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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.
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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.
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Kohler JM, Mammo DA, Bennett SR, Davies JB. Primary ocular toxoplasmosis secondary to venison consumption. Am J Ophthalmol Case Rep 2022; 29:101776. [PMID: 36544752 PMCID: PMC9762148 DOI: 10.1016/j.ajoc.2022.101776] [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: 11/15/2021] [Revised: 11/04/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose To describe primary ocular toxoplasmosis infection related to ingestion of undercooked venison. Observations This single site, retrospective case series reviewed 4 patients with primary ocular toxoplasmosis that was acquired by ingesting undercooked venison. De-identified data was collected regarding baseline patient characteristics including age, sex, past medical and ocular history, onset of symptoms, visual acuity (VA), response to treatment, and workup. All patients with acquired toxoplasmosis had similar chronology of systemic and ocular symptoms. Exposure occurred in October or November and systemic symptoms developed within 2 weeks, followed by ocular symptoms an average of 2.6 months later. Average age at onset was 56 ± 13 (age ± SD) years old and all were male. Average initial and final VA were 20/50 and 20/50, respectively. Positive anti-toxoplasma IgM and IgG serologies were found in all cases. All patients were treated with trimethoprim/sulfamethoxazole and achieved rapid improvement. Complications occurred in 50% of cases and included epiretinal membrane, cystoid macular edema, vitreoretinal traction, and neovascularization. Conclusions and importance Consumption of undercooked venison is a source of primary ocular toxoplasmosis even in immunocompetent hosts and has a clear chronology. A presentation of retinochoroiditis during the winter months should prompt questioning for exposure to wild game.
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Affiliation(s)
- James M. Kohler
- University of Utah Department of Ophthalmology & Visual Sciences, Salt Lake City, USA
| | | | | | - John B. Davies
- Retina Consultants of Minnesota, Minneapolis, USA,Corresponding author. Retina Consultants of Minnesota, 3601 W 76th St, Suite 300, Edina, MN, 55435, USA.
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Dillon AB, Budoff G, McCannel CA, Tsui E, Pullarkat ST, Schwartz SD. Ocular Toxoplasmosis: No Stranger to the Masquerade Ball. JOURNAL OF VITREORETINAL DISEASES 2022; 6:391-398. [PMID: 37006900 PMCID: PMC9954925 DOI: 10.1177/24741264211056769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This article illustrates multiple atypical manifestations of ocular toxoplasmosis masquerading as acute retinal necrosis and vitreoretinal lymphoma. Methods: Two case presentations are discussed, and the body of pertinent literature is reviewed and discussed. Results: In these cases, an extensive workup and attention to history lead to the correct diagnosis and management. Conclusions: Aggressive cases of ocular toxoplasmosis may present in a variety of phenotypes that may mimic other vision- and potentially life-threatening conditions, particularly in a milieu of inadequate endogenous and exogenous antimicrobial defenses.
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Affiliation(s)
- Alexander B. Dillon
- Vitreoretinal Surgery Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Greg Budoff
- Vitreoretinal Surgery Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Colin A. McCannel
- Vitreoretinal Surgery Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Edmund Tsui
- Uveitis Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | | | - Steven D. Schwartz
- Vitreoretinal Surgery Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
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Kalogeropoulos D, Sakkas H, Mohammed B, Vartholomatos G, Malamos K, Sreekantam S, Kanavaros P, Kalogeropoulos C. Ocular toxoplasmosis: a review of the current diagnostic and therapeutic approaches. Int Ophthalmol 2022; 42:295-321. [PMID: 34370174 PMCID: PMC8351587 DOI: 10.1007/s10792-021-01994-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 07/30/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up and therapeutic approach of ocular toxoplasmosis focusing mainly on the postnatally acquired form of the disease. METHODS A meticulous literature search was performed in the PubMed database. A supplementary search was made in Google Scholar to complete the collected items. RESULTS Ocular toxoplasmosis is one of the most frequent infectious etiologies of posterior uveitis. It typically presents with retinochoroiditis. Setting an accurate diagnosis depends to a considerable degree on detecting characteristic clinical characteristics. In addition to the evaluation of clinical features, the diagnosis of toxoplasmosis relies at a large degree on serologic testing. The detection of the parasite DNA in the aqueous or vitreous humor can provide evidence for a definitive diagnosis. The current mainstay for the treatment, if necessary, is the use of oral antibiotic with systemic corticosteroids. Recent evidence suggests other therapeutic approaches, such as intravitreal antibiotics can be used. CONCLUSION Recent developments in the diagnostic and therapeutic approach have contributed to preventing or limiting vision loss of patients suffering from ocular toxoplasmosis. Further studies are required to provide a better understanding of epidemiology, pathogenesis, diagnosis, and treatment with a significant impact on the management of this challenging clinical entity.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece.
| | - Hercules Sakkas
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | - Georgios Vartholomatos
- Hematology Laboratory, Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Malamos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
| | | | - Panagiotis Kanavaros
- Department of Anatomy-Histology-Embryology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
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Abstract
Glaucoma is an intraocular pressure-related ophthalmic disease with multiple causes that results in an optic neuropathy and vision loss. Intraocular pressure elevation is among its strongest risk factors. While glaucoma is mostly primary in etiology, secondary glaucoma is not infrequent. Recognizing its cause is imperative, since treatment is often different depending on the pathophysiologic mechanism. Numerous clinically relevant ophthalmic infections can result in robust inflammatory responses that may result in pressure elevation or intraocular anatomic configurations that predispose to pressure elevation. Knowing the mechanisms by which these infections can lead to glaucoma is critical in treating, and we consolidate what is currently known in regards to how infectious diseases lead to glaucoma.
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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.
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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.
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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.
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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
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Canamary AM, Monteiro IR, Machado Silva MKM, Regatieri CVS, Silva LMP, Casaroli-Marano RP, Muccioli C. Quality-of-Life and Psychosocial Aspects in Patients with Ocular Toxoplasmosis: A Clinical Study in a Tertiary Care Hospital in Brazil. Ocul Immunol Inflamm 2020; 28:679-687. [PMID: 31589483 DOI: 10.1080/09273948.2019.1612453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate quality of life in patients with uveitis-related to toxoplasmosis and its correlation with demographic, ocular involvement and psychosocial aspects.Methods: Data were collected through standardized interviews using a form to collect clinical and demographic data, in addition forms such as HADS, SF-12, NEI-VFQ-25 for health-related quality of life and anxiety and depression symptoms.Results: 81 patients were included with a mean age of 41.5 ± 14.5 years, females (50.6%) They were divided into three categories of best corrected visual acuity in the better seeing eye: normal (0-0.4 logMAR, 60 participants), low vision (0.48-0.9 logMAR, 9 participants) and blindness (>1 logMAR, 12 participants). The mean of VFQ-25 score was 75.5 ± 19.5 and the mean of SF-12 physical and mental components scores were 48.5 ± 7.4 and 52.4 ± 10.6 for health-related quality of life (HRQol). Anxiety symptoms were most prevalente than depression and were found in 38% of the subjects.Conclusions: Slightly more than a quarter of the sample presented impaired vision. It is associated with worsening of the quality of life since it affects mostly mental and related to the vision domains. This affects familiar, social and in addition, labor relations, since the majority of the subjects are in the economically active age group.
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Affiliation(s)
| | - Isabela Ribeiro Monteiro
- Ophthalmology and Visual Science, Universidade Federal de Sao Paulo Escola Paulista de Medicina , Sao Paulo, Brazil
| | | | | | - Luci Meire Pereira Silva
- Ophthalmology and Visual Science, Universidade Federal de Sao Paulo Escola Paulista de Medicina , Sao Paulo, Brazil
| | | | - Cristina Muccioli
- Ophthalmology and Visual Science, Universidade Federal de Sao Paulo Escola Paulista de Medicina , Sao Paulo, Brazil
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Magliyah MSA, Al-Khars WI. Ocular toxoplasmosis related macular traction: A case report and review of the literature. Saudi J Ophthalmol 2019; 33:84-87. [PMID: 30930669 PMCID: PMC6424709 DOI: 10.1016/j.sjopt.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 07/02/2018] [Accepted: 07/17/2018] [Indexed: 12/04/2022] Open
Abstract
This is a case of toxoplasmosis retinochoroiditis which has resulted in the formation of vitreomacular traction upon resolution which is rarely associated with ocular toxoplasmosis. A 39-year-old male came with an active toxoplasmosis retinochoroiditis. Best-corrected visual acuity, full ophthalmic slitlamp examination, colour fundus photography, spectral domain optical coherence tomography (SD-OCT), and fluorescein angiography were performed. Presumed ocular toxoplasmosis diagnosis was supported by serological tests. The patient was treated medically for 45 days and on his follow up he developed macular traction which was shown in SD-OCT with a good visual acuity. Vitreoretinal traction is a rare complication of ocular toxoplasmosis and ranges from mild to severe traction which might require surgery. We suggest a close follow up for patients with toxoplasmosis retinochoroiditis and early recognition could avoid exposing patients to surgery.
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Scott NL, Sridhar J, Flynn HW. Management of giant retinal tear and retinal detachment in a patient with active toxoplasmosis retinochoroiditis. Am J Ophthalmol Case Rep 2018; 10:226-228. [PMID: 29780938 PMCID: PMC5956709 DOI: 10.1016/j.ajoc.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/27/2018] [Accepted: 03/05/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To describe the management of a giant retinal tear with retinal detachment in a patient with active toxoplasmosis retinochoroiditis. Results While receiving systemic medications for toxoplasmosis, the patient underwent scleral buckling, pars plana vitrectomy, and C3F8 gas tamponade without removal of the lens. At last follow-up, best corrected visual acuity was 20/20 with an attached retina and the toxoplasmosis lesion was inactive. Conclusions and Importance: Using modern surgical techniques, anatomic and clinical success is possible during active retinochoroiditis.
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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.
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Oray M, Ozdal PC, Cebeci Z, Kir N, Tugal-Tutkun I. Fulminant Ocular Toxoplasmosis: The Hazards of Corticosteroid Monotherapy. Ocul Immunol Inflamm 2015; 24:637-646. [DOI: 10.3109/09273948.2015.1057599] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Merih Oray
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pinar Cakar Ozdal
- Ulucanlar Eye Education and Training Hospital Ophthalmology Clinic, Ankara, Turkey
| | - Zafer Cebeci
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nur Kir
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Surgical Management of Uveitis Patients. CURRENT SURGERY REPORTS 2015. [DOI: 10.1007/s40137-015-0121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE To assess the frequency of retinal detachment (RD) and associated clinical features in ocular toxoplasmosis. METHODS A review of the medical records of patients diagnosed with ocular toxoplasmosis and follow-up of 6 months or more was conducted. All patients were seen at the Casey Eye Institute at the Oregon Health & Science University over a 9-year period (2003-2012). Demographic data, presence of RD and/or vitritis, and treatments were reviewed. Main outcome measures were the rate of RD in ocular toxoplasmosis, degree of vision loss, and final anatomical status of the retina. Disease- and treatment-related factors associated with poor visual outcome were also analyzed. RESULTS Thirty-five eyes of 28 patients with ocular toxoplasmosis and sufficient follow-up were studied. Median age of patients was 40 years (range, 7-93 years). Median follow-up time was 22.5 months (range, 6-96 months). Four of thirty-five eyes (11.4%) developed RD with a frequency of 0.06 RD events per patient-year of follow-up in this sample in a single center. Of four patients with RD, three underwent pars plana vitrectomy and one underwent laser retinopexy. Two of the 4 patients had recurrent RD requiring scleral buckle. At final follow-up, all patients who underwent surgical repair had attached retinas; however, 3 of 4 patients had severe vision loss (20/200 or worse). CONCLUSION Retinal detachment occurred in 11% of eyes in this study that led to severe vision loss despite successful RD repair.
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Fieß A, Halstenberg S, Fellas A, Frisch I, Steinhorst UH. Anaphylactic reaction to intravenous corticosteroids in the treatment of ocular toxoplasmosis: a case report. J Med Case Rep 2014; 8:110. [PMID: 24694257 PMCID: PMC4230808 DOI: 10.1186/1752-1947-8-110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 01/17/2014] [Indexed: 11/24/2022] Open
Abstract
Introduction This case report presents for the first time an acute systemic allergic reaction to corticosteroids in a patient with ocular toxoplasmosis after treatment with intravenous cortisone, and discusses alternative treatments. Case presentation We present the case of a 57-year-old Caucasian woman with an anaphylactic reaction after intravenous injection of prednisolone-21-hydrogensuccinate (Solu-Decortin® H) given for the treatment of toxoplasmosis-associated chorioretinitis. Immediately after the injection, she developed an acute erythema of the legs and abdomen, angioedema, hypotension (blood pressure 80/40mmHg), tachycardia (heart rate 140/minute), hyperthermia (38.8°C), and respiratory distress. Allergological examinations showed a positive skin-prick test to prednisolone and methylprednisolone. In addition, an oral exposure test with dexamethasone (Fortecortin®) and betamethasone (Celestamine®) was conducted to find alternative corticosteroids for future treatments. After oral application, no local or systemic reactions were observed for these two substances. Conclusions This case report demonstrates that systemic allergic reactions are possible in patients with uveitis or other inflammatory ophthalmological conditions treated with intravenous corticosteroids. Intravenous administration of cortisone, for example, in the treatment of ocular toxoplasmosis, should always be conducted with caution because of a possible allergic reaction. For patients who react to a particular steroid, it is necessary to undergo allergological testing to confirm that the compound in question is indeed allergenic, and to identify other corticosteroids that are safe for future anti-inflammatory treatments.
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Affiliation(s)
- Achim Fieß
- Department of Ophthalmology, Dr, Horst-Schmidt-Clinics, Wiesbaden, Germany.
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Macular hole secondary to toxoplasmic retinochoroiditis. Int Ophthalmol 2013; 34:141-3. [PMID: 23479051 DOI: 10.1007/s10792-013-9754-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 03/02/2013] [Indexed: 10/27/2022]
Abstract
Ocular toxoplasmosis causes abnormalities in the vitreous that are responsible for several types of well-known complications including retinal detachment and epiretinal membranes. We report on a patient who developed toxoplasmic panuveitis with a full-thickness macular hole (MH) and was successfully treated with vitreoretinal surgery. A 35-year-old Hispanic female presented with a 2-week history of loss of visual acuity and metamorphopsia in her right eye. Funduscopy revealed a typical toxoplasmosis lesion and a MH, which was confirmed by optical coherence tomography. After 8 weeks of medical treatment with sulfamethoxazole (800 mg)/trimethoprim (160 mg) and steroids, the intraocular inflammation was considered inactive. Pars plana vitrectomy with inner limiting membrane peeling and injection of 24 % sulphur hexafluoride gas were performed to treat the MH, without success. Repeat pars plana vitrectomy was then performed with injection of 14 % perfluoropropane (C3F8). Closure of the MH was achieved after this second procedure. Vitreoretinal surgery may be safe and effective for treating MHs secondary to toxoplasmosis lesions, a very uncommon complication of this disease.
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de Smet MD, Julian K. Management of Combined Inflammatory and Rhegmatogenous Retinal Detachment. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00112-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hazar L, Altan C, Basarır B, Yazıcı AT, Oyur G, Demirok A. Reactivation of ocular toxoplasmosis after pars plana vitrectomy. Retin Cases Brief Rep 2013; 7:368-370. [PMID: 25383807 DOI: 10.1097/icb.0b013e3182964fa5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report a case with reactivation of toxoplasma choroiretinitis after pars plana vitrectomy. PATIENTS AND METHODS A 58-year-old female patient was diagnosed with secondary epiretinal membrane in her right eye. Bimanual 23-gauge pars plana vitrectomy and membrane peeling was performed. At first week postoperatively, visual acuity decreased; in slit-lamp examination, there were 3+ cells in the anterior chamber with keratic precipitate. Fundoscopic examination revealed reactivation of chorioretinitis adjacent to the previous scar. RESULTS The patient was diagnosed with reactivation of toxoplasma chorioretinitis and treated with oral trimethoprim-sulfamethoxazole, clindamycin and topical prednisolon acetate, and cyclopentolate drops for 5 weeks. Forty-eight hours after initiation of antibiotics, oral prednisone was added to the regimen and the dose was tapered to zero over the following 5 weeks. After 3 weeks of treatment, lesion was inactivated. CONCLUSION Ocular toxoplasmosis reactivation may develop after pars plana vitrectomy. After intraocular surgery, reactivation of ocular toxoplasmosis should be considered in the follow-up.
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Affiliation(s)
- Leyla Hazar
- *Eye Department, K\x{0131}z\x{0131}ltepe Hospital, Mardin, Turkey †Beyoglu Eye Research and Training Hospital, İstanbul, Turkey ‡Eye Department, Batman Hospital, Batman, Turkey
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Park S, Lew HM, Song JH. Intravitreal Clindamycin Injection for Toxoplasmic Retinochoroiditis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.7.1046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Suyoun Park
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Ho Min Lew
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Ji Hun Song
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
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Delair E, Latkany P, Noble AG, Rabiah P, McLeod R, Brézin A. Clinical manifestations of ocular toxoplasmosis. Ocul Immunol Inflamm 2011; 19:91-102. [PMID: 21428746 DOI: 10.3109/09273948.2011.564068] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Clinical manifestations of ocular toxoplasmosis are reviewed. Findings of congenital and acute acquired ocular toxoplasmosis include retinal scars, white-appearing lesions in the active phase often associated with vitritis. Complications can include fibrous bands, secondary serous or rhegmatogenous retinal detachments, optic neuritis and neuropathy, cataracts, increased intraocular pressure during active infection, and choroidal neovascular membranes. Recurrences in untreated congenital toxoplasmosis occur in teenage years. Manifestations at birth are less severe, and recurrences are fewer in those who were treated promptly early in the course of their disease in utero and in the first year of life. Severe retinal involvement is common at diagnosis of symptomatic congenital toxoplasmosis in the United States and Brazil. Acute acquired infections also may be complicated by toxoplasmic retinochoroiditis, with recurrences most common close to the time of acquisition. Suppressive treatment can reduce recurrent disease.
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Affiliation(s)
- Emmanuelle Delair
- Université Paris Descartes, Service d'Ophtalmologie, Hôpital Cochin, Paris, France
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Pars plana vitrectomy in the treatment of severe complicated toxoplasmic retinochoroiditis. Eur J Ophthalmol 2011; 21:83-8. [PMID: 20602328 DOI: 10.5301/ejo.2010.2075] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To present the anatomic and functional results of pars plana vitrectomy performed in severe complicated toxoplasmic retinochoroiditis. METHODS Three patients, 2 women and 1 man aged 57, 22, and 57 years, are presented. The first patient was under immunosuppressive therapy for dermatomyositis and underwent diagnostic/therapeutic vitrectomy for severe toxoplasmic panuveitis with dense vitritis. The other 2 patients underwent vitrectomy for macula-off rhegmatogenous retinal detachment that developed after severe toxoplasmic panuveitis. RESULT Preoperative visual acuity was hand movement for the first 2 patients and 20/400 for the third. All patients received pars plana vitrectomy with epiretinal membrane peeling, laser photocoagulation, and SF6 gas tamponade. The second and third patients needed 5 and 3 additional operations, respectively, including extensive retinotomies and silicone-oil tamponade, for recurrent retinal detachment due to proliferative vitreoretinopathy. At the end of the follow-up period (11, 5, and 1 year, respectively), the retina was attached and visual acuity was 20/30 for the first patient but counting fingers for the other 2 patients. CONCLUSIONS Severe panuveitis and/or recurrent retinal detachment may develop in some cases of ocular toxoplasmosis, compromising the visual prognosis. Retinal detachment due to toxoplasmosis is generally complex, and long-acting tamponade with silicone oil should be contemplated for anatomic retinal reattachment.
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Affiliation(s)
- Miriam Englander
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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