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C. T. Bou Chacra, A. Al Dawalibi, K. F. Tabbara; Management of Macular Toxoplasmic Retinochoroiditis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5133.
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To assess the effects of corticosteroids with the concomitant systemic antimicrobial therapy in patients with macular toxoplasmic retinochoroiditis.
We conducted a retrospective, comparative, interventional case series study according to a defined protocol for the treatment of macular toxoplasmic retinochoroiditis. Thirteen immunocompetent patients with clinical evidence of macular toxoplasmic retinochoroiditis lesions measuring less than 1.5 mm each were included. All patients received antimicrobial therapy for toxoplasmic retinochoroiditis. Five had posterior subtenon’s triamcinolone, three were given oral prednisone, and the remaining five were not given steroids.
All thirteen patients demonstrated signs of clinical improvement with therapy. Patients were followed-up for a mean follow-up period of 13 months with a range of 6-27 months. One out of the 13 patients developed recurrence of toxoplasmic retinochoroiditis 11 months after treatment. Distance of the lesion from the fovea and not the type of treatment determined the final visual outcome. Patients whose lesions were close to the fovea had poor visual outcome.
Toxoplasmic lesions in the macular region may lead to rapid damage of the photoreceptors in the macular area. The use of periocular triamcinolone acetonide and oral prednisone with antimicrobial coverage was equally effective when compared to antimicrobial therapy alone in patients with macular toxoplasmosis. The use of periocular steroids may abrogate the inflammatory response and prevent such damage. The proximity of the lesion to the fovea and not the type of therapy was responsible for the poor visual outcome. Prophylactic intermittent use of antimicrobial agents may be indicated in patients with macular toxoplasmosis in immunocompetent hosts.
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