Abstract
Purpose::
To present 23 cases from 23 patients with recurrent ocular Toxoplasmosis, analyzing the incidence of macular involvement within these cases.
Methods::
This is an Institutional prospective study of 23 eyes from 23 immunocompetent patients who were evaluated between January 2001 and September 2005. There were 10 female and 13 male subjects ranging in age from 17 to 41 years old with an average age of 28. All patients had an active unilateral recurrent toxoplasmic retinitis. The patients were submitted to an ocular examination including fluorescein and indocyanine green angiography: 1) at the time of diagnosis; 2) with the improvement of the inflammation; and 3) after the cicatrization of the active recurrent lesion. We used the Friedman and Knox classification of the recurrent retinitis presentation at the time of diagnosis.In order to classify macular involvement, we used the Hogan description of the macula as the center of the retina, anatomically measuring approximately 5.5 mm in diameter . All patients were treated during six weeks with oral antitoxoplasmic drugs, such as sulfadiazine and pyrimethamine, and folinic acid. Oral prednisone (20 mg/day) was also used in patients who presented vitreous inflammation, or a recurrent lesion close to or in the macula region.
Results::
Seven patients (30,4%) presented macular involvement during a recurrence of the ocular Toxoplasmosis. Large destructive recurrent retinitis, in which active retinitis involves an area usually larger than the optic nerve head, was the most common form of recurrence presented among these patients (5 out of 7). 2 out of the 7 patients presented the punctate inner retinal form of recurrence, characterized by a gray area of the active retinitis with minimal edema and vitreous reaction. On the ICG angiography, we also found multiple hypofluorescent dots surrounding the active lesions in four out of seven eyes with macular involvement. In two eyes, remote hypofluorescent dots were also seen in areas of the fundus, distant from the active recurrent lesion and in areas of retina that appeared normal on fundoscopy and fluorescein angiography at the time of diagnosis
Conclusions::
Recurrence is a common event in ocular Toxoplasmosis. In our series of recurrent ocular Toxoplasmosis, macular involvement was diagnosed in 30.4 % of the cases. Large destructive retinochoroiditis involving the macular region was found to be the most frequent form of the recurrence. Remote hypofluorescent dots, as we found on ICG angiography was an undescribed finding in macular involvement following ocular Toxoplasmosis.
Keywords: fungal disease • chorioretinitis • macula/fovea