Posterior Segment Inflammation Research Articles

Intravitreal Infliximab for Sight-Threatening Relapsing Uveitis in Behçet Disease: A Pilot Study in 15 Patients

To assess the safety and to conduct a preliminary assessment of efficacy of intravitreal infliximab, an anti-tumor necrosis factor antibody, for sight-threatening relapsing uveitis in Behçet disease. Prospective, noncomparative, interventional pilot study. A single intravitreal injection of infliximab (1 mg/0.05 mL) was given to 15 patients with relapsing posterior uveitis at the onset of a unilateral attack. Best-corrected visual acuity, anterior chamber cells, vitreous haze, and posterior eye segment inflammation were assessed at baseline and at 1, 7, 14, and 30 days after treatment. Ocular or extra-ocular side effects were not observed. Baseline best-corrected visual acuity (mean logarithm of minimal angle of resolution, 0.74; range, 0.15 to 1.7) improved significantly by day 7 and continued to improve through day 30 after infliximab (mean, 0.30; P < .0001). Profound decreases in anterior chamber cells and vitreous haze (both P < .0001), as well as beneficial effects in retinal vasculitis (P = .0001) and retinitis (P = .001) were evident through day 30. Cystoid macular edema persisted in 9 of 11 eyes affected, but central macular thickness decreased from a baseline mean of 434 to 309 mm at the end of follow-up (P < .0001). Lack of systemic treatment at baseline in 4 patients or background immunosuppressive medications, which remained unchanged during follow-up, did not influence significantly these responses; additional treatment was not required. These findings suggest that intraocularly produced or acting tumor necrosis factor, or both, is crucial in Behçet disease-associated relapsing uveitis and that intravitreal infliximab should be considered when systemic administration is not feasible or contraindicated. Further studies may identify patients for whom intravitreal infliximab is preferable to systemic treatment.

Visual evoked potential (VEP) and multifocal electroretinogram (mfERG) in ocular syphilitic posterior segment inflammation

The aim of this study is to correlate multifocal electroretinogram (mfERG) and visual evoked potential (VEP) changes with visual acuity and clinical features in patients with posterior segment inflammation secondary to syphilis. A retrospective interventional case series of 4 patients with visual loss secondary to syphilitic uveitis is reported. The mfERG (P1) showed diminished amplitudes and prolonged latency in 7 affected eyes. Visual acuity rapidly improved 2 weeks after initiation of therapy. OCT demonstrated anatomical recovery at 1 month. In three patients, visual acuity was restored to 6/6 at 6-9 months but mfERG responses remained significantly reduced and delayed for 12-15 months before recovery to normal levels. One patient developed a retinal detachment, but achieved 6/9 vision at 30 months. VEP changes, interpreted in combination with mfERG responses, showed evidence of optic nerve involvement in 6 eyes. Ocular findings, including posterior placoid chorioretinitis, are important diagnostic features of secondary and tertiary syphilis. Visual acuity and clinical recovery occur early with appropriate diagnosis and treatment, and precede full electrophysiological recovery of the outer retina-RPE complex. Ophthalmologists have the opportunity to play a key role in undetected or missed diagnoses of syphilis, and with appropriate treatment the visual prognosis is excellent.

Intravitreal Ketorolac for Chronic Uveitis and Macular Edema

To investigate the adverse ocular effects of intravitreal ketorolac (4 mg) in patients with chronic uveitis and complications of chronic inflammation (macular edema). We conducted a prospective phase 1 clinical trial involving 10 eyes of 10 adult patients with chronic inflammation and/or macular edema for whom previous treatment failed or who could not tolerate corticosteroids because of adverse ocular effects. Baseline (day 0) electroretinography, fluorescein angiogram, spectral domain optical coherence tomography (OCT), Goldmann visual field, and complete ophthalmic examination were performed, and then a single intravitreal injection of ketorolac (4 mg) was administered. Another ophthalmic examination with OCT was performed on day 3. Ophthalmic examination with fluorescein angiogram and OCT was repeated on days 7 and 30, and ophthalmic examination with fluorescein angiogram, OCT, electroretinography, and Goldmann visual field was performed on day 90. The study took place from March 1, 2010, through February 28, 2011. On the basis of ophthalmic examination findings, visual field, and electroretinography testing, there were no observed adverse ocular effects of intravitreal ketorolac. In 2 of 2 eyes with active intraocular inflammation, there was early resolution of inflammation, and in 4 of 8 eyes with macular edema, there appeared to be transient reduction in OCT thickness and/or fluorescein angiogram leakage. A single intravitreal injection of ketorolac (4 mg) appeared to be well tolerated. Intravitreal ketorolac requires further clinical trials to determine whether it is an effective means to treat posterior segment inflammation as a safer alternative to corticosteroids in patients at increased risk of cataract formation and increased intraocular pressure.

Clinical signs of uveitis associated with latent tuberculosis

To identify the clinical ocular signs of uveitis associated with latent tuberculosis. Retrospective case-control study. Consecutive patients from Singapore National Eye Centre Uveitis over 9 years. Sixty-two patients with uveitis associated with latent tuberculosis were compared with 72 matched controls diagnosed with other known uveitides. Patients were categorized as: (A) predominantly anterior segment inflammation (anterior uveitides) and (B) predominantly posterior segment inflammation (intermediate, posterior or pan-uveitides). The diagnostic performance of combining these clinical signs with investigations such as interferon-gamma release assay positivity and chest X-ray results suggestive of pulmonary tuberculosis was done using area under the receiver operator characteristic curve. Sensitivity, specificity and likelihood of association with tuberculosis of various clinical signs. Extensive posterior synechiae and concomitant anterior scleritis in Group A; low-grade anterior chamber activity, retinal phlebitis and severe vitritis in Group B were significantly associated with latent tuberculosis. Combining these clinical signs with a positive interferon-gamma release assay and tuberculin skin test improved the diagnostic performance in both groups (area under the receiver operator characteristic curve for Group A = 0.779; Group B = 0.789). Patients with a combination of suggestive clinical signs with positive interferon-gamma release assay and tuberculin skin test are more likely to be accurately diagnosed with uveitis associated with latent tuberculosis, which responds to anti-tuberculosis therapy.

Diagnostic yield of vitreous biopsy in presumed sarcoidosis-related posterior segment inflammation

Diagnostic vitrectomy is frequently used to help establish a diagnosis in challenging uveitis cases. The usefulness of this procedure in patients with suspected sarcoidosis with posterior segment involvement, in whom a diagnosis cannot be determined by conventional methods, has not been well-described. We hypothesized that diagnostic vitrectomy would help establish a diagnosis of presumed sarcoidosis-related posterior segment inflammation in these challenging cases, and evaluated the diagnostic yield of vitreous biopsy in these eyes. Retrospective interventional case series. Diagnostic vitrectomy was performed on eyes with intermediate, posterior, or panuveitis in which an etiology could not be characterized by history, clinical examination, ancillary testing, and/or laboratory testing. Retrospective chart review was conducted on consecutive eyes that underwent diagnostic, or diagnostic and therapeutic vitrectomy by a single surgeon between January 1989 and June 2006. Diagnostic and therapeutic vitrectomy was performed on 150 eyes. The final diagnosis was established by positive vitreous fluid analysis in 63 eyes (42 %). Eight of these vitreous specimens (5.3 %) yielded cytopathology consistent with presumed sarcoidosis-related posterior segment inflammation. Sarcoidosis can cause characteristic inflammatory changes in the vitreous. In the appropriate clinical setting, cytopathologic assessment of these inflammatory changes observed in vitreous specimens can support the diagnosis of presumed sarcoidosis-related posterior segment inflammation, and help direct clinical management.

Fibrin Glue–Assisted Fixation of Decentered Posterior Chamber Intraocular Lens

To report the feasibility and outcome of the technique of glue-assisted fixation of decentered posterior chamber intraocular lens (PCIOL) in the posterior chamber using the same IOL. The procedure was performed in three eyes having decentered PCIOL with inadequate capsular rim to support the IOL. The haptics were exteriorized under a partial thickness scleral flap at 1.5 mm behind the limbus and placed into a partial thickness scleral pocket and fixed with fibrin glue. No suture was placed at any site. On day 1 and at 6 weeks, the IOLs were well centered. There was no significant anterior or posterior segment inflammation, and the intraocular pressure was normal. Fibrin glue-assisted fixation of PCIOL is a feasible technique with good outcome in eyes with decentered IOL with inadequate capsular support.

The impact of cataract on the quantitative, non-invasive assessment of retinal blood Flow

The aim of the study was to determine the impact of cataract on the quantitative, non-invasive assessment of retinal blood flow assessed by bidirectional laser Doppler flowmetry and simultaneous vessel densitometry. Ten patients scheduled for extracapsular cataract extraction using phacoemulsification and intraocular lens implantation between the ages of 61 and 84 (mean age 73 years, SD ± 8) were prospectively recruited. Two visits were required to complete the study; one visit prior to extracapsular cataract extraction and one at least 6 weeks after the surgery to allow for sufficient postoperative recovery. The severity of cataract was documented using the Lens Opacity Classification System (LOCS, III) at the first visit. Retinal arteriolar hemodynamics were measured at both visits using the high-intensity setting of the Canon Laser Blood Flowmeter. All eyes showed no clinical signs of postoperative intraocular inflammation. The quantitative assessment of retinal arteriolar diameter and blood flow were reduced following extracapsular cataract extraction (Wilcoxon signed-rank test, p = 0.022 and p=0.028, respectively); however, centreline blood velocity was not significantly changed (Wilcoxon signed-rank test, p=0.074). Intraocular pressure was unchanged pre- and postcataract extraction. Retinal vessel densitometry assessment in the presence of cataract results in the erroneous elevation of the diameter measurement and thereby the calculation of blood flow. The bidirectional Doppler assessment of blood velocity appears to be more robust to light scatter induced by cataract. Care needs to be exercised in the interpretation of studies of retinal vessel diameter or blood flow that utilize similar densitometry techniques.

Fluorescein angiography in uveitis

AbstractPurpose Fluorescein angiography (FA) is an important test in the evaluation and management of patients with uveitis. FA in uveitis is giving information principally on the superficial structures of the fundus (retina, retinal vessels and optic nerve head / disc), on the retinal pigment epithelium, on the choriocapillaris in the first 60 seconds of angiography as well as immediatelly subclinical pathology such as subretinal neovascular membranes.Methods FA is indicated when a posterior segment involvement is present or suspected. It should examine the posterior pole, optic disc, and periphery, with angiograms at early, intermediate, and late phases. FA results should be interpreted in relation to the results of clinical examination and other testsResults There are many roles for FA in the evaluation of patients with uveitis 1. Evaluation of the activity and extent of chorioretinitis: 2. Diagnosis of uveitic entities with typical features. 3. Evaluation of retinal vascular involvement : focal, multifocal, or diffuse retinal vascular leakage, occlusive complications, optic disc or retinal neovascularization, 4.Identication of macular complications 5. Evaluation of optic disc involvement. 6. Monitoring of response to treatmentConclusion FA can be helpful in the diagnosis, treatment, and monitoring of patients with posterior segment inflammation.

Occult intraocular foreign body masquerading as panuveitis: inductively coupled mass spectrometry and electrophysiologic analysis

Retained intraocular foreign bodies (IOFB) may rarely present as chronic uveitis, either with isolated anterior uveitis or with posterior segment inflammation. The heavy metals copper and iron may lead to both acute and chronic inflammatory processes resulting in severe inflammation, retinal degeneration, and resultant visual loss. Penetrating or perforating ocular injuries are easily recognizable in the majority of cases; however, a high index of suspicion is necessary to recognize an occult penetrating injury because of the severe visual impairment that can ensue. We describe an unusual case of a retained IOFB, which presented 6 months after a probable occult penetrating injury from metallic IOFB trauma. The severity of the patient's inflammation on presentation and retinal findings in the contralateral eye prompted further diagnostic testing including inductively coupled mass spectrometry of the IOFB and electrophysiologic testing. This rare clinical scenario, laboratory findings, and therapeutic considerations are presented.

The Effects of Th17 Cytokines on the Inflammatory Mediator Production and Barrier Function of ARPE-19 Cells

Th17 cells have emerged as a key factor in the pathogenesis of uveitis as well as other autoimmune disorders. They secrete a number of cytokines including IL-17A, IL-17F and IL-22 and until now the effects of these cytokines on resident cells of the eye were not yet clear. The purpose of this study was to investigate the effects of Interleukin (IL)-17A, IL-17F and IL-22 on the production of inflammatory mediators and barrier function of retinal pigment epithelium cells. We showed that ARPE-19 cells, a spontaneously arisen cell line of retinal pigment epithelium (RPE), constitutively expressed IL-17RC and IL-22R, but not IL-17RA. IL-17A significantly enhanced the production of CXCL8, CCL2, CCL20 and IL-6 by these cells. IL-17F had a similar effect on the production of CXCL8, CCL2 and IL-6 by ARPE-19 cells, but did not influence the expression of CCL20. Both IL-17A and IL-17F significantly decreased the transepithelial electrical resistance (TER) of the ARPE-19 monolayer and increased the diffusion rate of fluorescein isothiocyanate (FITC)-dextran. They also disrupted the distribution of the junction proteins zonula occludens (ZO)-1 and occludin at the interface of adjacent cells. IL-22 did not have a detectable effect on the production of the tested inflammatory mediators by ARPE-19 cells, TER of the ARPE-19 monolayer, the diffusion rate of FITC-dextran or the distribution of ZO-1 and occludin. This study demonstrates that IL-17A and IL-17F, but not IL-22, significantly promoted ARPE-19 cells to secrete inflammatory mediators and compromised the ARPE-19 monolayer barrier function in association with a disrupted distribution of ZO-1 and occludin. These results suggest that both IL-17A and IL-17F may play a role in posterior segment inflammation of the eye.

Uveitis in Rheumatic Diseases

Uveitis is a common extra-articular manifestation of many rheumatic diseases and can be associated with considerable morbidity, both in terms of vision loss and the need for systemic immunosuppression. Anterior uveitis is symptomatic in adults, presenting as a red, painful eye with photophobia, and is most commonly associated with HLAB27 disease. In contrast, chronic anterior uveitis can be silent in children with juvenile idiopathic arthritis, necessitating regular screening to detect its presence. Posterior segment inflammation carries a worse prognosis for vision, and usually manifests as floaters and visual impairment. This article reviews the pathophysiology and clinical features of uveitis occurring in association with systemic inflammatory disease, as well as discussing the current and emerging therapies available for treating its various manifestations.

Paraneoplastic Exudative Retinal Detachment Associated with Adenocarcinoma of the Lung

To report a case of bilateral paraneoplastic exudative retinal detachment (ERD) associated with asymptomatic adenocarcinoma of the lung. Case report. A 47-year-old man presented with bilateral ERD accompanied by anterior and posterior segment inflammation. Extensive investigations for local and systemic causes of ERD were unrewarding. Only when computed tomography scanning of the thorax was performed were enlarged thorax lymph nodes demonstrated and revealed biopsy-proven adenocarcinoma. Paraneoplastic phenomena should be considered in patients presenting with ERD. Ocular paraneoplastic pathologies may be the initial manifestation of an underlying malignancy.

Behçet’s uveitis

AbstractAbstract not provided

Interobserver Agreement in Scoring of Dual Fluorescein and ICG Inflammatory Angiographic Signs for the Grading of Posterior Segment Inflammation

Purpose: To test interobserver agreement in the fluorescein/indocyanine green angiography (FA/ICGA) scoring system for uveitis.Methods: Four observers scored 32 dual FA/ICGAs. Spearman rank correlation was used to analyze correlation between pairs of observers in scores assigned to angiographic signs. Kappa statistics were used to test agreement between pairs of observers in comparative total FA and ICGA scores.Results: The authors found a significant correlation between pairs of observers in scores assigned to all FA signs and all except one ICGA sign. The only discordant sign was early stromal vessel hyperfluoresence on ICGA. There was a moderate to substantial agreement between pairs of observers in comparative FA/ICGA total scores.Conclusions: The level of agreement between uveitis specialists in scoring of dual FA/ICGA indicates that the scoring system tested in this study will be useful for clinical studies of uveitis. Increased experience with this system may further improve its reproducibility.

New Developments in Corticosteroid Therapy for Uveitis

Corticosteroids remain the mainstay of the management of patients with uveitis. Topical corticosteroids are effective in the control of anterior uveitis, but vary in strength, ocular penetration and side effect profile. Systemic corticosteroids are widely used for the management of posterior segment inflammation which requires treatment, particularly when it is associated with systemic disease or when bilateral ocular disease is present. However, when ocular inflammation is unilateral, or is active in one eye only, local therapy has considerable advantages, and periocular injections of corticosteroid are a useful alternative to systemic medication and are very effective in controlling mild or moderate intraocular inflammation. More recently, the injection of intraocular corticosteroids such as triamcinolone have been found to be effective in reducing macular oedema and improving vision in uveitic eyes which have proved refractory to systemic or periocular corticosteroids. The effect is usually transient, lasting around 3 months, but can be repeated although the side effects of cataract and raised intraocular pressure are increased in frequency with intraocular versus periocular corticosteroid injections. This has led to the development of new intraocular corticosteroid devices which are designed to deliver sustained-release drugs and obviate the need for systemic immunosuppressive treatment. The first such implant was Retisert, which is surgically implanted (in the operating theatre) and is designed to release fluocinolone over a period of about 30 months. More recently, Ozurdex, a ‘bioerodible’ dexamethasone implant which can be inserted in an office setting, has completed phase III clinical trials in patients with intermediate and posterior uveitis. This implant lasts approximately 6 months, and has been found to be effective with a much better side effect profile than Retisert or intravitreal triamcinolone injection, at least for one injection.

The short-term efficacy and safety treatment study of recurrent uveitis in Behcet disease with etanercept

To investigate the short-term efficacy and safety of etanercept for recurrent Behcet disease (BD). Retrospective review of 12 recurrent BD uveitis patients (16 eyes) who were followed up in Department of Ophthalmology and Department of Rheumatology of Peking Union Medical College Hospital during April 2007 to June 2008 and received etanercept for treatment of uveitis. On the basis of conventional corticosteroid and immunosuppressive therapy, subcutaneous injection of 25 mg etanercept twice per week was instituted initially, followed by a tapering to once per week based on efficacy and economic consideration. Complete ocular examination including visual acuity, intraocular pressure, anterior segment and fundus conditions were well documented at base line and at each visit. Fundus photography, fluorescein angiography, ocular B ultrasound were conducted when necessary. Endpoint of observation: substantial improvement of ocular inflammation or etanercept treatment was stopped for various reasons. Of 12 patients, 9 had shown improvement on visual acuity at least in one eye, although 3 of them did not show improvement. At end point, as compared to base line, of 16 eyes, 10 (63%) had better visual acuity, 6 (37%) had the same visual acuity, and none decreased; substantial improvement or remission of both anterior and posterior segment inflammation were observed for all patients. No serious adverse reaction was observed during follow up. On the basis of corticosteroid and immunosuppressive therapy, etanercept has good short term efficacy and safety for recurrent BD uveitis.

Global angiographic scoring system for inflammatory diseases

Abstract Purpose Fundus fluorescein and indocyanine green angiography are essential imaging techniques in the appraisal of posterior segment inflammation. A combined fluorescein and indocyanine green angiographic scoring system has been developed in order to provide semi‐quantitative data for follow‐up of disease progression, monitoring response to treatment, and comparison between clinical studies. We tested interobserver variations in the semi‐quantitative scoring of dual fluorescein/indocyanine green angiograms. Methods Four observers scored 32 dual fluorescein and indocyanine green angiograms. Spearman rank correlation was used to analyze correlation between scores assigned to each angiographic sign. We used the Kappa statistics to test agreement between pairs of observers in comparative total fluorescein and indocyanine green angiographic scores. Results We found a significant correlation between pairs of observers in scores assigned to each fluorescein angiographic sign and the total score of fluorescein angiograms. A significant correlation was found only between 2 separate pairs of observers in scores assigned to early stromal vessel hyperfluoresence on indocyanine green angiography. However, a significant correlation was found in other indocyanine green angiographic signs and the total score of indocyanine green angiograms. There was a good agreement between observers in comparative fluorescein – indocyanine green angiographic total scores. Conclusion Further experience with the scoring system, especially with the indocyanine green angiographic scoring, may improve its reproducibility.

The present role of corticosteroids in uveitis

AbstractCorticosteroids are the most widely used anti‐inflammatory and immunosuppressant drugs in ophthalmology in general, and remain the mainstay of therapy for patients with uveitis.An infectious etiology for intraocular inflammation should be adequately excluded or appropriately covered with anti‐infectious therapy before administration of corticosteroid therapy. Topical corticosteroids alone are usually effective in the management of anterior uveitis and have little activity against intermediate or posterior uveitis. Ocular adverse effects of topical steroid therapy mainly include ocular hypertension and cataract. The use of periocular steroid injections (subconjunctival, anterior or posterior subtenon, orbital floor) are important modalities in the management of anterior uveitis refractory to topical treatment and intermediate or posterior uveitis, particularly unilateral cases. Systemic corticosteroids remain the initial drug of choice for most patients with severe bilateral intermediate or posterior uveitis. Therapy is initiated with 1.0 to 2.0 mg/Kg of oral prednisone or prednisolone as a single morning dose, followed by a slow taper. Use of intravenous pulse steroid therapy is an important option in acute, severe, bilateral posterior segment inflammation. In several cases, the level of systemic steroid required to control the inflammation is too high and unacceptable. Immunosuppressive drugs as steroid‐sparing agents are indicated is such cases. Intravitreal injection of triamcinolone acetonide and slow‐release intraocular devices are therapeutic options that can be used in selected uveitis cases refractory to conventional therapy and biologic agents.

Behçet′s uveitis

Behçet's disease is a multisystem inflammatory disorder that is most common in countries along the ancient “Silk Road”. The eye is the most commonly involved vital organ in Behçet's patients and the typical form of involvement is a relapsing remitting panuveitis and retinal vasculitis. Uveitis is the initial manifestation of the disease in 10-15% of the patients. Anterior uveitis is always nongranulomatous. Diffuse vitritis, retinal infiltrates, sheathing of predominantly retinal veins, and occlusive vasculitis are the typical signs of posterior segment inflammation. Spontaneous resolution of acute inflammatory signs is a diagnostic feature. Fundus fluorescein angiography is the gold standard in monitoring inflammatory activity. Laser flare photometry is a useful noninvasive tool since flare readings correlate with fluorescein angiographic leakage. The most common complications are cataract, maculopathy, and optic atrophy. Male patients have a more severe disease course and worse visual prognosis. Immunomodulatory therapy is indicated in all patients with posterior segment involvement. Corticosteroids combined with azathioprine and/or cyclosporine is used initially. Biologic agents, including interferon alfa and infliximab, are used in resistant cases. Visual prognosis has improved in recent years with an earlier and more aggressive use of immunomodulatory therapy and the use of biologic agents in resistant cases.

Optical Coherence Tomography in ocular toxoplasmosis

Optical Coherence Tomography (OCT) is now a method of choice to asses conditions such as macular holes, diabetic macular edema or central serous chorioretinopathy 1. OCT measurements of retinal thickness have a good reproducibility as demonstrated in repeated examinations. The main application of OCT in inflammatory eye diseases is for the analysis of cystoid macular edema 2;3. Ocular toxoplasmosis is the most frequent cause of posterior segment inflammation. 4. Twenty-five consecutive patients seen in a single referral center between November 2003 and August 2004 were studied. Presumed ocular toxoplasmosis was diagnosed based on the clinical appearance of retinochoroiditis and a positive serology. Lesions were presumed to be active in the presence of whitish edematous areas.5 Fluorescein angiography was performed in active cases. Lesions were presumed to be scarred when pigmented and/or atrophic. Areas of retinochoroiditis were further analyzed by the Zeiss OCT3 imager (Humphrey-Zeiss, San Leandro, California, USA). Two perpendicular scans centered on the lesion were performed. The length of scans was 3 or 6 mm, according to the size of the lesion. The vitreoretinal interface was analyzed and measures of retinal thickness were performed. Fourteen men and 11 women were included. The mean age was 25.5 ± 9.9 years. Fifteen patients (60%) had had a previous episode of retinochoroiditis. Active lesions were observed in 16 subjects and scarred lesions in 9 subjects. Active areas appeared as hyperreflective images, which were localized in the retina in 15 cases and in the choroid in 1 case. Partial posterior vitreous detachment with a localized vitritis contiguous to the site of active retinochoroiditis, was observed in 13 cases. Sub-retinal fluid was detected by OCT in 3 cases, but was present on fluorescein angiograms only in 2 of these cases (Figure ​(Figure1).1). Scarred areas were characterized by retinal atrophy. The mean retinal thickness at the center of active lesions was 353 ± 98 µm (range 184 - 614 µm), compared to 135 ± 95 µm (range 0 - 338 µm) for scarred lesions (p<0.001). Figure 1 Optical Coherence Tomography in ocular toxoplasmosis OCT is safe, non invasive and devoided of any side effects, therefore follow-up measurements are unlimited, while fluorescein angiography is invasive and it carries some risks and side effects in certain subjects. Active toxoplasmic lesions have shown 3 main OCT characteritics: A highly reflective intraretinal area corresponding with the area of retinitis. A posterior hyaloid thickened and detached over the lesion and contained irregular hyperreflective formation. A shadow effect of the underlying choroidal tissue. Reliable measurements of retinal thickness by OCT may be impossible in the presence of severe vitritis. Fluorescein angiograms remain very useful for the assessment of vasculitis and blood-retinal barrier breakdowns, whereas OCT detects sub-retinal fluid with a higher sensitivity. We have shown that OCT imaging can distinguish between active and scarred toxoplasmic lesions. OCT provides quantitative measurements of retinal thickness, which could be useful in future prospective studies, to guide therapeutic decisions and to monitor the efficacy of treatments.