Third-generation optical coherence tomography findings in punctate retinal toxoplasmosis

A new perspective in the treatment follow-up of toxoplasma retinochoroiditis: Infiltrate thickness measurement

BACKGROUND

This study aimed to describe the spectral domain optical coherence tomography (SD-OCT) findings of active lesions in toxoplasma retinochoroiditis cases and to examine the changes in retinochoroidal infiltrate thickness after treatment.

METHODS

A total of 21 newly diagnosed patients with ocular toxoplasmosis were included in this prospective study. A complete ophthalmologic examination and SD-OCT were performed at the first visit. The patients were followed up weekly, and the SD-OCT images were taken over the lesion at each visit for 6 weeks. The characteristics of the active retinochoroiditis focus at the first visit were determined, and the infiltrate thicknesses at all visits were analyzed.

RESULTS

A statistically significant BCVA difference was observed at the first visit and at the last visit 6 weeks later (p < 0.01). The first week after treatment showed a significant decrease in infiltrate thickness (113.904 ± 86.001 µm). In the following weeks, this decrease continued more softly. The thickness change at 6 weeks was significantly reduced (16.095 ± 14.784 µm) compared with the previous ones. Weekly infitrate thickness changes were compared among themselves; a statistically significant difference was found between the 1st and 2nd weeks and the 5th and 6th weeks (p = 0.035 and p = 0.007, respectively). Detached posterior vitreous in 71% (15/21) and increased posterior vitreous thickness in 76% (16/21) of active lesion were detected. All patients had 100% (21/21) increased retinal reflectivity and disorganized retinal layers, and choroidal hypo-reflectivity was observed in 86% (18/21).

CONCLUSION

SD-OCT is a useful imaging modality in the diagnosis and follow-up of ocular toxoplasmosis cases. Serial thickness measurements of toxoplasma retinochoroiditis lesions may help confirm our diagnosis and determine the need for treatment.

Vitreoretinal interface anomalies in patients with a history of toxoplasmosis retinochoroiditis

PURPOSE

To evaluate vitreoretinal interface anomalies over time in patients diagnosed with toxoplasmosis retinochoroiditis (TRC) and progression of the chronic disease.

STUDY DESIGN

Retrospective clinical study.

METHODS

The clinical records of 36 patients with TRC were studied retrospectively. All patients underwent standard ophthalmological examinations and optical coherence tomography (optical coherence tomography: OCT). Vitreoretinal interface changes and retinal layers in the macula and lesion area were evaluated.

RESULTS

The fovea was involved in 9 (25%) patients. OCT of the scar region showed retinal layer thinning and disorganization in all cases. Complete posterior vitreous detachment (PVD) was detected in 9 (25%) cases, incomplete PVD in 22 (61%) cases and no PVD in 5 (13.8%) cases. In 23 (63%) of the 36 patients with inactive TRC lesions, an epiretinal membrane (ERM) was detected by follow-up OCT, i.e., in 14 (60%) patients with incomplete PVD, 8 (34.7%) with complete PVD, and 1 (4%) with no PVD. Vitreoschisis was found in 5 of 22 patients with incomplete PVD; an ERM developed in 4 of these 5 patients. No ERM developed only in the macula, i.e., independent of the TRC scar region.

CONCLUSIONS

Vitreoretinal interface anomalies are common in patients diagnosed with TRC, including those with incomplete PVD. We observed no progression of vitreoretinal interface anomalies during the follow-up of patients diagnosed with TRC.

Foveal reorganization after treatment of acute foveal toxoplasmic retinochoroiditis

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.

Optical coherence tomography findings in toxoplasma retinochoroiditis

Purpose:

This study aimed to evaluate the optic coherence tomography (OCT) findings in patients with toxoplasmic retinochoroiditis (TRC).

Methods:

A total of 12 eyes of 12 patients with active TRC were included in the study. At baseline, at the first-month follow-up, at the sixth-month follow-up and at the 1-year follow-up, the TRC lesion OCT and macula OCT were evaluated.

Results:

Hyperreflectivity of the inner retinal layers and an increase in retinal thickness were observed on the OCT examinations of all the patients with an active TRC lesion. The retinal thickness decreased and the reflectivity of retinal layers was disorganized in the OCT images obtained in the follow-up period. Partial posterior hyaloid detachment (PHD) and no PHD were detected in 11 cases and 1 case, respectively. Epiretinal membrane (ERM) had developed in the adjacent region of the scar in 7 patients. With the regression of the lesion, the disruption of the ellipsoid zone (EZ), retinal pigment epithelium (RPE) and external limiting membrane (ELM) improved in the adjacent areas. In all the eyes, ERM and the PHD configuration did progress during the follow-up period. Vitreoschisis was found in 4 of the 11 patients with partial PHD. It was observed that ERM developed in all the patients with vitreoschisis.

Conclusion:

ERM and partial PHD were common in the TRC patients, and there was no progression during the follow-up period. Regeneration of the EZ, RPE and ELM was observed in the follow-up period.

Sequential optical coherence tomography images of retinal necrosis in acute ocular toxoplasmosis

PURPOSE

To describe the features of sequential spectral-domain optical coherence tomography (OCT) images in an eye with acute primary toxoplasmosis.

METHODS

Case report of an individual diagnosed with acute primary toxoplasmic retinochoroiditis. Initial and follow-up spectral-domain OCT findings are described.

RESULTS

This patient developed retinitis as a result of an acute infection consistent with Toxoplasma gondii suggested by toxoplasma-specific IgM serology and the response to therapy. The retinitis appeared initially as a hyperreflective region on spectral-domain OCT. An intraretinal cyst consistent with T. gondii parasitic infection was identified. Subsequent OCT images demonstrated progression to full-thickness retinal necrosis with the development of cystic spaces in the retina.

CONCLUSION

Optical coherence tomography may be useful in characterizing the features, extent, and location of retinitis caused by T. gondii. Specific OCT features may indicate whether the infection is acute phase or becoming quiescent.

Spectral optical coherence tomography findings in patients with ocular toxoplasmosis and active satellite lesions (MINAS Report 1)

PURPOSE

To characterize the active retinochoroiditis lesion observed in patients with the classic clinical presentation of ocular toxoplasmosis (OT) utilizing spectral optical coherence tomography (SOCT).

METHODS

Twenty-four patients with OT and satellite lesions underwent standardized ophthalmologic examination and multimodal fundus imaging. The SOCT findings observed at presentation were described.

RESULTS

The mean age of the fourteen (58.3%) women and ten (41.7%) men was 27.6 years. The mean LogMAR ETDRS best-corrected visual acuity was 0.58 (Snellen equivalent, 20/80(+1) ). On SOCT evaluation, the posterior hyaloid was diffusely thickened in 23 (95.8%) of 24 eyes, increased hyper-reflective signals in the vitreous were observed in 18 (75.0%), and vitreal spherical hyper-reflective depositions were observed in 12 (50.0%) eyes. In all patients, at the active OT lesion site, the inner retinal layers were abnormally hyper-reflective with full-thickness disorganization of the retinal reflective layers (smudge effect); associated choriocapillaris/choroidal optical shadowing was observed in 22 (91.7%) eyes. The retina was thickened in 22 (91.7%) eyes, the retinal pigment epithelium-Bruch membrane reflective complex was focally increased or contained focal splits in 16 (66.7%) eyes and the choroid appeared thickened in 17 (70.8%) eyes. Disorganization of the outer retinal highly reflective layers adjacent to the active OT lesion was observed in all eyes.

CONCLUSION

Full-thickness disorganization of the retinal reflective layers, generally associated with some degree of posterior optical shadowing, was observed in the active OT lesion in all patients. The posterior hyaloid was often thickened and, adjacent to the OT lesion, the outer retina was consistently altered.

Review for disease of the year: differential diagnosis of ocular toxoplasmosis

The diagnosis of ocular toxoplasmosis is mainly clinical, based in the presence of focal necrotizing retinochoroiditis often associated with a preexistent chorioretinal scar, and variable involvement of the vitreous, retinal blood vessels, optic nerve, and anterior segment of the eye. Recognition of this clinical spectrum of toxoplasmic retinochoroiditis is crucial, but other infectious, noninfectious, and neoplastic entities should also be considered in the differential diagnosis. Investigations such as serological tests, polymerase chain reaction of ocular fluids, and assessment of intraocular antibody synthesis are helpful in uncertain cases. This article provides an overview of the differential diagnosis of ocular toxoplasmosis, focusing on the most important entities to be considered and emphasizing distinctive features of each one of them in the clinical setting. Ocular toxoplasmosis has multiple clinical manifestations, which partially overlap with those of other entities and these should be carefully considered when making the differential diagnosis, particularly in less typical cases.

Evaluation of spectral domain and time domain optical coherence tomography findings in toxoplasmic retinochoroiditis

PURPOSE

To investigate spectral domain optical coherence tomography (SD-OCT) findings and compare them with time domain (TD)-OCT imaging of macula and retinochoroiditis lesions of patients with toxoplasmosis.

DESIGN

Prospective cross-sectional study.

METHODS

Ten eyes of 10 patients with active toxoplasmic retinochoroiditis were included. Morphologic features from the macula and retinochoroiditis lesions were obtained at baseline and at 6-week follow up. Scan acquisition protocols for TD-OCT included raster and radial lines through the retinochoroiditis lesion, fast macular, and a linear scan from the lesion to the fovea, whereas the acquisition protocols for SD-OCT also included horizontal volume scans at the lesion site and at the macula. Thickness measurements obtained by SD-OCT were analyzed.

RESULTS

At baseline, macular serous retinal detachment was observed in five patients; two of them only seen by SD-OCT. Retinochoroidal lesions were 4260 μm distant from the fovea on average (R = 681-7130) and this distance had an indirect correlation to the presence of macular detachment. Epiretinal membrane and vitreo-macular traction were also observed. The posterior hyaloid was not identified in four patients by TD-OCT and only in one by SD-OCT at baseline. Perilesional subretinal fluid was observed in two patients. The median retinal thickness significantly decreased at the retinochoroiditis lesion (P = 0.0004), and all the patients remained with disorganized retinal layers reflectivity at follow up.

CONCLUSION

SD-OCT is a useful tool in the diagnosis of macular changes related with toxoplasmic retinochoroiditis. SD-OCT is superior in evaluating retinal changes associated with ocular toxoplasmosis.

Optical coherence tomography applications in pediatric ophthalmology

In pediatric ophthalmology, test results may be limited by a child's ability to cooperate. Invasive and contact methods such as applanation tonometry, ultrasound biometry, and pachymetry are sometimes difficult to perform. Optical coherence tomography (OCT) has become a widely used noncontact method to obtain cross-sections of various ocular structures. In this review, we describe the principles and clinical applications of OCT, with special attention to pediatric ophthalmology.

Vitreoretinal morphology in active ocular toxoplasmosis: a prospective study by optical coherence tomography

AIM

To investigate the third generation optical coherence tomography (OCT3) findings in patients with active ocular toxoplasmosis.

METHODS

A prospective observational case series, including 15 patients with active ocular toxoplasmosis in at least one eye evaluated at a single centre. Vitreoretinal morphological features at baseline and changes within a 24-week follow-up interval on OCT3 were evaluated.

RESULTS

The active ocular toxoplasmosis lesion was classified clinically as punctate (n = 6), focal (n = 6) or satellite (n = 3). Retinal layers were hyper-reflective at the active lesion site, and some degree of retinal pigment epithelium-choriocapillaris/choroidal optical shadowing was seen in all patients. In general, the retina was thinned at the active lesion site in eyes with punctate lesions and thickened in eyes with focal and satellite lesions. When detected by OCT3, the posterior hyaloid appeared thickened. While focally detached over punctate lesions, the posterior hyaloid was partially detached, but still attached to the lesion in focal and satellite lesions. Additional findings (not detected on clinical examination) include diffuse macular oedema (n = 6), vitreomacular traction (n = 3) and maculoschisis (n = 1). During follow-up, a decrease in retinal thickness and focal choriocapillaris/choroidal relative hyper-reflectivity were observed at the former lesion site, and posterior vitreous detachment progressed/occurred in all patients.

CONCLUSION

OCT3 enabled identification of morphological features underestimated on clinical examination in patients with ocular toxoplasmosis, which may expand the clinical spectrum of the disease. Further studies are needed to verify the relevance of OCT3 in assisting with the diagnosis and management of ocular toxoplasmosis.