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Julie M. Rosenthal, David Kim, Christina Flaxel, Eric B. Suhler, Thomas Hwang, Steven Bailey; Spectral-Domain OCT in Active Toxoplasmosis Chorioretinitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2170.
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Toxoplasmosis chorioretinitis is frequently diagnosed based on a constellation of clinical findings. In the acute setting, it can be difficult to differentiate toxoplasmosis from other infections, such as viral infections, and invasive ocular fluid sampling is necessary. In the present study, spectral-domain optical coherence tomography (sd-OCT) obtained images of patients with active toxoplasmosis chorioretinitis are reviewed and morphologic features are characterized.
A retrospective case review of patients with active toxoplasmosis seen at Casey Eye Institute who underwent Heidelberg Spectralis sd-OCT testing. To be included, active toxoplasmosis chorioretinal lesions were required to have the typical clinical characteristics of toxoplasmosis chorioretinitis along with a white appearance to the retina with limited vitritis allowing for quality sd-OCT images. Volumetric line scans with 19 raster line scans centered on the active retinitis were reviewed for the presence of the following: sub-retinal fluid, inner retinal disorganization, loss of inner segment/outer segment junction, hyper-reflective particles in the vitreous adjacent to the retina (corresponding to vitritis), intact retinal pigment epithelial layer and ability to characterize choroid.
Diagnosis of toxoplamosis chorioretinitis was based on classic clinical findings in 5 patients while the 6th patient required PCR confirmation. Sub-retinal fluid was present in five of six patients. All patients demonstrated inner retinal disorganization, loss of inner segment /outer segment junction, and hyper-reflective particles in the vitreous adjacent to retina. The retinal pigment epithelium appeared intact in all patients and the choroid could not be adequately visualized.
In patients with active toxoplasmosis chorioretinitis, the majority of patients have subretinal fluid and all had significant loss of both inner and outer retinal structures with preservation of the retinal pigment epithelium. Further study and characterization of sd-OCT images with comparisons to other infectious retinitis may help determine possible distinguishing characteristics.
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