Abstract
PurposeTo present unique cystoid changes occurring in patients with ocular toxoplasmosis observed in spectral domain optical coherence tomography (OCT).MethodsForty-six patients (80 eyes) with a diagnosis of ocular toxoplasmosis, who underwent volume OCT examination between January 2005 and October 2012, were retrospectively collected. Review of clinical examination findings, fundus photographs, fluorescein angiograms (FA) and OCT image sets obtained at initial visits and follow-up. Qualitative and quantitative analyses of cystoid space phenotypes visualized using OCT.ResultsOf the 80 eyes included, 17 eyes (15 patients) demonstrated cystoid changes in the macula on OCT. Six eyes (7.5%) had cystoid macular edema (CME), 2 eyes (2.5%) had huge outer retinal cystoid space (HORC), 12 eyes (15%) had cystoid degeneration and additional 3 eyes (3.75%) had outer retinal tubulation due to age related macular degeneration. In one eye with HORC, the lesion was seen in the photoreceptor outer segment, accompanied by photoreceptor elongation and splitting. Three eyes presented with paravascular cystoid degeneration in the inner retina without other macular OCT abnormality.ConclusionsIn this study, different phenotypes of cystoid spaces seen in eyes with ocular toxoplasmosis using spectral domain OCT (SD-OCT) were demonstrated. CME presented as an uncommon feature, consistently with previous findings. Identification of rare morphological cystoid features (HORC with/without photoreceptor enlongation or splitting) on clinical examination had provided evidence to previous experimental models, which may also expand the clinical spectrum of the disease. Cystoid degeneration in the inner retina next to the retinal vessels in otherwise “normal” looking macula was observed, which may suggest more often clinical evaluation for those patients. Further studies are needed to verify the relevance of cystoid features seen on SD-OCT in assisting with the diagnosis and management of ocular toxoplasmosis.
Highlights
Ocular toxoplasmosis is the most common form of posterior uveitis in otherwise healthy individuals, leading to legal blindness in at least one eye in approximately 25% of cases [1]
Baseline Characteristics One hundred and fifty patients with a diagnosis of ocular toxoplasmosis were seen in our tertiary center within the study period
All optical coherence tomography (OCT) images included in the study met reading center criteria for sufficient image quality
Summary
Ocular toxoplasmosis is the most common form of posterior uveitis in otherwise healthy individuals, leading to legal blindness in at least one eye in approximately 25% of cases [1] It occurs mainly in children and young adults, with significant morbidity, and has considerable socio-economic implications. More severe disease commonly develops in immunosuppressed patient populations, those with the acquired immune deficiency syndrome In such patients, the occurrence of ocular toxoplasmosis may be an important indicator of intracranial involvement [2]. The majority of recurrent retinal lesions arise at the borders of old retinochoroidal scars. The appearance of such lesions may be the result of parasite release from tissue cysts, with invasion and destruction of adjacent cells [3], [4]. Advances in in vivo imaging of retinal lesion morphology, especially optical coherence tomography (OCT), combined with known histopathology, may enable further understanding of disease progression mechanisms
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