Optic nerve involvement in ocular toxoplasmosis: 12 year data from a tertiary referral center in Turkey.

Mert Simsek,Pinar Cakar Ozdal,Ali Mert Kocer

doi:10.5935/0004-2749.20190058

Abstract

To evaluate the prevalence, clinical characteristics, and types of optic nerve involvement in patients with ocular toxoplasmosis. For this retrospective cross-sectional study, we examined all patients with active ocular toxoplasmosis referred to our Uveitis Section during the last 12 years, and we included patients with optic nerve involvement in the study. The primary outcome was the prevalence of optic nerve involvement, and secondary outcomes included the types of optic nerve involvement and the final best-corrected visual acuity after treatment. The prevalence of optic nerve involvement was 14.4%, with the leading cause being the activation of a juxtapapillary lesion (70.5%). We found papillitis in two eyes and neuroretinitis in two eyes (11.7% for each). We only detected one optic nerve involvement secondary to a distant active lesion (5.8%). Sixteen patients (94.1%) had unilateral ocular toxoplasmosis. The overall final best-corrected visual acuity after treatment was 10/10 (LogMAR = 0.0) excluding the three patients with a juxtapapillary scar involving the macula. Optic nerve involvement was common in patients with ocular toxoplasmosis. The main type of optic nerve involvement was caused by activation of an old juxtapapillary lesion. Treatment was quickly effective, but the best-corrected visual acuity was dependent on the presence of a scar in the papillomacular bundle.

Highlights

Ocular toxoplasmosis (OT) is a parasitic infection caused by Toxoplasma gondii (T. gondii) that usually invades the posterior segment of the eye and is the major cause of infectious posterior uveitis[1] causing 25%-85% of the cases[2].Ocular involvement in toxoplasmosis is the result of a postnatally acquired infection or a congenital disorder in patients exposed in utero
ABSTRACT | Purpose: To evaluate the prevalence, clinical characteristics, and types of optic nerve involvement in patients with ocular toxoplasmosis. For this retrospective cross-sectional study, we examined all patients with active ocular toxoplasmosis referred to our Uveitis Section during the last 12 years, and we included patients with optic nerve involvement in the study
The primary outcome was the prevalence of optic nerve involvement, and secondary outcomes included the types of optic nerve involvement and the final best-corrected visual acuity after treatment

Summary

Introduction

Ocular toxoplasmosis (OT) is a parasitic infection caused by Toxoplasma gondii (T. gondii) that usually invades the posterior segment of the eye and is the major cause of infectious posterior uveitis[1] causing 25%-85% of the cases[2].Ocular involvement in toxoplasmosis is the result of a postnatally acquired infection or a congenital disorder in patients exposed in utero. Ocular toxoplasmosis (OT) is a parasitic infection caused by Toxoplasma gondii (T. gondii) that usually invades the posterior segment of the eye and is the major cause of infectious posterior uveitis[1] causing 25%-85% of the cases[2]. OT signs are most commonly detected in the posterior ocular segment with a retinitis lesion that appears as a white-gray, elevated, and edematous area of retinal tissue frequently adjacent to an old pigmented scar[5]. This typical retinal lesion may be associated with varying degrees of vitritis (especially overlying the active retinal lesion) and retinal vasculitis (involving both the retinal veins and arteries) in the posterior segment. The lesions may involve the optic nerve directly or develop in its proximity[6,7]

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