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PubMed2004

Photodynamic therapy with verteporfin for subfoveal choroidal neovascularization secondary to toxoplasmic chorioretinal scar.

BACKGROUND: To assess the effect of photodynamic therapy in the treatment of subfoveal choroidal neovascularization consecutive to a toxoplasmic chorioretinal scar. HISTORY AND SIGNS: Three patients with a previous history of toxoplasmic chorioretinal scar noticed a decrease in visual acuity and metamorphopsia. Fundus examination and fluorescein angiography revealed the presence of subfoveal choroidal neovascularization at the edge of the toxoplasmic chorioretinal scar. THERAPY AND OUTCOME: The first patient, aged 78, was treated by photodynamic therapy followed by three subsequent treatments of feeder vessel by laser photocoagulation. Visual acuity decreased during follow-up in the presence of recurrence of choroidal neovascularization and subretinal fibrosis. The second patient, a 20-year-old lady, was treated with three sessions of photodynamic therapy for a subfoveal choroidal neovascularization related to a toxoplasmic scar. Visual acuity was stabilized on the last follow-up visit at 0.3. The third patient, aged 53, received four treatments with photodynamic therapy at an interval of 3 - 4 months. choroidal neovascularization was stabilized and the last visual acuity was 0.2. CONCLUSIONS: This preliminary report suggests that photodynamic therapy with verteporfine may be an effective therapeutic modality for subfoveal choroidal neovascularization related to a toxoplasmic chorioretinal scar. Further assessment is needed in order to confirm this preliminary findings.

Adult↗

PubMed2004

[Fundus quiz 2003].

6 cases with pathognomonic fundus pathologies are presented and discussed using multiple-choice questions.

Adult↗

PubMed1998

[Toxoplasmosis retinochorioiditis, a therapy comparison between spiramycin and pyrimethamine/sulfadiazine].

BACKGROUND: The treatment of toxoplasma retinochoroiditis with spiramycin is an alternative to sulfadiazine and pyrimethamine. The treatment with sulfadiazine is associated with multiple side effects. Sulfadiazine is contraindicated during pregnancy and breastfeeding period. Spiramycin has less side effects and is recommended during pregnancy and breastfeeding period. The efficacy of spiramycin in treatment of toxoplasma retinochoroiditis is still a matter of controversy. PATIENTS AND METHODS: In a retrospective study, side effects and outcome of therapy in 44 patients with toxoplasma retinochoroiditis treated with sulfadiazine and pyrimethamine (n = 30) or spiramycin (n = 14) were compared. We assessed duration of therapy and healing, ophthalmoscopic findings and observed side effects. RESULTS: The mean healing time in the group of spiramycin was 63.83 days in comparison to 88 days for the group of patients treated with sulfadiazine/pyrimethamine. The frequency of side effects was lower in the group treated with spiramycin. CONCLUSION: In comparison to a combined application of sulfadiazine and pyrimethamine the treatment with spiramycin alone requires a shorter duration of therapy and healing period. Additionally, side effects and contraindications appear to be less frequent. In view of these findings, spiramycin therapy must be considered as a promising approach in the treatment of toxoplasma retinochoroiditis.

Adult↗

PubMed1996

[Retinal tear in retinochoroiditis toxoplasmotica].

PATIENT: A 29-year-old white female presented with an episode of recurrent focal toxoplasmic retinochoroiditis in her right eye. Apart from a white active lesion between the temporal vascular arcades, marked vitreous opacification was present. Treatment with oral pyrimethamine and sulfadiazine led to resolution of retinochoroiditis activity including vitreous clearing within 10 weeks. Another 3 weeks later, a fresh peripheral retinal tear was noted on routine fundus examination of the right eye. While the left eye showed no signs of vitreoretinal pathology, biomicroscopy revealed a posterior vitreous detachment and marked vitreous degeneration in the right eye of this emmetropic patient. Prophylactic laser treatment was performed. No further abnormalities were observed during a 5 months follow-up period. CONCLUSION: Retinal tears (and rhegmatogenous retinal detachment) are rare complications of toxoplasmic retinochoroiditis. However, a tear may occur due to vitreoretinal traction following postinflammatory structural alteration of the vitreous. Thus, in toxoplasmic retinochoroiditis the diagnostic attention should not be limited to the evaluation of optical transparency of the vitreous. Vitreous structure should be assessed as well and if structural changes are noted, repeated ophthalmoscopy is mandatory in order to detect retinal tears and rhegmatogenous retinal detachment timely.

Adult↗

PubMed1994

[Bilateral papilledema and retinochoroiditis ad papillam in a 12-year-old girl].

Ophthalmoscopy in a somnolent girl of 12 years revealed papilloedema of R = 3D and L = 4D. In the right eye there was an additional retinochoroiditis ad papillam. Seroreactions for toxoplasmosis were highly positive. By treatment with Daraprim, Durenat and Leucovorin, the left eye recovered nearly completely, but the right eye developed a severe optic atrophy.

Child↗

PubMed1992

[Clindamycin therapy of suspected toxoplasmosis retinochoroiditis].

It is generally accepted that toxoplasmic retinochorioiditis should be treated when central visual function is threatened. Although controlled trials of treatment led to contradictory results, a combination of pyrimethamin, sulphadiazine and folinic acid is regarded to be the most effective treatment strategy. Nevertheless, hematological complications necessitate a discontinuation of these drugs in up to 1/4 of the patients. Clindamycin, a semisynthetic antibiotic, also has an antitoxoplasmal effect on animals and is less toxic to the bone marrow. A theoretical advantage is that Clindamycin can penetrate and act on the encysted form of the parasite and that it will accumulate in the uveal tissue of the eye. Between 1983 and 1991 we performed 102 courses of treatment in 90 patients with presumed toxoplasmic retinochorioiditis. 900-1800 mg Clindamycin were given in combination with 60-80 mg Fluorcortolon which was gradually decreased during a 4 to 6 week period. In general Clindamycin was given for 6 weeks. Duration varied from 4 to 12 weeks. 15 patients experienced side effects of treatment. 6 of them complained of diarrhea and gastrointestinal bleeding and 7 patients developed allergic exanthem and acne. Mild lymphopenia and hepatotoxicity were further complications. In 8 patients the drugs had to be discontinued; 4 times for gastrointestinal discomfort, 3 times for allergic exanthem and in one patient for mild hepatotoxicity. We did not observe any serious complications during therapy. Only 9 complications were attributable to clindamycin, they disappeared immediately after discontinuing treatment.

Adult↗

PubMed1992

[Pars plana vitrectomy in uveitis].

A vitrectomy was performed in 30 eyes suffering from different forms of uveitis. An improvement of visual acuity was obtained in 29 cases and was explained by removal of vitreous haze and/or of the cataract, but not by the improvement of the inflammatory process.

Adolescent↗

PubMed1991

[Automatic perimetry of the central visual field in diseases of the macula].

We developed a program for testing the central 12 degrees of the visual field with a spatial resolution of 1.6 degrees that was easy to operate. The program was designed for the Octopus computer-perimeter and created by means of the SARGON-utility. Our way of examining differed slightly from the standard Octopus procedure. We tested 16 normal eyes and 13 eyes of patients with various diseases of the central retina. Our normal values of differential threshold sensitivities were about 1.8 dB below the normal values of the Octopus system. Sensitivity and specificity of the program were nearly identical irrespective of using our normal values or the Octopus normal values for the calculation of the above mentioned parameters. Sensitivity was 84.6%, specificity 87.5%. The ability of the program to correctly localize retinal defects was shown. The program was designed for follow-up of patients having undergone paramacular lasercoagulation.

Adult↗

PubMed1987

[Initial diagnosis of acquired immunologic deficiency syndrome (AIDS) by the ophthalmologist].

The authors report on two patients who presented with sudden loss of vision, due to irodocyclitis and retinochoroiditis in one patient and optic neuritis in the other. AIDS was diagnosed in both patients on the basis of a positive HIV antibody assay, lymphopenia, and a reduced helper-to-suppressor subset ratio. Soon afterwards, the patient with retinochoroiditis developed the full-blown picture of AIDS with cerebral involvement. Neither anticytomegaly treatment with DHPG nor triple therapy for toxoplasmosis was able to prevent the fatal course. The patient died within six months. In contrast, the patient with optic neuritis recovered full visual acuity. So far there has been no relapse, nor any opportunistic infection in other organs.

Acquired Immunodeficiency Syndrome↗

PubMed1983

[Vitrectomy in inflammatory diseases of the posterior segment of the eye].

Eight patients with chronic endogenous uveitis, chorioretinitis, toxoplasmosis and infective endophthalmitis underwent pars plana vitrectomy mainly to improve vision by clearing the media or removing membranes. Beyond this it turned out that in eyes with chronic endogenous uveitis vitrectomy might also alter or diminish the severity as well as the frequency of attacks. The role of the vitreous as an autoimmune agent is discussed.

Adult↗

PubMed1981

[Argon laser coagulation in the treatment of active chorioretinitis (author's transl)].

Three cases of active chorioretinitis due to toxoplasmosis, which in the past had shown numerous recurrences, were subjected to argon laser coagulation after the preceding treatment with drugs had proved ineffective. Our procedure with the argon laser beam aimed not only at covering the entire area of the active chorioretinitis, but also at encircling and covering the old focus. In our case 2, in which in one phase of the condition argon laser coverage was confined merely to the active focus, there was a recurrence originating from another point of the same lesion. Argon laser coagulation appears to be effective, given the fact that no recurrence was observed after its application in any of our three cases over a follow-up period ranging from 2-4 years.

Adolescent↗

PubMed1980

[Branch artery occlusion due to focal necrotizing retinitis -- probably caused by toxoplasmosis (author's transl)].

A case of necrotizing retinitis, probably due to toxoplasma gondii, is described in a 21-year-old man. Transient occlusion of the arteriole lying over the lesions was confirmed angiographically. The presence of inflammatory chorioretinal foci in the vicinity of retinal vessels was documented photographically in three other cases. The fundus changes and the field defects in these patients suggested that retinal perfusion had been temporarily impaired. The customary administration of steroids combined with antibiotics appears justified in order to minimise the occurrence of retinal vascular damage in the presence of necrotizing retinitis.

Adolescent↗

PubMed1978