Treatment Of Ocular Toxoplasmosis Research Articles

New advances in immune mechanism and treatment during ocular toxoplasmosis.

Ocular toxoplasmosis (OT) is an intraocular infection caused by the parasite Toxoplasma gondii. OT is manifested as retinal choroiditis and is the most common infectious cause of posterior uveitis. Invasion of the retina by T. gondii leads to disruption of the blood-ocular barrier and promotes the migration of immune cells to the ocular tissues. Cytokines such as IFN-γ and IL-1β are effective for controlling parasite growth, but excessive inflammatory responses can cause damage to the host. In this review, we will discuss in detail the latest advances in the immunopathology and treatment of OT.

Diagnostics and treatment of ocular toxoplasmosis : Results of a survey

Ocular toxoplasmosis (OT) is the most common infectious cause of posterior uveitis. This survey aimed to evaluate the current diagnostic and therapeutic approach to OT in Germany. Adetailed questionnaire with specific patient examples was sent in July 2021 to the members of the Uveitis Section of the German Ophthalmological Society (DOG) and the Retinological Society (RG). The questionnaire was answered by 53 (29RG and 24DOG) ophthalmologists. Of the respondents 16 (30%) work in private practice, 18 (34%) in aclinical facility and 19 (36%) in university hospital, 9 (17%) colleagues see < 50, 28 (53%) 50-200 and 16 (30%) more than 200 uveitis patients per year. The clinical results are still the gold standard (87%) for the diagnosis of OT and in cases of first manifestation 60% are supported by serological antibody investigations, while 10out of 53 (19%) ophthalmologists rely on the clinical presentation only. An IgM test is requested by 25 (47%) respondents, 6 expected an increase in IgG titer (11%) and 1 the detection of specific IgA antibodies (2%). The majority (n = 28, 53%) of ophthalmologists would aim at confirming the diagnosis by an anterior chamber puncture, from which 20(38%) prefer PCR, 3(6%) determination of Goldmann-Witmer coefficients (GW) and 5(9%) acombination of both methods. Clindamycin was most frequently used for treatment (n = 21, 40%), followed by pyrimethamine/sulfadiazine (n = 17, 32%) and trimethoprime + sulfamethoxazole (TMP/SMX) (n = 10, 19%); the latter was also used (n = 40, 75%) for secondary prophylaxis. The results show that apart from the clinical results as the gold standard for the diagnosis, there is no uniform approach to diagnosis and treatment of OT. The high request rate for serum IgM antibodies indicates awidespread uncertainty about the importance of serological findings. This should be viewed critically, given the continued high seroprevalence in Germany.

Spiramyin-loaded PLGA implants for the treatment of ocular toxoplasmosis: development, characterization, biocompatibility, and anti-toxoplasma activity.

Ocular toxoplasmosis is the major cause of infectious posterior uveitis worldwide, inducing visual field defect and/or blindness. Despite the severity of this disease, an effective treatment is still lacking. In this study, spiramycin-loaded PLGA implants were developed aiming at the treatment of ocular toxoplasmosis. Implants were manufactured by a hot-molding technique, characterized by Fourier Transform Infrared Spectroscopy, X-Ray Diffraction, Differential Scanning Calorimetry, Scanning Electron Microscopy; evaluated in terms of ocular biocompatibility by immunofluorescence, flow cytometry, cell migration, Hen's egg test-chorioallantoic membrane (HET-CAM) irritation test; and investigated in terms of in vitro efficacy against Toxoplasma gondii . Characterization techniques indicated that spiramycin was dispersed into the polymeric chains and both substances preserved their physical structures in implants. The HET-CAM test indicated that implants did not induce hemorrhage or coagulation, being non-irritant to the CAM. ARPE-19 cells showed viability by MTT assay, and normality in cell cycle kinetics and morphology, without stimulating cell death by apoptosis. Finally, they were highly effective against intracellular parasites without inducing human retinal pigment epithelial cell death. In conclusion, spiramycin-loaded PLGA implants represent a promising therapeutic alternative for the local treatment of ocular toxoplasmosis.

Leczenie toksoplazmozy ocznej za pomocą doszklistkowych iniekcji klindamycyny: opis dwóch przypadków

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Rogaczewska M, Stopa M. Intravitreal clindamycin in the treatment of ocular toxoplasmosis: a report of two cases. Klinika Oczna / Acta Ophthalmologica Polonica. 2021;123(1):42-45. doi:10.5114/ko.2021.104752. APA Rogaczewska, M., & Stopa, M. (2021). Intravitreal clindamycin in the treatment of ocular toxoplasmosis: a report of two cases. Klinika Oczna / Acta Ophthalmologica Polonica, 123(1), 42-45. https://doi.org/10.5114/ko.2021.104752 Chicago Rogaczewska, Małgorzata, and Marcin Stopa. 2021. "Intravitreal clindamycin in the treatment of ocular toxoplasmosis: a report of two cases". Klinika Oczna / Acta Ophthalmologica Polonica 123 (1): 42-45. doi:10.5114/ko.2021.104752. Harvard Rogaczewska, M., and Stopa, M. (2021). Intravitreal clindamycin in the treatment of ocular toxoplasmosis: a report of two cases. Klinika Oczna / Acta Ophthalmologica Polonica, 123(1), pp.42-45. https://doi.org/10.5114/ko.2021.104752 MLA Rogaczewska, Małgorzata et al. "Intravitreal clindamycin in the treatment of ocular toxoplasmosis: a report of two cases." Klinika Oczna / Acta Ophthalmologica Polonica, vol. 123, no. 1, 2021, pp. 42-45. doi:10.5114/ko.2021.104752. Vancouver Rogaczewska M, Stopa M. Intravitreal clindamycin in the treatment of ocular toxoplasmosis: a report of two cases. Klinika Oczna / Acta Ophthalmologica Polonica. 2021;123(1):42-45. doi:10.5114/ko.2021.104752.

Therapeutic alternatives for the treatment of ocular toxoplasmosis

Therapeutic alternatives for the treatment of ocular toxoplasmosis

New findings useful for clinical practice using swept-source optical coherence tomography angiography in the follow-up of active ocular toxoplasmosis

BackgroundOcular toxoplasmosis is one of the most common causes of intraocular inflammation and posterior uveitis in immunocompetent patients. This paper aims to investigate swept-source optical coherence tomography angiography (SS-OCTA) findings in eyes with active toxoplasmic retinochoroiditis.MethodsThis case series was conducted from November 2017 through October 2019 in two Brazilian centers. 15 eyes of 15 patients with active toxoplasmic retinochoroiditis were included, and were imaged at baseline and after at least 4 weeks of follow-up. All patients underwent ophthalmic examinations and multimodal imaging including SS-OCT and SS-OCTA before and after treatment of ocular toxoplasmosis. The differential diagnoses included toxoplasmosis, syphilis, and human immunodeficiency virus, which were eliminated through serologic and clinical evaluations.ResultsAll 15 patients presented with positive anti-Toxoplasma gondii immunoglobulin G titers and three also presented with positive anti-T. gondii immunoglobulin M titers. The mean age at examination was 32.4 years ± 12.7 years (range 15–59 years). Sixty percent of the patients were female. In all eyes, the inner retinal layers were abnormally hyperreflective with full-thickness disorganization of the retinal reflective layers at the site of the active toxoplasmic retinochoroiditis. At baseline, 80% of eyes had focal choroidal thickening beneath the retinitis area, and all eyes had a choroidal hyporeflective signal. Before treatment, SS-OCTA showed no OCTA decorrelation signal next to the lesion site in all eyes, and flow signal improvement was noticed after treatment. Three eyes presented with intraretinal vascular abnormalities during follow-up. SS-OCTA showed retinal neovascularization in one patient and a presumed subclinical choroidal neovascular membrane in another patient.ConclusionsSS-OCT and SS-OCTA are useful for assessing unexpected structural and vascular retinal and choroidal changes in active and post-treatment toxoplasmic retinochoroiditis and these findings are useful for clinical practice.

Clinical spectrum of atypical ocular toxoplasma chorioretinitis

AbstractPurposeTo describe the clinical spectrum of patients with atypical ocular toxoplasmosis, requiring confirmatory diagnosis with PCR (due to uncommon clinical presentation or non‐response to conventional treatment).MethodsAll cases with confirmed positive PCR for Toxoplasma gondii seen in the Bristol Eye Hospital over the last 5 years were retrospectively reviewed for patient demographic, known systemic immunosuppression, clinical presentation, response to treatment and recurrences/complications.ResultsA total number of 16 patients were included. Five of which were immunocompromised. Bilateral disease was seen in three cases (18.7%). The mean age at diagnosis was 64.9, with 37.5% female and 62.5% male patients. 10 out of the 19 affected eyes (52.6%) had multifocal lesions with 9 eyes (47.4%) having an isolated lesion. Eleven patients (one bilateral) had fluorescein angiography during their follow‐up, which confirmed the presence of vasculitis in nine of those eyes (75%) with five of these having occlusive vasculitis (41.7%). Of the twelve patients treated with azithromycin as first line, only 4 (25%) showed a response to treatment.ConclusionsPCR is warranted to identify cases of atypical ocular toxoplasmosis. These atypical forms were also seen in immunocompetent patients. Although azithromycin has been proved to be an alternative therapy in the treatment of ocular toxoplasmosis, we identified a lack of response to azithromycin in 75% of patients in our series of patients with atypical ocular toxoplasmosis.

Vanishing bile duct syndrome following treatment of ocular toxoplasmosis with pyrimethamine and TMP-SMX

Vanishing bile duct syndrome following treatment of ocular toxoplasmosis with pyrimethamine and TMP-SMX

Spiramycin : A Safe and Effective Option for Treatment of Ocular Toxoplasmosis

Spiramycin : A Safe and Effective Option for Treatment of Ocular Toxoplasmosis

Current Therapy of Acquired Ocular Toxoplasmosis: A Review.

Caused by the parasite Toxoplasma gondii, ocular toxoplasmosis (OT) is the most common form of posterior infectious uveitis. Combined antiparasitic therapy is the standard treatment for OT, but several other schemes have been proposed. The purpose of the present study was to review the literature on the treatment of OT and provide ophthalmologists with up-to-date information to help reduce OT-related visual morbidity. In conclusion, no ideal treatment scheme was identified; currently prescribed therapeutic schemes yield statistically similar functional outcomes.

Anaphylactic reaction to intravenous corticosteroids in the treatment of ocular toxoplasmosis: a case report

IntroductionThis case report presents for the first time an acute systemic allergic reaction to corticosteroids in a patient with ocular toxoplasmosis after treatment with intravenous cortisone, and discusses alternative treatments.Case presentationWe present the case of a 57-year-old Caucasian woman with an anaphylactic reaction after intravenous injection of prednisolone-21-hydrogensuccinate (Solu-Decortin® H) given for the treatment of toxoplasmosis-associated chorioretinitis. Immediately after the injection, she developed an acute erythema of the legs and abdomen, angioedema, hypotension (blood pressure 80/40mmHg), tachycardia (heart rate 140/minute), hyperthermia (38.8°C), and respiratory distress. Allergological examinations showed a positive skin-prick test to prednisolone and methylprednisolone. In addition, an oral exposure test with dexamethasone (Fortecortin®) and betamethasone (Celestamine®) was conducted to find alternative corticosteroids for future treatments. After oral application, no local or systemic reactions were observed for these two substances.ConclusionsThis case report demonstrates that systemic allergic reactions are possible in patients with uveitis or other inflammatory ophthalmological conditions treated with intravenous corticosteroids. Intravenous administration of cortisone, for example, in the treatment of ocular toxoplasmosis, should always be conducted with caution because of a possible allergic reaction. For patients who react to a particular steroid, it is necessary to undergo allergological testing to confirm that the compound in question is indeed allergenic, and to identify other corticosteroids that are safe for future anti-inflammatory treatments.

Current treatment of toxoplasma retinochoroiditis: an evidence-based review.

Objective. To perform an evidence-based review of treatments for Toxoplasma retinochoroiditis (TRC). Methods. A systematic literature search was performed using the PubMed database and the key phrase “ocular toxoplasmosis treatment” and the filter for “controlled clinical trial” and “randomized clinical trial” as well as OVID medline (1946 to May week 2 2014) using the keyword ‘‘ocular toxoplasmosis”. The included studies were used to evaluate the various treatment modalities of TRC. Results. The electronic search yielded a total of 974 publications of which 44 reported on the treatment of ocular toxoplasmosis. There were 9 randomized controlled studies and an additional 3 comparative studies on the treatment of acute TRC with systemic or intravitreous antibiotics or on reducing the recurrences of TRC. Endpoints of studies included visual acuity improvement, inflammatory response, lesion size changes, recurrences of lesions, and adverse effects of medications. Conclusions. There was conflicting evidence as to the effectiveness of systemic antibiotics for TRC. There is no evidence to support that one antibiotic regimen is superior to another so choice needs to be informed by the safety profile. Intravitreous clindamycin with dexamethasone seems to be as effective as systemic treatments. There is currently level I evidence that intermittent trimethoprim-sulfamethoxazole prevents recurrence of the disease.

Ocular Toxoplasmosis: Controversies in Primary and Secondary Prevention.

Ocular toxoplasmosis is the most common cause of posterior uveitis in the United States and worldwide. It commonly follows a relapsing course with the potential for multiple adverse visual sequelae and, rarely, blindness. Both immune-competent and immune-suppressed populations can develop severe relapsing disease. There is considerable debate regarding the initial treatment of ocular toxoplasmosis in both groups, with multiple antiparasitic agents commonly used with little evidence to support any particular regimen. The precise role of corticosteroids in treatment also has yet to be rigorously defined. Secondary prevention is commonly implemented in the immune suppressed population, but there is a lack of level one evidence to support its role in immune-competent patients, though it warrants future investigation.

Clinical Features and Treatment of Ocular Toxoplasmosis

Ocular toxoplasmosis is a disease caused by the infection with Toxoplasma gondii through congenital or acquired routes. Once the parasite reaches the retina, it proliferates within host cells followed by rupture of the host cells and invasion into neighboring cells to make primary lesions. Sometimes the restricted parasite by the host immunity in the first scar is activated to infect another lesion nearby the scar. Blurred vision is the main complaint of ocular toxoplasmic patients and can be diagnosed by detection of antibodies or parasite DNA. Ocular toxoplasmosis needs therapy with several combinations of drugs to eliminate the parasite and accompanying inflammation; if not treated it sometimes leads to loss of vision. We describe here clinical features and currently available chemotherapy of ocular toxoplasmosis.

Controversies in Ocular Toxoplasmosis

Toxoplasmosis, a major cause of infectious uveitis, was elected by the editors of Ocular Immunology and Inflammation as the disease of the year for 2011. The aim of the present review was to report on the results of a survey of leading uveitis experts, in which the authors asked participants to address some of the most important issues related to diagnosis, pathophysiology, and treatment of ocular toxoplasmosis. The survey revealed generally good consensus regarding clinical signs of typical and atypical toxoplasmic retinochoroiditis. In contrast, views regarding diagnostic approach, possible epidemiological influences, transmission of disease, and trigger factors seemed less clearly defined. Responses revealed a large number of drug regimens in use for both congenital and acquired disease. Finally, recurrence prophylaxis was not regularly recommended by the majority of experts.

Randomized Trial of Intravitreal Clindamycin and Dexamethasone versus Pyrimethamine, Sulfadiazine, and Prednisolone in Treatment of Ocular Toxoplasmosis

To compare the efficacy of intravitreal injection of clindamycin and dexamethasone with classic treatment for ocular toxoplasmosis. Prospective, randomized single-masked clinical trial. A total of 68 patients with active ocular toxoplasmosis were assigned randomly to 2 treatment groups: 34 in the intravitreal clindamycin plus dexamethasone (IVCD) group and 34 in the classic treatment (CT) group. The IVCD group received 1 to 3 injection(s) of 1 mg intravitreal clindamycin and 400 μg dexamethasone, and the CT group received 6 weeks of treatment with pyrimethamine and sulfadiazine plus prednisolone. Antitoxoplasmosis antibodies (immunoglobulin [Ig] M and IgG) were measured using an enzyme-linked immunosorbent assay. Changes in retinochoroidal lesion size, measured by a computer program written in the MATLAB environment, 6 weeks after initiation of treatment. Visual acuity (VA) changes, vitreous inflammatory response, adverse drug reactions, and rate of recurrence were secondary outcome measures. The mean number of injections in the IVCD group was 1.6. The lesion size reduction was statistically significant after treatment in both IVCD and CT groups (P < 0.001 and P = 0.009, respectively). However, the difference in mean percentage of reduction at 6 weeks was not significant: 57.0 ± 27.8% in the IVCD group versus 58.4 ± 29.3% in the CT group (P = 0.569). In relation to the baseline, VA increased by 0.44 ± 0.24 and 0.29 ± 0.19 logarithm of the minimum angle of resolution units in the IVCD and CT groups, respectively (P < 0.001); however, the difference of VA improvement between the groups was not significant. The interaction effect of IgM and treatment group on lesion size reduction was significant (P = 0.002); this indicated that IgM-positive cases responded better to CT and IgM-negative cases responded better to IVCD treatment. Vitreous inflammation reduction was insignificant between the groups. Within 2 years, 4 eyes (2 in each group) had 1 episode of recurrence. Adverse drug reactions occurred in 2 patients in the CT group. No major injection-related complication was encountered in the IVCD group. Intravitreal injection of clindamycin and dexamethasone may be an acceptable alternative to the classic treatment in ocular toxoplasmosis. It may offer the patient more convenience, a safer systemic side effect profile, greater availability, and fewer follow-up visits and hematologic evaluations.

Update on the treatment of ocular toxoplasmosis

Ocular toxoplasmosis is the most frequent cause of posterior uveitis. 1 The parasite has an intracellular cycle. During the primary infection, the subject is usually asymptomatic and can present flu-like symptoms. A dissemination of the parasites occurs and the tissular cysts will persist during the all life of the host. An ocular reactivation of the disease can occur when the cysts are present within the retina (Figure ​(Figure1).1). The patients present a photophobia and floaters are seen. The slit-lamp examination reveals the presence of a granulomatous inflammation, a mild to moderate anterior chamber inflammation. Fundoscopy reveals the presence of a yellow focus of retinochoroiditis. Recent epidemiological data have shown that most cases of ocular toxoplasmosis result from reactivation of ocular toxoplasmosis and not from primary infection. Disease evolution depends on many factors: the immune response of the host, the virulence of the parasite and environmental factors and ocular toxoplasmosis can heals spontaneously after two to three months even in the absence of therapy. Figure 1 Active retinitis area adjacent to previous cicatricial foci. A review of ophthalmic literature shows that no standard therapy could be proven by large multicentric clinical trials. 2 A survey of the opinion of ophthalmic specialists in uveitis was performed recently by Gary Holland. 3 The reasons that were commonly accepted to introduce a therapy were the following: a) the presence of a lesion within the vascular arcades of the posterior pole (zone 1) b) the presence of a lesion in the proximity of the optic nerve or the macula c) or a severe inflammatory reaction within the eyes. The zone 1 area was defined as a lesion that was in a sight-threatning area and corresponding to an area extending 3000 μm (2 disk diameters) from the fovea (approximately that area enclosed by the major temporal vascular arcades or 1500 μm from the margins of the optic disk. The prospective study performed by Perkins in 1956 could not demonstrate the efficacy of daraprim in the therapy of ocular toxoplasmosis. But the outcome was measured 4 weeks after initiation of therapy. Dihydrofolate reductase inhibitors (DHFR) have shown their efficacy in vivo in the treatment of toxoplamosis. To increase the efficacy of therapy a combination of sulfadiazine and pyrimethamine was proposed since synergistic effect of these two drugs could be demonstrated in vitro. Pyrimethamine interferes with the conversion of folic acid to folinic acid through dihydropteroate synthase (DHPS) whereas sulfonamide interferes with the formation of folic acid from para-amino benzoic acid. Human beings unlike T. gondii can utilize exogenous folinic acid for their cells. Classical therapy of ocular toxoplasmosis consists in a association of 2 to 4.0 g of sulfadiazine loading dose given over 24 hours, followed by 1g given 4 times daily associated with 75mg to 100mg pyrimethamine loading dose initially followed by 25 to 50 mg daily. Systemic steroids 1mg/kg is associated in the presence of severe ocular inflammation or in the presence of a zone 1 infection. A prospective randomised trial of trimethoprim/sulfamethoxazole versus pyrimethamine and sulfadiazine described a 61% reduction of lesions size was observed in the classic treatment group versus 59% in the TMP/S group. Reaction to sulfadiazine therapy is observed in overall 5% of patients. The main side effects are crystalluria, disorders of hematopoietic system hypersensitivity reaction nausea and vomiting and depression. The sulfadiazine cristalluria occurs in 1-4% of patients. The predisposing factors are a poor fluid intake, fever, diarrhoea, hypoalbuminuria and acidification of the urine. Cofactors in AIDS patients are concomitant use of acyclovir, triamterene or primidone. The leukopenia or thrombocytemia occur in the presence of interactions with the metabolism of folic acid. Folinic acid therapy is given three times a week to avoid leukopenia. Discontinuation of the therapy is recommended if the leukocytes are below 4 000 cells or if thrombocytes are below 100 000 cells. Maculo-papular rush appears in the presence of an allergy to sulfadiazine. Atovaquone therapy is used as second line treatment of toxoplasmosis. Atovaquone tablets 750mg QID have been given for the treatment of Toxoplasma retinochoroiditis. Azithromycine is an alternative to classical therapy was proposed as an alternative therapy in the treatment of ocular toxoplasmosis. The efficacy of the drug was reported in cerebral toxoplasmosis in AIDS patients. The dosage used by Rothova et al was 250mg a day or 500mg every other day and therapy was associated with pyrimethamine 100mg on the first day that was followed by 50mg a day.

Usefulness of vitrectomy in the treatment of ocular toxoplasmosis

Although not useful in acute ocular toxoplasmosis, vitrectomy can be indicated at a later stage for the management of complications such as persistent vitreous opacification, secondary epimacular membrane, and retinal detachment. In some cases, vitreous opacification can persist despite intensive antibiotic and steroid treatment. After 2 or 3 months of treatment, we must ask the following questions: is the vitreous opacification due to inflammatory cells or to vitreous degeneration? Is it still possible to reduce it with steroids ? If opacification is due to large vitreous cords and secondary vitreous degeneration, steroid treatment is no longer indicated and vitrectomy could be proposed in order to clear the posterior cavity, to improve the visual acuity and to avoid overtreatment with steroids. Epimacular membranes secondary to toxoplasmosis are not much different from idiopathic ones, and the postoperative prognosis is good. Retinal detachment is rare. It can be either rhegmatogenous and/or tractional. In some rare cases, vitrectomy is indicated in the management of the acute phase, especially when the diagnosis is not clear. Vitrectomy can help rule out ocular lymphoma and viral retinitis. At the beginning, vitrectomy should be performed, with the infusion turned off, until the eye collapses. Generally, we can obtain 1 cc of undiluted vitreous. Once the infusion is turned on, other syringes are used for the collection of peripheral vitreous. With this material, it is possible to examine the lymphocytes and perform PCR. Viruses can be detected as well by PCR. Vitrectomy increases the clearance of the posterior cavity. Some specialists believe that it can favorably influence the evolution of uveitis, although this point is debatable. In our series of eight cases of vitrectomy performed for toxoplasmosis, one case is interesting in this respect. A 40 year old woman visited us for the 7th recurrence of toxoplasmosis. On fundus examination, we could see the consecutive scars of previous infection along the upper temporal arcade. At the end of this chain, there was a large peripheral active retinochoroiditis, measuring 2 disc diameters. This lesion was treated with antibiotics and steroids, but despite several months of treatment, a dense network of vitreous cords persisted. Because of decreased visual acuity and vitreous debris, a vitrectomy was performed. No further recurrence was observed during a follow-up of twenty years. One can ask if vitrectomy had not removed factors that could be implicated in the recurrence process.

Introduction to special issue on Eye and Zoonosis - from the guest editors

On the occasion of the first International Congress on Ocular Zoonoses held in Lausanne, Switzerland in 2006, we were asked by the promoter, Dr. Yan Guex-Crosier, to organize the second Congress in Parma, Italy. It was a great pleasure for us to accept this invitation. We do believe that every ophthalmologist coping with inflammatory eye diseases, either because specifically working on inflammation or because inflammation has been observed by chance during an ocular examination performed for other purposes, must be aware of zoonotic diseases that affect the eye. This Congress held in Parma during two half-day sessions could not cover all zoonoses; consequently, only those most frequently observed in the European/Mediterranean area were dealt with. Zoonoses may be imported by immigrants, who represent a relatively recent phenomenon in Italy; but also travellers coming back from endemic areas are transmitting diseases hitherto unknown or forgotten in our own countries. Moreover, it must be remembered that our domestic animals can also be transmitters of zoonoses. If our pets, such as dogs and cats, are correctly cared for, they will not represent a reservoir for ticks, fleas and other potential vectors. Ocular zoonoses can no longer be ignored; every ophthalmologist, working on his own or in a public institution must remember that a red eye or a vitriitis or retinitis without any current explanation might be due to a disease transmitted by arthropod vectors from foreign countries or by animals. Correct information on this subject will prove extremely useful to our patients, avoiding severe consequences of ocular function. Contents of this special issue are based on the presentations given in the Congress “Eye and Zoonosis” - October 10-11th 2008, Parma (Italy). They include: Incidence of ocular Zoonoses referred to the Inflammatory and Autoimmune Ocular Diseases Service of the University of Parma (Italy) Introduction into Pathology of Ocular Zoonoses Local epidemiology and clinical manifestations of Lyme disease Ocular manifestations of Lyme borreliosis in Europe Ocular manifestations of Rickttesiosis: 1. Mediterranean Spotted Fever: laboratory analysis and case reports Ocular manifestations of Rickttesiosis: 2. Retinal involvement and treatment Ocular Toxocariasis Ocular Bartonellosis Human toxoplasmosis and the role of veterinary clinicians Laboratory diagnosis of Toxoplasma gondii infection Congenital and acquired Toxoplasmosis (The content of Dr Brezin's presentation has been published in the December 2008 issue of the American Journal of Ophthalmology: Delair E, Monnet D, Grabar S, Dupouy-Camet J, Yera H, Brezin AP. Respective roles of acquired and congenital infections in presumed ocular toxoplasmosis. Am J Ophthalmol 2008;146:851-5). Optical Coherence Tomography in ocular toxoplasmosis Usefulness of vitrectomy in the treatment of ocular toxoplasmosis Update on the treatment of ocular toxoplasmosis. We hope that this special issue will be interesting to readers and provides researchers with timely update on various topics in this important field.

Clinical Experience with Trimethoprim - Sulfamethoxazole and Prednisolone in the Treatment of Ocular Toxoplasmosis with Zone -1 Posterior Pole and Peri-papillary Lesions

To evaluate the efficacy of trimethoprim- sulfamethoxazole and oral prednisolone in the treatment of ocular toxoplasmosis with zone-1 posterior pole and peri-papillary lesions. Retrospective evaluation of records of patients in our tertiary care referral hospitals. 22 eyes of 21 patients with active toxoplasma retino-choroiditis in zone -1 posterior pole and peri-papillary areas were included in the study. One patient developed active lesion in the fellow eye after 6 months which regressed after re-institution of the treatment. There were 11 females and 10 males. Age varied between 18–52 (mean age 29 ± 8.8) years. The follow-up period varied between 4- 46 (mean 15 ± 11) months. All patients showed resolution of retino-choroiditis and improvement of visual acuity between 1-9 lines (mean 4.18 lines± 2.3).The mean lesion size pre-treatment was 0.89 disc diameters±0.3 and post-treatment was 0.70 disc diameters±0.28. The mean time taken for the sharpening of lesion borders was 2.3 ± 0.4 (range 2–3) weeks. No complications reported with the medication. The combination of trimethoprim-sulfamethoxazole and prednisolone is quite effective in treating the patients with active vision threatening posterior pole and peri-papillary toxoplasmosis lesions.