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Alexandre Brito Cosimo, Rodrigo Costa, Joao Paulo Fernandes Felix, Rodrigo Pessoa Cavalcanti Lira, Carlos E Arieta, Mauricio Nascimento, ; Clinical features and visual prognosis of 148 patients diagnosed with ocular toxoplasmosis evaluated in a Brazilian public hospital.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5282.
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To ascertain the clinical features, visual outcome and ocular complications in a large series of patients diagnosed with ocular toxoplasmosis.
For the period of 26 months from 08/2011 to 10/2013, we evaluated 148 patients with presumed ocular toxoplasmosis. To determine the patients to be included in our study, we defined acute toxoplasmic retinochoroiditis as cream-white lesions associated with vitreitis and positive IgG or IgM sorology. All patients were treated with 800mg-160mg of trimethoprim-sulfamethoxazole twice daily.
In our study, 49% of the patients were male, and only 1.36% of all patients presented bilateral acute lesions. The mean age at time of presentation was 33.23 years old. The main symptom was blurred vision, which was cited as the first symptom in 61% of the patients. Exams revealed that 28% of the patients presented visual acuity and were able to see fewer than 34 letters (ETDRS scale); in addition, 49% had visual acuity between 34 and 73 letters, and 23% had vision better than 73 letters in the affected eye before treatment. Conjunctival injection was found in 34% of the patients, and keratic precipitates were observed in 37% of the affected eyes. Anterior chamber cells were seen in 53% of the participants. We also found that 4.76% of the patients had posterior synechia. In the posterior segment evaluation, vitreitis was observed in 79.5% of the patients. Retinochoroiditis lesions were located in the Holland zone I in 22.44% of the patients. In the serological examination, no IgM-positive patients were found. In addition, 45.3% of the patients had IgG titles higher than 1:200. Iris bombé, retinal detachment, vitreous opacities, and epiretinal membranes were observed as complications.
Ocular toxoplasmosis is responsible for visual impairment in many patients. The disease affects young patients. In our patient pool, the most common symptom was blurred vision. Therefore, early diagnosis and treatment is important for preventing ocular complications and improving visual outcome.
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