Toxoplasma Gondii is one of the most common zoonoses worldwide, with one-third of the world population affected, based on seropositivity. Based on a recent study at our institute, ocular toxoplasmosis among uveitis patients is approximately 7%, making it the most common infectious agent after ocular tuberculosis.
Methods
Challenges faced in day-to-day management include management of active disease in small children, pregnant women and complications of disease including chronic iridocyclitis, choroidal neovascular membranes (CNVM), secondary glaucoma, cataracts, epiretinal membranes (ERM) and rarely vasculitis/retinitis and retinal detachments (RD).
Results
Traditional therapy mandated a combination of pyrimethamine and sulfadiazine, together with corticosteroids for control of inflammation. A combination of clindamycin and azithromycin is our preferred approach for conventional therapy. Sulphamethoxazole and trimethoprim used together have similar efficacy. Intravitreal administration of clindamycin and dexamethasone is effective, and is mandatory in pregnancy, small children and intolerance to oral therapy. Management of complications require a thorough control of inflammation prior to any intervention; CNVM can often regress with control of inflammation, and do not always require anti-VEGF. Surgical management is rare (e.g. in ERM or RD).
Conclusion
Diagnosis of toxoplasmosis is essentially clinical, and aided by suitable investigations to confirm diagnosis and exclude differentials. There are a lot of therapeutic options, with intravitreal therapy the most promising new development. Although challenging in certain situations, appropriate and timely therapy avoids visual morbidity, particularly when the macula is threatened.
Conflict of interest
No
Authors 1
Last name
MALEK
Initials of first name(s)
M
Department
Vitreo-Retina and Uvea, Ispahani Islamia Eye Institute and Hospital
City
Dhaka
Country
Bangladesh
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