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A. A. Macedo, S. Hsieh, D. Chruscicki, R. M. Lieberman, R. M. Fischer; A Comparison of Presentation and Outcome in Immunocompetent and Immunocompromised Patients With Posterior Uveitis Secondary to Toxoplasmosis in an Indigent Patient Population. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5128. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
: To investigate the impact immune status has upon the presentation and visual outcome in patients with ocular Toxoplasmosis gondii.
Retrospective chart review (1/2003 to the present) was performed to include the following data: patient demographics, initial and long-term best corrected visual acuities (BCVA), location and size of lesion, associated ocular manifestations, serology, immune status, treatment and complications.
Eighteen patients were identified with posterior uveitis secondary to toxoplasmosis. Of those patients, 14 patients (15 eyes) had follow up of one month or longer and were included in this cohort of patients. There were 10 Hispanic patients, one African-American patient, and one Caucasian patient. Age ranged from 22 to 56, with a gender distribution of 8 males and 6 females. Three patients were HIV positive ( 21.4%), with CD4 counts ranging at presentation of ocular disease from 64 to 302. The two documented recurrences, both in HIV positive patients, occurred at CD4 counts <200. Average follow up time for all patients was 1.12 years, (range from 1 month to 4.36 years). Initial BCVAs ranged from 20/20 to light perception (LP) in immunocompetent patients, and from 20/40 to LP in immunocompromised patients. Final BCVA ranged from 20/20 to counting fingers. Final BCVA was calculated using both logmar and patient-years.Associated ocular manifestations include vitritis (graded 0-4), vasculitis, presumed congenital versus acquired disease, recrudescence of disease, size of initial lesion and presence of multiple or satellite lesions. In the immunocompromised patients, 100% exhibited vascultis, and all had newly acquired disease, as well. Nine immunocompetent patients had a presumed recrudescence of disease, and 9 showed vasculitis . There appeared to be no difference in gradation of vitritis at presentation between the two groups. Initial lesion size was calculated using fundus photographs (Zeiss, Visupac 3.4), and comparison made between the two groups. Complications included macular hole and epiretinal membrane.
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