ObjectiveTo investigate the clinical characteristics, treatments and prognosis of ocular toxoplasmosis (OT).MethodsA retrospective clinical trial. Twelve cases (14 eyes) with OT which was confirmed by clinical and laboratory tests were included in the Department of Ophthalmology, Taihe Hospital in Shiyan and the Department of Ophthalmology, Beijing Chaoyang Hospital in Beijing from July 2011 to June 2019. Among the 12 cases, 6 cases were female (7 eyes) and 6 cases were male (7 eyes). The mean age of the participants was 33.4±12.8 years and the duration of illness ranged from 7 days to 30 years. Fungal endophthalmitis, viral uveitis and non-infectious uveitis were misdiagnosed in 2 cases respectively at the first visit. All the patients underwent BCVA, intraocular pressure, slit-lamp microscope, fundus color photography examinations and toxoplasma-specific serological antibodies tests. Intraocular influid were detected for 7 cases, among which 1 case for antibody only, and 6 cases for Goldmann-witmer coefficient (GWC). Of the 6 cases tested for GWC, 4 cases were tested with PCR assay in the ocular fluid addtionally. FFA was performed in 5 cases (6 eyes) and OCT in 6 cases (6 eyes). Eleven cases were treated with antitoxoplasma therapy. The follow-up duration after treatment varied from 1 week to 39 months. BCVA, clinical features and prognosis were retrospectively analyzed.ResultsSpecific antibody seropositivity of Toxoplasma gondii was detected in all 12 patients. Of the 7 cases tested with intraocular fluid, 1 case was IgG positive and the other 6 cases with 5 cases with GWC ＞4 and 1 case with 2＜ GWC ＜4. Only 1 case (25%) was positive among 4 cases with PCR assays meanwhile. BCVA was:＜0.1 in 4 eyes, 0.1～0.3 in 6 eyes and ＞0.3 in 4 eyes. KPs with or without anterior chamber flash or cells could be detected in 6 eyes,congenital macular defect 1 eye, vitreitis 3 eyes (2 eyes with multiple retinal pigmentation foci and 1 eye with tractive retinal detachment), and coexistence of new and old lesions with Kyrieleis arteritis 2 eyes. Nine eyes showed different degrees of vitreous inflammation (75% of 12 active eyes). Single lesion was present in 4 case (4 eyes) and multiple lesions were present in 8 cases (10 eyes). There were no statistically significant changes in BCVA of OT patients before and after treatment (P=0.83). Involvement or adjacent to macula of he primary lesions, misdiagnosis and mistreatment led to the poor prognosisi of visual acuity.ConclusionsThe fundus of OT can show single lesion or multiple lesions, and the active phase is often accompanied by vitreous inflammation. The primary lesion involves or is close to the macular area, misdiagnosis and mistreatment are the main reasons for the poor visual prognosis of patients.
ObjectiveTo observe the clinical characteristics of adult patients with ocular toxoplasmosis (OT).MethodsThis study was a retrospective clinical trial. Among the 83 consecutive OT patients diagnosed in the Zhongshan Eye Center of Sun Yat-Sen University, 14 patients (16.9%, adult group) aged ≥18 years were included in the study from January 2017 to December 2019. A total of 14 OT patients (children group) aged less than 18 years who had consecutive visits from July to December 2019 were selected as controls. All patients underwent BCVA, slit lamp microscope, fundus color photography, and B-mode ultrasound examination. Eighteen cases underwent UBM examination, including 6 and 12 cases in the adult group and child group respectively; 23 cases underwent FFA examination, including 12 and 11 cases in the adult group and child group respectively. Snellen visual acuity chart was used for BCVA examination, which was converted into logMAR visual acuity in statistics. We compared the two groups of patients' residence (urban or rural), history of contact with dogs and cats, main symptoms, reasons for treatment, course of disease, and clinical and imaging characteristics and so on. For measurement data conforming to normal distribution, t-test was performed for comparison between groups; for Skewness distribution measurement data, rank sum test was performed for comparison between groups.ResultsCompared with the adult group and the child group, there was no significant difference in the canine-cat contact history (Z=2.661, P=0.257) and the time from first diagnosis to diagnosis (t=−0.186, P=0.351); compared with the children group and the adult group, the patient's living environment was mainly urban, and the course of disease was significantly shorter (Z=−2.005), and the difference was statistically significant (P=0.047). The logMAR BCVA of the adult group and the child group were 0.81±1.08 and 2.08±1.30, respectively, and the difference was statistically significant (Z=−2.811, P=0.004); compared with the child group, the adult group had lighter vitreous opacities, but the difference was statistical significance (Z=7.847, P=0.048). FFA examination revealed 20 cases of "fern-like" leakage of retinal capillaries. Among them, the adult group and child group were 10 (83.3%, 10/12) and 10 (90.9%, 10/11) cases respectively.ConclusionsAdult patients account for 16.9% of OT patients. Compared with children, adult patients mostly live in towns or cities, have a short course of disease, good vision at first diagnosis, and mild inflammation or hyperplasia of the vitreous cavity. FFA is helpful for the diagnosis of adult OT.
ObjectiveTo observe the efficacy of parsplana vitrectomy (PPV) combined with 0.7 mg dexamethasone sustained-release Ozurdex intravitreal implantation in the treatment of children with ocular toxocariasis (OT). MethodsA retrospective clinical study. Fifty-three pediatric patients (53 eyes) diagnosed with OT and underwent PPV in Beijing Tongren Eye Center of Beijing Tongren hospital from March 2015 to December 2021 were included. There were 30 males and 23 females, with an average age of 7.07±3.45 (4-14) years; all were unilateral. Color Doppler imaging, fundus color photography, optical coherence tomography examinations were performed for patients who can cooperated with the examiners. Forty-three eyes were examined by best corrected visual acuity (BCVA); 47 eyes were examined by intraocular pressure; 29 eyes were examined by ultrasound biomicroscopy. According to the location of granuloma, OT was divided into posterior pole granulomatous type (posterior type), peripheral granulomatous type (peripheral type), and chronic endophthalmitis type. According to whether Ozurdex was implanted into the vitreous cavity after PPV, the children were divided into the oral glucocorticoid group after PPV (group A) and the PPV combined with vitreous cavity implantation of Ozurdex group (group B), 37 cases with 37 eyes and 16 cases with 16 eyes, respectively. There was no significant difference in age (t=0.432), sex composition ratio (χ2=0.117), BCVA (χ2=0.239), and clinical type (χ2=0.312) between the two groups (P＞0.05). The follow-up time after surgery was ≥5 months. The intraocular pressure at 1 week and 1, 3, and 6 months after surgery, the changes of BCVA and the occurrence of complications such as concurrent cataract and epimacular membrane were observed at the last follow-up, and the incidence of obesity in the children during the follow-up period was recorded. The measurement data between groups was compared by independent sample t test; the enumeration data was compared by χ2 test. ResultsOne month after the operation, the intraocular pressure of group A and group B were 15.17±6.21 and 25.28±10.38 mm Hg (1 mm Hg=0.133 kPa) respectively; the intraocular pressure of group B was significantly higher than that of group A, the difference was statistically significant (t=0.141, P=0.043). At the last follow-up, there was no significant difference in the percentage of visual acuity improvement between the two groups (χ2=0.315, P=0.053); there was no significant difference in the incidence of concurrent cataract and epimacular membrane (χ2=0.621, P＞0.05). Among the 37 cases in group A, 32 cases (86.5%, 32/37) developed obesity symptoms during the follow-up period. ConclusionPPV combined with intravitreal implantation of Ozurdex and oral glucocorticoid after PPV can effectively improve the visual acuity of the affected eye; the incidence of complications is similar, however, the incidence of obesity after oral glucocorticoid is higher.
Congenital toxoplasmosis is one of the most common types of intrauterine infection, with the triad of retinal choroiditis, intracranial calcification, and hydrocephalus as the main clinical manifestations, which can lead to serious sequelae such as cerebral palsy, cognitive impairment and visual impairment. Therefore, early diagnosis and early treatment are important to improve the prognosis of patients. Recommended treatment options include pyrimethamine, sulfadiazine combined with folic acid, or new drugs such as azithromycin and atorvastatin. This article reviews the research progress of epidemiology, clinical manifestations, diagnosis and treatment of congenital toxoplasmosis, in order to provide a reference for clinicians to improve their understanding of clinical diagnosis and treatment of this disease.