptly, several side effects were noted. Transient diplopia occured after large periocular doses and papillitis resulted from retrobulbar administration. Despite its efficacy, the results do not seem to warrant high systemic doses for prolonged periods in view of its systemic toxicity. Clindamycin may be most useful as a periocular injection in moderate dosage. A controlled double-blind study is needed.

Cooperative clinical trials. The Second Ticho Memorial Lecture

As exemplified by the collaborative Diabetic Retinopathy Study, all the appropriate techniques involved in a clinical trial-random assignment of treatment, appropriate controls, and avoidance of investigator bias-should be incorporated during the earliest testing of a new therapy for a chronic disease, for the sake of the patient and for the progress of medical science. This approach to clinical trials in the testing of new ocular therapies can provide the most scientifically sound and rational therapy to the patient.

Manifestations and management of ocular toxoplasmosis

Images

Effects of an interferon inducer, poly I:C, on acute ocular infection produced by intracameral inoculation of Toxoplasma gondii

A potent interferon inducer, synthetic polyinosinic acid-polycytidylic acid complex (poly I:C), was used prophylactically and therapeutically in experimental ocular Toxoplasma infections in rabbits. Daily intravenous injections of poly I:C alone or when combined with daily subconjunctival injections of the inducer delayed the appearance of conjunctivitis, corneal opacity, and iritis in Toxoplasma-infected eyes provided that the treatment was started 1 day before the infection. When the treatment was begun at the same time or 1 day after the infection, no delay in the production of the ocular lesions was noted. In no case was the treatment curative or completely suppressive.