Local treatment of toxoplasmic retinochoroiditis with intravitreal clindamycin and dexamethasone

Abstract

Approved by the following research ethics committee: UNIFESP/EPM, project number: 0358/04. ABSTRACTPurpose: To report the clinical outcomes of local treatment of toxoplasmic retinochoroiditis (TRC) with intravitreal injections of clindamycin and dexamethasone. Methods: Study population: 16 eyes (16 patients) with active TRC sparing the macula and juxtapapillary area treated with intravitreal injections of clindamycin (1 mg) and dexamethasone (1 mg) without concomitant systemic antitoxoplasmic or anti-inflammatory therapy. Measured parameters: Best-corrected visual acuity (BCVA) was measured by an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. BCVA and clinical characteristics of retinochoroiditis were assessed at baseline and at 1, 3, 6, and 12 months. Primary outcome measures: Resolution of retinochoroiditis and changes in BCVA. Results: Control of TRC was achieved in all cases with a mean interval of 2.48 ± 1.03 weeks (2-6 weeks). A single injection of intravitreal clindamycin and dexamethasone was performed in 12 patients, and four patients required two intravitreal injections, during the follow-up period. Fourteen eyes (87.5%) improved ≥ 2 ETDRS lines of BCVA, of two or more Early Treatment Diabetic Retinopathy Study lines, BCVA remained stable in two eyes (12.5%), and no patient had decreased BCVA at the end of the follow-up period. No ocular or systemic adverse events were observed. Conclusion: Local treatment with intravitreal injections of clindamycin and dexamethasone without concomitant systemic therapy was associated with resolution of TRC in patients without macular or juxtapapillary involvement. Intravitreal clindamycin and dexamethasone may represent a viable treatment option in patients with allergies or inadequate responses to oral medications. Keywords

Ocular Toxoplasmosis: No Stranger to the Masquerade Ball

“…Time to resolution of disease activity was 2.5 + 1 week with no adverse drug reactions in another similar IVI cohort. 19 In addition to COT, oral TMP-SMX, azithromycin, and atovaquone have all been found effective in treating OT. A randomized study comparing oral azithromycin 500 mg � 1 followed by oral 250 mg daily with a prednisone taper to 1 double-strength TMP-SMX tablet twice daily found similar efficacy including VA improvement, lesion size and vitritis reduction, as well as response time.…”

Congentinal Central Toxoplasma Chorioretinitis - Case Study

“…K dalším očním komplikacím, které byly v literatuře popsány, patří vitritida, epiretinální membrána, subretinální kolekce tekutiny až vývoj serózního odchlípení sítnice [19,26].…”

“…V poslední době je často diskutována možnost podání léčby intravitreálně. Byly popsány případy regrese aktivního ložiska toxoplasmové chorioretinitidy a zlepšení centrální zrakové ostrosti u dospělých pacientů po intravitreálním podání klindamycinu v kombinaci s dexamethasonem [26]. Autoři studie zabývající se možnostmi intravitreální terapie toxoplasmové chorioretinitidy jako alternativy ke klasické kombinaci léčiv popsali dobrý efekt a zlepšení centrální zrakové ostrosti minimálně o dva řádky ETDRS optotypu (early treatment diabetic retinopathy study).…”

<p>Intravitreal Clindamycin as First-Line Therapy for Toxoplasmic Retinochoroiditis: A Case Series</p>

“…3 Intravitreal clindamycin alone or in combination with dexamethasone had been previously reported as an alternative treatment for ocular toxoplasmosis. 2,3,[5][6][7][8][9][10][11][12][13] However, the use of intravitreal clindamycin alone as the first-line therapy for toxoplasmic retinochoroiditis is not commonly practised. We report our experience with intravitreal clindamycin as first-line treatment in four patients of toxoplasmic retinochoroiditis.…”