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Coexisting choroidal neovascularization and active retinochoroiditis-an uncommon presentation of ocular toxoplasmosis.

Hegde S, Relhan N, Pathengay A, Bawdekar A, Choudhury H, Jindal A, Flynn HW - J Ophthalmic Inflamm Infect (2015)

Bottom Line: All lesions had adjacent subretinal hemorrhage.The patients were managed with a combination of treatments including intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), oral anti-Toxoplasma treatment, and oral corticosteroids.In all patients, the retinitis lesion resolved in 6 weeks and the coexisting choroidal neovascular membrane resolved over 6 to 12 weeks.

View Article: PubMed Central - PubMed

Affiliation: GMRV Campus, LV Prasad Eye Institute, Visakhapatnam, India.

ABSTRACT

Background: Choroidal neovascularization during the active stage of Toxoplasma retinochoroiditis is an uncommon clinical presentation. The authors retrospectively reviewed medical charts of patients with coexisting choroidal neovascular membrane and active Toxoplasma retinochoroiditis.

Findings: Three patients presented with coexisting choroidal neovascular membrane and active Toxoplasma retinochoroiditis. All lesions had adjacent subretinal hemorrhage. The diagnosis was confirmed based on clinical presentation, fundus fluorescein angiography (FFA), and optical coherence tomography (OCT) findings. The patients were managed with a combination of treatments including intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), oral anti-Toxoplasma treatment, and oral corticosteroids. In all patients, the retinitis lesion resolved in 6 weeks and the coexisting choroidal neovascular membrane resolved over 6 to 12 weeks.

Conclusions: Recurrences in Toxoplasma retinochoroiditis are common as satellite lesions adjacent to an old atrophic scar. Coexisting choroidal neovascularization with active Toxoplasma retinochoroiditis is an important presentation and should be suspected in the presence subretinal hemorrhage and managed with a combination of anti-Toxoplasma treatment and intravitreal anti-VEGF.

No MeSH data available.


Related in: MedlinePlus

At presentation—a Color fundus photo of the right eye of case 1 shows a yellow-white active retinitis lesion (approximately 1 disc diameter, infero-temporal to fovea) adjacent to an old pigmented scar, a part of which is embedded in the active lesion. Coexisting subretinal hemorrhage was present at and inferior to the fovea along with macular thickening and subretinal fluid at the posterior pole. b Optical coherence tomography scan (horizontal) over the lesion shows an elevated foveal contour with increased retinal thickness, hyper-reflectivity, and pockets of subretinal fluid. At 20 weeks of follow up—c Color fundus picture shows healed, pigmented, and scarred lesion infero-temporal to fovea and d OCT scan over the lesion shows reduced retinal thickness, distorted architecture of retinal layers temporal to the fovea, reduced amount of subretinal fluid, and relative restoration of the foveal contour
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Fig1: At presentation—a Color fundus photo of the right eye of case 1 shows a yellow-white active retinitis lesion (approximately 1 disc diameter, infero-temporal to fovea) adjacent to an old pigmented scar, a part of which is embedded in the active lesion. Coexisting subretinal hemorrhage was present at and inferior to the fovea along with macular thickening and subretinal fluid at the posterior pole. b Optical coherence tomography scan (horizontal) over the lesion shows an elevated foveal contour with increased retinal thickness, hyper-reflectivity, and pockets of subretinal fluid. At 20 weeks of follow up—c Color fundus picture shows healed, pigmented, and scarred lesion infero-temporal to fovea and d OCT scan over the lesion shows reduced retinal thickness, distorted architecture of retinal layers temporal to the fovea, reduced amount of subretinal fluid, and relative restoration of the foveal contour

Mentions: A 15-year-old male patient presented with sudden onset blurring of vision in his right eye for 2 days and in the left eye for 2 years. His visual acuity at presentation in the right eye was 20/50, N18, and in the left eye 9/200, N36. Anterior segment findings were unremarkable. The right eye showed 1+ vitreous cells and a yellow-white active retinitis lesion (approximately 1 disc diameter, infero-temporal to fovea) adjacent to an old pigmented scar, a portion of which is embedded in the active lesion (Fig. 1). Coexisting subretinal hemorrhage was present at and inferior to the fovea along with macular thickening and subretinal fluid at the posterior pole. The left eye fundus showed disc pallor and a large (approximately 1.5 disc diameter in size), punched out, hyperpigmented scar at the macula. Fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) (Fig. 1) confirmed the presence of a coexisting active lesion with classic choroidal neovascular membrane in the right eye. A diagnosis of recurrent Toxoplasma retinochoroiditis with active CNVM in the right eye and a healed Toxoplasma scar in the left eye was made. He was treated with an intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) (bevacizumab) along with oral anti-parasitic medication (320 mg trimethoprim and 1600 mg sulfamethoxazole—i.e., cotrimoxazole twice a day) along with anti-inflammatory medication (oral prednisone 60 mg/day). The visual acuity started improving within 1 week (right eye visual acuity—20/25 at 1 week with reduced subretinal fluid at macula). Cotrimoxazole was continued, and a dose of oral prednisolone was tapered over 1 month to 10 mg/day. Oral steroids were gradually tapered off while cotrimoxazole was discontinued after 2 weeks. At 20 weeks, the visual acuity was 20/20 with healing and scarring of the chorioretinal lesion (Fig. 1).Fig. 1


Coexisting choroidal neovascularization and active retinochoroiditis-an uncommon presentation of ocular toxoplasmosis.

Hegde S, Relhan N, Pathengay A, Bawdekar A, Choudhury H, Jindal A, Flynn HW - J Ophthalmic Inflamm Infect (2015)

At presentation—a Color fundus photo of the right eye of case 1 shows a yellow-white active retinitis lesion (approximately 1 disc diameter, infero-temporal to fovea) adjacent to an old pigmented scar, a part of which is embedded in the active lesion. Coexisting subretinal hemorrhage was present at and inferior to the fovea along with macular thickening and subretinal fluid at the posterior pole. b Optical coherence tomography scan (horizontal) over the lesion shows an elevated foveal contour with increased retinal thickness, hyper-reflectivity, and pockets of subretinal fluid. At 20 weeks of follow up—c Color fundus picture shows healed, pigmented, and scarred lesion infero-temporal to fovea and d OCT scan over the lesion shows reduced retinal thickness, distorted architecture of retinal layers temporal to the fovea, reduced amount of subretinal fluid, and relative restoration of the foveal contour
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499335&req=5

Fig1: At presentation—a Color fundus photo of the right eye of case 1 shows a yellow-white active retinitis lesion (approximately 1 disc diameter, infero-temporal to fovea) adjacent to an old pigmented scar, a part of which is embedded in the active lesion. Coexisting subretinal hemorrhage was present at and inferior to the fovea along with macular thickening and subretinal fluid at the posterior pole. b Optical coherence tomography scan (horizontal) over the lesion shows an elevated foveal contour with increased retinal thickness, hyper-reflectivity, and pockets of subretinal fluid. At 20 weeks of follow up—c Color fundus picture shows healed, pigmented, and scarred lesion infero-temporal to fovea and d OCT scan over the lesion shows reduced retinal thickness, distorted architecture of retinal layers temporal to the fovea, reduced amount of subretinal fluid, and relative restoration of the foveal contour
Mentions: A 15-year-old male patient presented with sudden onset blurring of vision in his right eye for 2 days and in the left eye for 2 years. His visual acuity at presentation in the right eye was 20/50, N18, and in the left eye 9/200, N36. Anterior segment findings were unremarkable. The right eye showed 1+ vitreous cells and a yellow-white active retinitis lesion (approximately 1 disc diameter, infero-temporal to fovea) adjacent to an old pigmented scar, a portion of which is embedded in the active lesion (Fig. 1). Coexisting subretinal hemorrhage was present at and inferior to the fovea along with macular thickening and subretinal fluid at the posterior pole. The left eye fundus showed disc pallor and a large (approximately 1.5 disc diameter in size), punched out, hyperpigmented scar at the macula. Fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) (Fig. 1) confirmed the presence of a coexisting active lesion with classic choroidal neovascular membrane in the right eye. A diagnosis of recurrent Toxoplasma retinochoroiditis with active CNVM in the right eye and a healed Toxoplasma scar in the left eye was made. He was treated with an intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) (bevacizumab) along with oral anti-parasitic medication (320 mg trimethoprim and 1600 mg sulfamethoxazole—i.e., cotrimoxazole twice a day) along with anti-inflammatory medication (oral prednisone 60 mg/day). The visual acuity started improving within 1 week (right eye visual acuity—20/25 at 1 week with reduced subretinal fluid at macula). Cotrimoxazole was continued, and a dose of oral prednisolone was tapered over 1 month to 10 mg/day. Oral steroids were gradually tapered off while cotrimoxazole was discontinued after 2 weeks. At 20 weeks, the visual acuity was 20/20 with healing and scarring of the chorioretinal lesion (Fig. 1).Fig. 1

Bottom Line: All lesions had adjacent subretinal hemorrhage.The patients were managed with a combination of treatments including intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), oral anti-Toxoplasma treatment, and oral corticosteroids.In all patients, the retinitis lesion resolved in 6 weeks and the coexisting choroidal neovascular membrane resolved over 6 to 12 weeks.

View Article: PubMed Central - PubMed

Affiliation: GMRV Campus, LV Prasad Eye Institute, Visakhapatnam, India.

ABSTRACT

Background: Choroidal neovascularization during the active stage of Toxoplasma retinochoroiditis is an uncommon clinical presentation. The authors retrospectively reviewed medical charts of patients with coexisting choroidal neovascular membrane and active Toxoplasma retinochoroiditis.

Findings: Three patients presented with coexisting choroidal neovascular membrane and active Toxoplasma retinochoroiditis. All lesions had adjacent subretinal hemorrhage. The diagnosis was confirmed based on clinical presentation, fundus fluorescein angiography (FFA), and optical coherence tomography (OCT) findings. The patients were managed with a combination of treatments including intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), oral anti-Toxoplasma treatment, and oral corticosteroids. In all patients, the retinitis lesion resolved in 6 weeks and the coexisting choroidal neovascular membrane resolved over 6 to 12 weeks.

Conclusions: Recurrences in Toxoplasma retinochoroiditis are common as satellite lesions adjacent to an old atrophic scar. Coexisting choroidal neovascularization with active Toxoplasma retinochoroiditis is an important presentation and should be suspected in the presence subretinal hemorrhage and managed with a combination of anti-Toxoplasma treatment and intravitreal anti-VEGF.

No MeSH data available.


Related in: MedlinePlus