Abstract
Purpose: :
To report the anatomic and functional outcomes of intravitreal clindamycin and dexamethasone for the treatment in zone 1 toxoplasmic retinochoroiditis (TRC).
Methods: :
Non-comparative, retrospective, multicentric interventional case series. We reviewed the medical records of twelve consecutive patients (eyes) with posterior pole (zone 1) TRC who were treated weekly or every 4 weeks (during pregnancy) with intravitreal injections of clindamycin (1.5 mg /0.1 mL) and dexamethasone (400 µg/0.1 mL).These patients had intolerance to oral medication, contraindication to oral medication due to pregnancy, lack of response despite oral antimicrobial treatment, or were treated with concomitant oral and local therapy to avoid or limit foveal and/or optic disc involvement. Ophthalmic evaluation included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), assessment of central macular thickness (CMT) and resolution of inflammation by optical coherence tomography (OCT), clinical examination, and fluorescein angiography, and assessment of adverse events. Patients were followed for 24 months. Main outcome measures were resolution of TRC, changes in BCVA, and OCT.
Results: :
Resolution of TRC was achieved in all cases with a mean number of injections of 3.6 (range: 2 to 5 injections) with a mean interval of 15.5 ± 4 days. At 24 months a significant reduction in CMT by OCT was observed from 387.6 ± 70.1 µm to 185.2 ± 44.7 µm (p=0.0004). Baseline BCVA was logarithm of the minimal angle of resolution (logMAR) 1 ± 0.4 (20/200) and it improved to 0.5 ± 0.4 (20/63) (p=0.002) at the end of follow up. Ten (83.3%) eyes improved 2 or more ETDRS lines of BCVA, and 2 (20%) eyes remained stable at 24 months. One patient's vision was limited because of macular scarring. No ocular or systemic adverse events were observed. No recurrences at 24 months of follow up were observed.
Conclusions: :
Intravitreal clindamycin and dexamethasone was associated with resolution of zone 1 TRC, functional and anatomic improvement in patients that did not tolerate systemic therapy, had contraindication to oral medications due to pregnancy, patients whose disease progressed despite systemic therapy or with lesions located at or near the fovea and/or optic disc.
Keywords: toxoplasmosis • antibiotics/antifungals/antiparasitics • chorioretinitis