1
|
Amaral DC, Lane M, Aguiar EHC, Marques GN, Cavassani LV, Rodrigues MPM, Alves MR, Manso JEF, Monteiro MLR, Louzada RN. Surgical management of retinal detachment and macular holes secondary to ocular toxoplasmosis: a systematic review and meta-analysis. Int J Retina Vitreous 2024; 10:23. [PMID: 38424638 PMCID: PMC10903043 DOI: 10.1186/s40942-024-00540-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/03/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Toxoplasma gondii causes ocular toxoplasmosis (OT), involving inflammation, scarring, and retinal complications. The OT complications were retinal detachment (RD), and retinal breakage (RB). Surgical interventions like scleral buckling (SB) and vitrectomy are common. Limited understanding exists of the safety and efficacy of surgical management of RD/RB secondary to OT. Another complication is toxoplasmosis-related macular holes (tMH), with sparse evidence on surgical outcomes. This meta-analysis aims to clarify clinical characteristics, and surgical results, and enhance understanding of RD, RB, and MH secondary to OT. METHODS PubMed, Cochrane, Embase and Web of Science database were queried for retrospective studies, case series and case reports that provided information on RD, RB and MH associated with OT and reported the outcomes of: (1) Retinal reattachment of RD/RB and tMH closure; (2) Best-corrected visual acuity (BCVA) improvement; and (3) Complications. Heterogeneity was examined with I2 statistics. A random-effects model was used for outcomes with high heterogeneity. Statistical analysis was performed using the software R (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria). RESULTS Fourteen final studies, comprising a total of 96 patients were analyzed, 81 with RD or RB and 15 with tMH. Overall, surgical management was associated with several advantages: a high rate of retinal reattachment of RD/RB of 97% (95% Confidence Interval [CI] 92-100%; I2 = 0%), retinal reattachment of just RD of 96% (95% CI 89-100%; I2 = 30%) and tMH closure 97% (95% CI 87-100; I2 = 12%). There were significant differences in BCVA after surgeries in studies of RD/RB (MD 0.60; 95% CI 0.35-0.65; I2 = 20%) and MH (MD 0.67; 95% CI 0.50-0.84; I2 = 0%). The overall complication rate associated with surgical procedures in RD/RB secondary to OT was confirmed to be 25%. CONCLUSIONS The systematic review and meta-analysis showed that the treatment approaches currently in use are effective, with a remarkable rate of retinal reattachment of RD/RB, tMH closure, and substantial improvements in visual acuity. More randomized, long-term studies on disease and surgical factors can provide valuable insights into their impact on anatomical and visual outcomes.
Collapse
Affiliation(s)
- Dillan Cunha Amaral
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | | - Ricardo Noguera Louzada
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
- Instituto de Olhos São Sebastião, Largo Do Machado 54, 1208, Rio de Janeiro, 22221-020, Brazil.
| |
Collapse
|
2
|
Souza GM, de Souza CE, Passos RM, Nascimento HMD, Belfort R. Recurrence of Ocular Toxoplasmosis after Vitrectomy: Case Report and Review. Ocul Immunol Inflamm 2023; 31:416-420. [PMID: 35081011 DOI: 10.1080/09273948.2022.2026408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study is to report one case of ocular toxoplasmosis (OT) recurrence after vitrectomy and review the scientific basis about it. CASE REPORT A 58-year-old male patient with previous OT, properly treated, underwent vitrectomy due to macular hole. During follow-up, patient evolved with recurrence of the OT. After 1 year, patient presents visual acuity of 20/200 and extensive macular scar. CONCLUSION There is no consensus on using perioperative antiparasitic therapy aiming recurrence prophylaxis. Studies with better statistical design are necessary to evaluate the recurrence risk after ocular surgeries and the possible recommendation of prophylaxis, especially in countries where the strains are more virulent and the recurrence more common.
Collapse
Affiliation(s)
- Guilherme Macedo Souza
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Carlos Eduardo de Souza
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Renato Magalhães Passos
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | | | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
3
|
Treatment outcomes of macular holes in the setting of uveitis: a scoping review. Graefes Arch Clin Exp Ophthalmol 2022; 260:2079-2086. [PMID: 35175410 DOI: 10.1007/s00417-022-05590-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 01/23/2022] [Accepted: 02/10/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We conducted a systematic review to evaluate the outcome of macular hole (MH) treatment in eyes with uveitis. DATA SOURCE We searched PubMed and Embase databases from inception through August 15, 2021. STUDY SELECTION We included eyes with MHs secondary to uveitis that were managed medically or underwent pars plana vitrectomy (PPV). We excluded eyes with idiopathic MH and those secondary to causes other than uveitis. RESULTS Of 27 articles, we identified 86 eyes with MH secondary to uveitis that received either conservative medical treatment alone or PPV with adequate follow-up. The mean (± SD) age of patients included in this review was 46.6 (± 16.8) years; 60.5% were males. The most common etiology of uveitis was Behçet's disease (34.6%) and toxoplasmosis (19.7%). The most common anatomical location of uveitis was posterior (59.3%) followed by panuveitis (35.2%). The mean (± SD) baseline LogMAR vision was 1.1 (± 0.5). Conservative medical treatment was employed in 34.9%, while PPV was performed in 65.1% of eyes. Overall, the mean (SD) LogMAR vision improved from 1.1 (± 0.5) at baseline to 0.7 (± 0.5) after treatment. Inflammation-related MHs were closed in 40% of eyes after conservative therapy and in 87.5% of eyes after PPV. Visual improvement occurred in most eyes (83.9%) that had successful closure of their MH. CONCLUSIONS Visual improvement occurs in most eyes that had successful closure of their inflammation-related MH. Conservative medical control of uveitis may lead to closure of inflammation-related MHs and is an important step prior to surgery, if required. Surgical intervention for inflammation-related MHs is associated with good functional and anatomical results.
Collapse
|
4
|
Erol MK, Bozdogan YC, Suren E, Gedik B. Treatment of a full-thickness macular hole and retinal detachment secondary to toxoplasma chorioretinitis that developed shortly after COVID-19: A case report. J Fr Ophtalmol 2022; 45:446-451. [PMID: 35034856 PMCID: PMC8733215 DOI: 10.1016/j.jfo.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 11/19/2022]
Abstract
Although ocular toxoplasmosis is usually a self-limiting infection, it can lead to severe reduction in visual acuity due to intense vitreous inflammation or involvement of posterior segment structures. Depending on the severity of intraocular inflammation, serious complications, including epiretinal membrane or retinal detachment may develop. In this paper, we aim to present a case that complicated by both a full-thickness macular hole and retinal detachment secondary to toxoplasmosis chorioretinitis that developed shortly after the novel coronavirus disease (COVID-19) and discuss our treatment approach. After the patient was diagnosed based on a routine ophthalmological examination, fundus imaging, and serological examination, functional and anatomical recovery was achieved through systemic antibiotherapy and vitreoretinal surgery. Full-thickness macular hole and retinal detachment are rare complications of ocular toxoplasmosis. However, there are only few publications in the literature concerning these complications and their surgical treatment. In this case report, we demonstrated the success of vitreoretinal surgery combined with antibiotic therapy on the posterior segment complications of ocular toxoplasmosis.
Collapse
Affiliation(s)
- M K Erol
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Y C Bozdogan
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey.
| | - E Suren
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - B Gedik
- Serik State Hospital, Antalya, Turkey
| |
Collapse
|
5
|
Shah S, Manayath GJ, Ranjan R, Venkatapathy N, Kanakath A. Sequential multimodal imaging of isolated necrotic full-thickness macular hole secondary to toxoplasma retinochoroiditis. Am J Ophthalmol Case Rep 2021; 23:101193. [PMID: 34435163 PMCID: PMC8374685 DOI: 10.1016/j.ajoc.2021.101193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/07/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose To describe the sequential multimodal imaging features of an isolated necrotic macular hole secondary to Toxoplasma retinochoroiditis. Observation A 23-year-old male was referred for surgical management of an idiopathic macular hole following sudden decrease in vision in his right eye. Right eye examination showed best-corrected visual acuity of 20/200, mild anterior segment inflammation, and a full thickness non operculated macular hole (MH) with ill-defined ragged margins and surrounding strip of pallid edema. Further multimodal imaging including optical coherence tomography (OCT), fundus autofluorescence (FAF), fluorescein angiography (FFA), and OCT-angiography confirmed the atypical configuration and inflammatory nature of MH. Serological tests showed elevated level of Toxoplasma gondii-specific antibodies. A diagnosis of necrotic isolated full-thickness MH secondary to toxoplasma retinochoroiditis was made. Patient was treated medically with anti-toxoplasma medication for 6 months. Sequential multimodal imaging highlighted the healing process of necrotic MH with vision improving to 20/80 at 6 months after presentation. Conclusion and importance A high level of suspicion and multimodal imaging plays an important role in accurate etiological diagnosis and management of atypical macular hole as in our case. Sequential multimodal imaging may provide an insight into the pathogenesis and healing pattern of such lesion.
Collapse
Affiliation(s)
- Shreyas Shah
- Department of Vitreoretina, Aravind Eye Hospital, Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
- Corresponding author.
| | - George J. Manayath
- Department of Vitreoretina, Aravind Eye Hospital, Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Ratnesh Ranjan
- Department of Vitreoretina, Aravind Eye Hospital, Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Narendran Venkatapathy
- Department of Vitreoretina, Aravind Eye Hospital, Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Anuradha Kanakath
- Department of Uvea, Aravind Eye Hospital, Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| |
Collapse
|
6
|
Abrishami M, Hosseini SM, Momtahen S, Zamani G. Foveal reorganization after treatment of acute foveal toxoplasmic retinochoroiditis. J Ophthalmic Inflamm Infect 2021; 11:18. [PMID: 34151385 PMCID: PMC8215007 DOI: 10.1186/s12348-021-00246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/18/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose To report a patient with impaired vision due to foveal involvement of toxoplasmic retinochoroiditis, who was successfully treated with intravitreal clindamycin and dexamethasone and oral therapy with azithromycin, trimethoprim-sulfamethoxazole, and prednisolone and led to successful visual and anatomic recovery. Case presentation A 32-year-old man presented with three-day history of gradually decreasing visual acuity, redness, pain and photophobia of the right eye. Anterior chamber cellular reaction, vitritis and a white retinochoroiditis patch with adjacent retinal vasculitis in the fovea was suggestive of the toxoplasmic retinochoroiditis. He was treated with intravitreal clindamycin and dexamethasone injection followed by six-week regimen of azithromycin, trimethoprim-sulfamethoxazole, and prednisolone. In serial optical coherence tomography imaging, retinitis patch changed to cavitary foveal destruction. Fovea reorganized gradually, and visual acuity concurrently improved from counting finger 3 m to 20/25. Conclusion In foveal toxoplasmic retinochoroiditis lesions, timely treatment is associated with retinal reorganization and visual improvement.
Collapse
Affiliation(s)
- Mojtaba Abrishami
- Eye Research Center, Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Qarani Blvd, Mashhad, 9195965919, Iran
| | - Seyedeh Maryam Hosseini
- Eye Research Center, Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Qarani Blvd, Mashhad, 9195965919, Iran
| | - Solmaz Momtahen
- Eye Research Center, Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Qarani Blvd, Mashhad, 9195965919, Iran
| | - Ghodsieh Zamani
- Eye Research Center, Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Qarani Blvd, Mashhad, 9195965919, Iran.
| |
Collapse
|
7
|
Zhang S, Xue CY, Liu YJ, Zhang WW, Xie ZG. Macular pucker, an atypical clinical presentation of ocular toxoplasmosis: a case report. BMC Ophthalmol 2021; 21:222. [PMID: 34001069 PMCID: PMC8130357 DOI: 10.1186/s12886-021-01983-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ocular toxoplasmosis caused by Toxoplasma gondii is an infectious disease which is widely distributed around the world and can present with various clinic manifestations. We are here reporting an unusual case presented with epiretinal membrane (ERM), i.e., macular pucker. CASE PRESENTATION A 16-year old male patient visited our outpatient clinic complaining of decreased vision for about 8 years in his left eye. The best-corrected visual acuity (BCVA) was 20/20 OD and 20/400 OS. There was sensory exotropia in his left eye. No inflammatory cells or flare were found in his anterior chamber or vitreous cavity OU. An ERM involving his left macular area was found on his dilated fundus exam, which was confirmed by Optical Coherence Tomography (OCT). The ERM was found to involve his left macular area with his foveal ellipsoid zone absent. The right eye was found to be within normal limit. After a thorough discussion with the patient and his parents about treatment options and surgical benefits, risks and alternatives, we performed vitrectomy, peeled off the ERM and collected the vitreous sample for parasite testing during the procedure. Patient's blood also was drawn for serological testing. Vitreous sample analysis and serological tests confirmed ocular toxoplasmosis OS as his final diagnosis. Unfortunately, the BCVA of this patient was not improved after the surgery, but the exotropia disappeared. CONCLUSION ERM is an unusual clinical presentation of ocular toxoplasmosis. We may add Toxoplasma gondii infection as a differential diagnosis when encountering ERM cases.
Collapse
Affiliation(s)
- Si Zhang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu Province, China
| | - Chun-Yan Xue
- Department of Ophthalmology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210008, Jiangsu Province, China
| | - Ya-Jun Liu
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu Province, China
| | - Wen-Wen Zhang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu Province, China
| | - Zheng-Gao Xie
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu Province, China.
| |
Collapse
|
8
|
Ikeda M, Baba T, Aikawa Y, Yotsukura J, Yokouchi H, Yamamoto S. Case of Macular Hole Secondary to Ocular Toxoplasmosis Treated Successfully by Vitrectomy with Inverted Internal Limiting Membrane Flap. Case Rep Ophthalmol 2021; 12:363-368. [PMID: 34054485 PMCID: PMC8136329 DOI: 10.1159/000514910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/31/2021] [Indexed: 11/19/2022] Open
Abstract
We report a case of ocular toxoplasmosis that developed a full-thickness macular hole (FTMH) which was successfully treated by pars plana vitrectomy combined with an inverted internal limiting membrane (ILM) flap. A 49-years-old Japanese man was aware of blurred vision in his right eye. Slit-lamp biomicroscopy, ophthalmoscopy, and optical coherence tomography (OCT) of the right eye showed that there was a grayish-white subretinal lesion at the macula accompanied by retinal exudation and mild vitreous flare and iritis. An increase in the level of serum IgM for toxoplasma led to a diagnosis of ocular toxoplasmosis. He developed a FTMH adjacent to the lesion 2 weeks after administering sulfamethoxazole/trimethoprim, and his decimal visual acuity was 0.15. Because the FTMH remained 3 months after the resolution of inflammation and his metamorphopsia persisted, vitrectomy with an inverted ILM flap was performed. After the surgery, the visual acuity improved to 0.2 with the closure of the FTMH confirmed by OCT. A FTMH in an eye with ocular toxoplasmosis was successfully closed by vitrectomy with an inverted ILM flap.
Collapse
Affiliation(s)
- Mizuki Ikeda
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuri Aikawa
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Jiro Yotsukura
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hirotaka Yokouchi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| |
Collapse
|
9
|
Ebrahimi Z, Torkashvand A, Zarei M, Faghihi H, Khalili Pour E, Imani Fooldi M, Ebrahimiadib N. Treatment of Inflammatory Macular Hole: Case Series and Review of Literature. Ocul Immunol Inflamm 2021; 30:966-972. [PMID: 33826475 DOI: 10.1080/09273948.2020.1867871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To present the success rate of nonsurgical management of full-thickness inflammatory macular hole (IMH)Method: Retrospective case series of five patients with IMH.Result: Five eyes from five patients with IMH enrolled in the current case series. All five eyes had successful closure with corticosteroid in the form of topical, periocular, or intravitreal injections. Systemic immunomodulatory treatment was employed for two patients, in addition to local therapy. For local therapy, one patient received topical eye drops, subtenon injection of corticosteroid, and intravitreal injection of combination of corticosteroid and anti-VEGF was performed in two patients. The closed macular hole reopened in one patient after two years, which required pars plana vitrectomy and anatomical and visual success achieved.Conclusion: Inflammatory macular holes can be closed with non-surgical interventions, although reopening may occur which requires surgery.
Collapse
Affiliation(s)
- Zohreh Ebrahimi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Torkashvand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zarei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooshang Faghihi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias Khalili Pour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Imani Fooldi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Sousa DC, Andrade GCD, Nascimento H, Maia A, Muccioli C. MACULAR HOLE ASSOCIATED WITH TOXOPLASMOSIS: A SURGICAL CASE SERIES. Retin Cases Brief Rep 2021; 15:110-113. [PMID: 29975259 DOI: 10.1097/icb.0000000000000757] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE There are currently limited data addressing the surgical outcomes of pars plana vitrectomy (PPV) in toxoplasmosis-related macular hole (tMH). We aim to report and discuss safety and efficacy of PPV for tMH. METHODS Surgical case series (n = 11), with minimum postoperative follow-up time of 6 months. Consecutive patients who underwent PPV for tMH from 2013 to 2016 were included. Indications for surgery were: visual acuity ≥ 0.6 logarithm of the minimum angle of resolution (Snellen 20/80 or less), no intraocular inflammation for more than 6 months, extrafoveal toxoplasmosis scar, elevated tMH borders on optical coherence tomography, and patient agreement with surgery. Surgery was performed-PPV with epiretinal (if present) and internal limiting membrane peeling. Safety and efficacy of PPV for tMH were addressed by evaluating: 1) surgery-related complications and 2) visual acuity improvement. RESULTS A total of 11 patients (6 male), with a mean age of 33.2 ± 11.0 years were studied. Mean preoperative best-corrected visual acuity significantly improved from 1.10 ± 0.24 (Snellen 20/252) to 0.43 ± 0.18 logarithm of the minimum angle of resolution (Snellen 20/54) at last follow-up visit (P < 0.01). The rate of visual acuity improvement (i.e., a gain of at least three lines) and tMH closure was 100% for both. The only reported surgery-related complication was cataract in one case. CONCLUSION Our results suggest that PPV is a safe and effective option in tMH cases. A controlled, longitudinal study would contribute to confirm these findings.
Collapse
Affiliation(s)
- David Cordeiro Sousa
- Department of Ophthalmology, Hospital de Santa Maria, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Vision Sciences Study Center, CECV, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Gabriel Costa de Andrade
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil ; and
- Research and Teaching Department, Retina Clinic, São Paulo, Brazil
| | - Heloísa Nascimento
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil ; and
| | - André Maia
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil ; and
- Research and Teaching Department, Retina Clinic, São Paulo, Brazil
| | - Cristina Muccioli
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil ; and
| |
Collapse
|
11
|
Babu K, Shah D, Bhagya M, Murthy KR. Near full thickness macular hole with an intact overlying internal limiting membrane following resolution of fulminant acquired toxoplasma retinitis -A unique finding. Indian J Ophthalmol 2020; 68:244-246. [PMID: 31856540 PMCID: PMC6951158 DOI: 10.4103/ijo.ijo_924_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 43-year-old immunocompetent male presented with focal macular retinitis with overlying vitritis in the right eye. His BCVA was counting fingers close to face. OCT showed increased intraretinal thickness at the area of retinitis with adjacent hypo reflectivity of the choroid. Serology was positive for IgM and IgG antibodies for toxoplasma. He received oral clindamycin 300 mg 4 times/day for 8 weeks. At 6 weeks, his BCVA was CF 2 metres. Fundus showed complete resolution of retinitis with formation of near, full thickness macular hole with intact overlying ILM. A small hyper reflective scar was seen at the base of the macular hole.
Collapse
Affiliation(s)
- Kalpana Babu
- Department of Uveitis and Ocular Inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Center, Bengaluru, Karnataka, India
| | - Dhwani Shah
- Department of Uveitis and Ocular Inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Center, Bengaluru, Karnataka, India
| | - M Bhagya
- Department of Uveitis and Ocular Inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Center, Bengaluru, Karnataka, India
| | - Krishna R Murthy
- Department of Uveitis and Ocular Inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Center; Department of Clinical Research, Institute of Bioinformatics, Bengaluru; Department of Clinical Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
12
|
Abstract
PURPOSE To study the etiology, clinical features, management options, and visual prognosis in various types of atypical macular holes (MHs). METHODS A review of the literature was performed, which focused on the etiopathogenesis of atypical or secondary MHs, their differentiating clinical features, management strategies, and varied clinical outcomes. Idiopathic or age-related, myopic, and traumatic MHs were excluded. RESULTS Atypical or secondary MHs arise out of concurrent ocular pathologies (dystrophy, degeneration, or infections) and laser/surgery. The contributing factors may be similar to those responsible for idiopathic or typical MHs, i.e., tangential or anteroposterior vitreofoveal traction or cystoid degeneration. The management is either observation or treatment of the underlying cause. The prognosis depends on the background pathology, duration of disease, and baseline visual acuity governed by the size of MH and morphologic health of underlying RPE and photoreceptors. The closer the morphology of atypical MH is to that of an idiopathic MH, the better the surgical outcome is. CONCLUSION With the advancements in retinal imaging, atypical MHs are now more frequently recognized. With increasing understanding of the underlying disease processes, and improvement in investigations and surgical treatment, management of atypical MHs may improve in the future.
Collapse
|
13
|
Abstract
PURPOSE To evaluate outcomes and complications of pars plana vitrectomy in patients with epiretinal membrane secondary to toxoplasmic retinochoroiditis. METHODS Retrospective evaluation of the records of 14 patients who underwent pars plana vitrectomy for epiretinal membrane secondary to toxoplasmic retinochoroiditis. The best-corrected visual acuity, intraoperative and postoperative complications, and macular optical coherence tomography were analysed. All patients received postoperative prophylactic treatment with trimethoprim/sulfamethoxazole. RESULTS Fourteen patients, 5 men and 9 women, were included. Mean follow-up period after surgery was 6.07 ± 2.64 months. Preoperative mean best-corrected visual acuity was 20/200, and postoperative mean best-corrected visual acuity was 20/60. There were no intraoperative complications. Three patients developed posterior capsule opacification, and one patient developed cataract. CONCLUSION Pars plana vitrectomy is a safe and effective procedure in patients with epiretinal membrane secondary to toxoplasmic retinochoroiditis, improving both visual acuity and anatomical result on macular optical coherence tomography. The most frequent postoperative complications were posterior capsule opacification and cataract. No recurrences of the disease were recorded.
Collapse
|
14
|
Branson SV, McClafferty BR, Kurup SK. Vitrectomy for Epiretinal Membranes and Macular Holes in Uveitis Patients. J Ocul Pharmacol Ther 2017; 33:298-303. [PMID: 28112568 DOI: 10.1089/jop.2016.0142] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Macular pathology, including macular holes (MHs), epiretinal membranes (ERMs), and macular edema, is a cause of irreversible vision loss in the setting of uveitis. Medical management involves corticosteroids, immunomodulatory medications, and biologics to control inflammation. Pars plana vitrectomy (PPV) has been suggested as a therapy for uveitis, with reports of reduced inflammation and decreased dependence on medication postoperatively. Currently, PPV is reserved for retinal detachments, vitreous opacities, and ERMs, causing vitreomacular traction. However, little is known about the visual outcomes of PPV with ERM peel for MH, or in ERM without evidence of traction in the context of uveitis. METHODS Review of small case series and case reports support both conservative medical treatment and vitrectomy, independently, and in combination, in the management of macular pathology in the setting of uveitis. RESULTS AND CONCLUSIONS Further studies are required to study uveitic etiologies separately with respect to visual outcomes after vitreoretinal surgery and medical management.
Collapse
Affiliation(s)
- Sara V Branson
- 1 Ophthalmology Department, Emory University School of Medicine , Atlanta, Georgia
| | - Brendan R McClafferty
- 2 Departments of Ophthalmology and Family Medicine, Wake Forest University , Winston-Salem, North Carolina
| | | |
Collapse
|
15
|
Tanaka R, Obata R, Sawamura H, Ohtomo K, Kaburaki T. Temporal changes in a giant macular hole formed secondary to toxoplasmic retinochoroiditis. Can J Ophthalmol 2015; 49:e115-8. [PMID: 25284113 DOI: 10.1016/j.jcjo.2014.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 06/16/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Rie Tanaka
- The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
| | - Ryo Obata
- The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hiromasa Sawamura
- The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kazuyoshi Ohtomo
- The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Toshikatsu Kaburaki
- The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
16
|
Kim BH, Cha DM, Yu HG. A Case of Full Thickness Macular Hole Secondary to Old Traumatic Choroidal Rupture. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.2.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Bo Hyuck Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Dong Min Cha
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea
| | - Hyeong Gon Yu
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| |
Collapse
|