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P. K. Huang, S. Teoh; Spectrum of Toxoplasma Ocular Infections in South East Asian Population. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5872.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the clinical and demographic features and outcomes of management of ocular toxoplasmosis (OT) seen in an East Asian population.
A retrospective case series review of fourteen patients.
Patients with ocular toxoplasmosis were identified from our database in Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, between 2003-2009. All patients underwent ophthalmological assessments by uveitis specialists with diagnosis of OT made clinically.
Of 955 patients seen at our Uveitis Specialist clinic between 2004-2009, 14 (1.5%) were diagnosed with clinical ocular toxoplasmosis. This comprised 6.0% of 237 patients with posterior uveitis seen. There were 11 females and 3 males, of which 7 (50.0%) were domestic helpers from Indonesia. The mean age at presentation was 31.4 years. Patients were followed-up for a mean of 37.7 weeks. Most common symptoms were blurring of vision (85.7%), floaters (71.4%). Nine out of 11 (81.8%) of patients were tested positive for Toxoplasma IgG, whilst IgM was negative in all but 1 patient. Toxoplasma PCR was positive in only 1 out of 5 (20.0%) samples tested. All patients presented with panuveitis, 3 (29.0%) presented with vision ≤20/60 and 2 (20.0%) had vitritis of at least grade 2+.Thirteen patients were treated with specific anti-toxoplasmic medications. Twelve (85.7%) had final visual acuity ≥20/40. Vision in 2 (14.3%) patients remained poor due to presence of macular scars, 1 patient had exudative retinal detachment. The median time to resolution was 5.5 weeks. No patients presented with a relapse during our follow-up.
From our study, a typical East Asian patient with acute OT would likely be a young female presenting with blurring of vision and floaters. Examination findings show panuveitis with anterior uveitis of 1-2+ cells and vitritis 1+ cells. Toxoplasma IgG may be a good serological marker in suspected individuals whilst use of aqueous sample for PCR still remains debatable from our series. Treatment modalities may be variable but good visual outcome can be expected in most cases in the absence of macular scars. Recurrent OT appears to be uncommon. The East Asian demographics, presentations and outcome of OT are generally similar to studies from Europe and United States. However, our patients were younger as compared to studies from North America.
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