Abstract
Purpose :
To describe ocular manifestations and risk factors for poor visual outcomes in patients with acute toxoplasmosis.
Methods :
From April 2015 to July 2023, patients presenting with ocular symptoms and serological markers indicative of recent T. gondii infection were enrolled in a prospective study at the Uveitis Service of the Hospital das Clínicas de Ribeirão Preto (Ribeirão Preto, São Paulo, Brazil). The diagnosis of ocular toxoplasmosis was established by a uveitis specialist, primarily based on a consistent clinical presentation plus serological evidence of acute infection with T. gondii (immunoglobulin M+), and exclusion of other specific causes of uveitis. Each patient had a complete eye examination using slit-lamp and indirect ophthalmoscopy, and best corrected visual acuity (BCVA) was documented at presentation and follow-up visits. Atypical disease was defined by: multiple active retinal lesions, extensive retinal lesions (>10 optic disc diameter), or intraocular inflammation without retinal lesions.
Results :
Fifty-one patients were included in the study (n=62 eyes). Forty-one individuals (80.4%) presented with typical disease, while ten (19.6%) had an atypical presentation. The majority of eyes had one retinal lesion (n=43; 69.4%), 15 had between two and four lesions (24.2%), one had five lesions (1.6%), and one had anterior uveitis only (1.6%); in two eyes (3.2%) fundus visualization was not possible. Retinal lesions were present in the macula in 19 eyes (30.6%), periphery in 21 (33.9%), posterior pole but not macula in 12 (19,4%), and posterior pole and periphery concurrently in seven (11.3%). Fourteen patients (27.4%) had at least one episode of reactivation, and the mean time to recurrence was 19.8 months. Twenty individuals suffered from ocular complications (39.2%). At the end of the follow-up period, 18 eyes (29.0%) had BCVA ≥ 20/40, 21 (33.9%) had BCVA of 20/50 - 20/200, and 23 (37.1%) had BCVA ≤ 20/200. Macular lesion (OR 33.50; p-value 0.0042) and presence of a complication (OR 28.99; p-value 0.0014), but not gender, age, reactivations, or size or number of lesions, were associated with final BCVA ≤ 20/200.
Conclusions :
Retinal lesions involving the macula and the presence of ocular complications were risk factors for poor visual outcomes in patients with ocular toxoplasmosis and serological evidence of acute infection.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.