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Ambar Faridi, Christina J. Flaxel, Steven Yeh, Justine R. Smith, Eric B. Suhler, James T. Rosenbaum, Steven T. Bailey, Tim Stout, Andreas K. Lauer; Outcomes Of Retinal Detachment Associated With Ocular Toxoplasmosis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2778.
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To evaluate functional and anatomic outcomes in patients with ocular toxoplasmosis who developed retinal detachment (RD).
A retrospective, comparative single-center study of patients diagnosed with ocular toxoplasmosis was performed. All patients were seen at the Oregon Health and Science University over an 8-year period (2003-2011). Demographic data, presence and type of retinal detachment, severity of vitritis, and surgical and medical (systemic and intravitreal) treatments were reviewed. Outcomes analyzed were rates of RD, complications, final status of the retina, and final visual acuity. Visual impairment (VI) was rated as mild (20/30-20/60), moderate (20/70-20/160), or severe (20/200 or worse).
35 eyes in 27 patients diagnosed with toxoplasmosis with sufficient follow-up (i.e. ≥ 6 months) were analyzed. The mean age of patients was 47.7 years (range 7-93). Mean follow-up time was 30.2 months (range 6-96). 11 eyes were treated with systemic medical therapy alone whereas 6 eyes were treated with combination systemic and intravitreal therapy. 12 patients were treated with systemic prednisone. 10 eyes were not treated due to inactive inflammation. 7 eyes (20%) developed RD; 4 were rhegmatogenous, 2 tractional, and 1 serous RD. 5 patients underwent surgical repair with pars plana vitrectomy in 4 eyes and scleral buckle in 1 eye. Pneumatic retinopexy was performed in 1 eye. Surgery was deferred in 1 patient. 2 of 6 eyes (33%) that underwent surgical repair had recurrent RD. 1 eye developed 3 recurrent RDs due to new breaks followed by proliferative vitreoretinopathy-related traction (PVR), while another eye developed 2 recurrent RDs secondary to PVR-related traction alone. Both eyes underwent repeat surgical interventions, including pars plana vitrectomy, scleral buckle, membrane peel, and silicone oil tamponade. All eyes that underwent operative repair were attached at final follow-up. Of 7 eyes with RD, 3 eyes (43%) had severe and 1 eye (14%) had moderate VI at final follow-up. 3 eyes had no VI.
20% of eyes with ocular toxoplasmosis developed RD. 33% of eyes that underwent surgical repair developed recurrent RDs. 43% of patients with RD had severe VI despite successful RD repair. Treatment of ocular toxoplasmosis and associated RDs may require several therapies, including surgery and systemic and intravitreal medications. In some patients, multiple surgical procedures are necessary due to recurrent RD, which may develop from new breaks or PVR-related traction. Further studies are needed to optimize the functional outcomes in ocular toxoplasmosis.
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