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Rabia Bourkiza, Benedict Girling, Angela Rees, Carlos Pavesio, Mark Westcott; Characteristics and outcomes of a cohort of primary ocular toxoplasmosis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4175.
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© ARVO (1962-2015); The Authors (2016-present)
The literature about primary ocular toxoplasmosis is quite limited. The purpose of this study was to explore the clinical features of primary ocular toxoplasmosis and to assess outcomes
A retrospective review of patients presenting to Moorfields Eye Hospital between 2010 and 2016. Pathology results were searched for raised toxoplasma IgM. Patient records were retrieved to identify cases diagnosed with ocular toxoplasmosis. Data was collected on patients’ demographics, size and location of chorioretinal lesions, anterior chamber and vitreous inflammation, presenting logMAR visual acuity (VA), treatment, and VA at 3 month, 6 month and last follow up.
21 eyes of 19 patients (11 male; 8 female) with primary ocular toxoplasmosis were identified over the 6 year study period. Mean age was 55.8 (28-74). Three patients were immunocompromised. Twelve (63%) had involvement of the left eye and five (26%) of the right; two (10%) had bilateral involvement. A chorioretinal lesion was present in 20 cases. The size of the lesion was >2 disc diameter (DD) in 6 cases, 2DD in 4, 1DD in 9, 1/2DD in 1. The lesion was in the macular area in 9 cases, in the supratemporal quadrant in 7 cases, infratemporal in 1, supranasal in 2, and infranasal in 1 case. AC inflammation was 3+ in 1 case, 2+ in 3, 1+ in 5, 0.5+ in 3 cases, and there was no AC inflammation in 9 cases. Vitreous inflammation was graded as 3+ in 1 case, 2+ in 6, 1+ in 4, 0.5+ in 1 and no inflammation in 9 cases. Mean IOP at presentation was 15.6mmhg (6-23). Mean presenting VA was 0.55 (0-1.3). Mean follow up was 20.85 (1-67 months). At 3 months, the mean VA was 0.43 (0-1.47), and at final follow up this was 0.73 (0-3). Nine eyes (45%) had <0.3 VA, 6 (30%) had 0.3-1 VA, and 5 (25%) had a VA of > 1. Adverse events at 6 months included retinal detachment in 3 cases and 1 epiretinal membrane. Seventeen patients received oral steroids (30-70mg) with a mean initial dose of 53.75mg and a mean time to <10mg of 7.8 weeks (4-12 weeks). Azithromycin was used in 16 (80%) cases and pyrimethamine in 15 (75%).
In this small retrospective case series primary ocular toxoplasmosis occurred in an older age group and was mainly a normotensive uveitis with mild involvement of the vitreous in most cases. 40% presented with macular involvement, which resulted in high visual morbidity despite widely accepted treatment protocols.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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