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Z. Ahmad, A. Hynes; Treatment of Ocular Bartonellosis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):705.
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Cat scratch disease is caused by the gram negative rod Bartonella hensalae. Well recognized ocular complications of the disease include Parinaud oculoglandular syndrome and neuroretinitis. The disease is usually self limited and does not require treatment. However, in cases of posterior ocular involvement, where there is concern for vision loss, the role of antibiotics and steroids remains unclear. We conducted a review of the literature in an effort to clarify the role of treatment in Bartonella associated neuroretinitis. To date, there have been no controlled clinical trials to investigate the role of antibiotics or steroids in the treatment of Bartonella neuroretinitis and no meta-analysis or comprehensive literature review.
A Medline search was conducted using the keywords "cat scratch and eye (102 articles)," "cat scratch and ocular (55 articles)," "Bartonella and eye (75 articles)," and "Bartonella and ocular (44 articles)." All English language articles including patients with posterior ocular involvement with proven Bartonella infection and recorded initial and final visual acuities were included in our review (50 articles, 122 patients).
A total of 122 patients were included. Patients presented with a large array of posterior findings including papillitis, multifocal retinochoroitidis, macular star, vascular occlusions, serous retinal detachments, retinal hemorrhages, and cotton wool spots. Visual acuity ranged from 20/15 to light perception in the afflicted eye. 24% of patients (n=29) had bilateral eye involvement. 43% of patients (n=52) were treated with various antibiotics, 3% (n=4) with steroids, 33% (n=40) with both, and 21% (n=26) received no treatment. Visual acuity improved in most patients (90%) regardless of treatment. Visual acuity at presentation was worse than 20/40 in 79% of patients (n=96), and worse than 20/200 in 41% of patients (n=50). Final visual acuity was worse than 20/40 in 25% of patients (n=31), and worse than 20/200 in 7% of patients (n=8). Vision improved in 90% of patients (n=110), remained unchanged in 4% of patients (n=5), and declined in 6% of patients (n=7). Of the patients with no change in visual acuity, 20% (n=1) received steroids, 40% (n=2) received both antibiotics and steroids, and 40% (n=2) received no treatment. Of the 7 who worsened, 29% (n=2) received antibiotics and 71% (n=5) received both antibiotics and steroids.
Based on our review, we find there is not enough clinical evidence to recommend treatment of B. hensalae related neuroretinitis. There was no significant difference in final visual outcome for those treated with antibiotics alone, steroids alone, or combination of both, and those who received no treatment.
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