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DM Moshfeghi, JL Davis, EM Dodds, CA Couto, CI Santos, CY Lowder; Disseminated Toxoplasmic Retinochoroiditis: Diagnostic Approach, Clinical Findings, Treatments, and Outcomes . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4300.
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Purpose: To describe the clinical features and diagnostic approach to patients with diffuse necrotizing retinitis due to ocular toxoplasmosis. Methods: This was a retrospective, multicenter investigation that identified patients with atypical ocular toxoplasmosis resembling acute retinal necrosis. Interventions included serum antibody testing for viral and T. gondii infection, vitreous cultures (virus, bacteria, fungi), vitreous serology for virus and T. gondii, and polymerase chain reaction (PCR) of aqueous and vitreous specimens for virus and T. gondii. Pars plana vitrectomy with retinal biopsy was performed as indicated. Response to anti-toxoplasma therapy was graded as resolution of inflammation, lack of progression of retinitis, or progressive disease. Functional outcome included final visual acuity and anatomic status of the retina. Results: Twenty-one eyes (19 patients) had atypical presentations of toxoplasmic retinochoroiditis simulating the acute retinal necrosis syndrome. Eight of 19 patients received acyclovir for presumed acute retinal necrosis syndrome prior to receiving appropriate anti-toxoplasma therapy. Seventeen of 19 patients had unilateral disease. Multifocal areas of retinitis occurred in 10 eyes, unifocal retinitis in 8 eyes, and panophthalmitis in 3 eyes. The diagnosis was finalized by different techniques: following response to anti-toxoplasma medications in 7 patients, positive intraocular T. gondii culture in 4 patients, vitreous T. gondii antibody in 3 patients, a positive PCR test in 2 patients, a positive Goldmann-Witmer coeffient in 2 patients, and retinal biopsy in 1 patient. Eighteen of 21 eyes responded to appropriate therapy. Two eyes were enucleated and one became phthisical. Conclusion: Ocular toxoplasmosis can present as a diffuse necrotizing retinitis that can present a diagnositic challenge. We utilized a combination of diagnostic modalities with a high degree of success at halting progression of disease in 18 of 21 eyes and secured a diagnosis in all patients. From this study we have arrived at an algorithm that can be utilized to differentiate between acute retinal necrosis and disseminated toxoplasmic chorioretinitis.
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