Abstract
PurposeTo ascertain the clinical features and visual outcome of toxoplasma retinochoroiditis in a large series of cases.Subjects and MethodsTwo hundred and thirty subjects diagnosed with active toxoplasma retinochoroiditis were prospectively followed for periods ranging from 269 to 1976 days. All patients presented with active retinochoroiditis and positive IgG T. gondii serology at the beginning of the study and received a standardized drug treatment for toxoplasmosis, both in the first episode and in the subsequent recurrences.ResultsThe group involved 118 (51.3%) men and 112 (48.7%) women, with ages ranging from 14 to 77 years, mean of 32.4 years (SD = 11.38). Primary retinochoroidal lesions were observed in 52 (22.6%) cases and active retinochoroiditis combined with old scars in 178 (77.4%) subjects at the beginning of the study. A hundred sixty-two recurrent episodes in 104 (45.2%) patients were observed during follow-up. New subclinical retinochoroidal lesions were detected in 23 of 162 (14.2%) recurrences episodes during the follow-up. Posterior segment complications were observed in 73 (31.7%) subjects. Retinochoroidal lesions adjacent to the optic nerve and in the macular area were observed in 27 of 40 (67.5%) cases of severe visual impairment (VA = 20/200 or worse).ConclusionToxoplasma retinochoroiditis in this population had a high recurrence rate after an active episode. Severe visual impairment was associated with location of the retinochoroidal scar, recurrences and posterior segment complications. It is crucial to consider the location of the lesion in studies analyzing visual prognosis as a measure for treatment effectiveness and prevention strategies.
Highlights
Severe visual impairment was associated with location of the retinochoroidal scar, recurrences and posterior segment complications
Ocular involvement by Toxoplasma gondii may cause severe visual impairment and is the main etiology of posterior uveitis in many parts of the world, questions about the course of the disease remain unanswered.[1,2,3]. Up to this day there is no consensus on treatment effectiveness and risk factors for the occurrence and recurrence of this eye disease. [2,4,5,6] Brazil hosts the highest prevalence ever described for ocular toxoplasmosis with a preponderance of different strains from those that predominate in Europe and North America, this alone would possibly justify clinical differences and long term outcome.[7,8,9,10]
The study presented describes the clinical characteristics of a series of prospectively followed cases of toxoplasma retinochoroiditis, analyzing the course of the disease, recurrence frequency and factors that may influence the visual prognosis
Summary
Ocular involvement by Toxoplasma gondii may cause severe visual impairment and is the main etiology of posterior uveitis in many parts of the world, questions about the course of the disease remain unanswered.[1,2,3] Up to this day there is no consensus on treatment effectiveness and risk factors for the occurrence and recurrence of this eye disease. [2,4,5,6] Brazil hosts the highest prevalence ever described for ocular toxoplasmosis with a preponderance of different strains from those that predominate in Europe and North America, this alone would possibly justify clinical differences and long term outcome.[7,8,9,10] The study of ocular toxoplasmosis offers many challenges to researchers, mainly because of the plethora of factors that may affect the course of the disease and the need of long term follow-ups.To observe outcomes of toxoplasma retinochoroiditis (TRC) and especially the causes of vision loss in affected patients it is crucial to guide the analysis of prevention strategies and treatment. Ocular involvement by Toxoplasma gondii may cause severe visual impairment and is the main etiology of posterior uveitis in many parts of the world, questions about the course of the disease remain unanswered.[1,2,3] Up to this day there is no consensus on treatment effectiveness and risk factors for the occurrence and recurrence of this eye disease. The study presented describes the clinical characteristics of a series of prospectively followed cases of toxoplasma retinochoroiditis, analyzing the course of the disease, recurrence frequency and factors that may influence the visual prognosis
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