An update on current practices in the management of ocular toxoplasmosis 1, 2 1InternetAdvance publication at ajo.com April 12, 2002. 2Additional information is available online at ajo.com.

Holland, Gary N.; Lewis, Kevan G.

doi:10.1016/s0002-9394(02)01526-x

Cited by 156 publications

(60 citation statements)

References 32 publications

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“…Considering the natural history of this disease and the side effects of medications, the risk of treatment secondary to the potential toxicity of antiparasitic medications may be greater than any benefit provided. However, treatment is recommended for lesions within the vascular arcades, adjacent to the optic disk, or larger than 2 optic disk diameters to reduce the chance of vision loss [58]. Toxoplasma retinochoroiditis in immunocompromised patients requires immediate treatment.…”

Section: Treatment and Managementmentioning

confidence: 99%

“…Clindamycin is often added to the classic triple therapy as part of the ‘quadruple therapy' [58]. Recent studies focused on the intravitreal injection of clindamycin and dexamethasone as a local treatment option.…”

Section: Treatment and Managementmentioning

confidence: 99%

“…Corticosteroid therapy without antiparasitics may lead to large retinal lesions even in immunocompetent patients [71,72]. The baseline indications for the use of corticosteroids include severe vitreous inflammation, decreased vision, proximity of lesions to the fovea or optic disk and the large size of the active lesion [58]. The preferred drug for oral corticosteroid is prednisone at a dose of 0.5-1.0 mg/kg/day.…”

Section: Treatment and Managementmentioning

confidence: 99%

“…The protocol for initiating corticosteroid therapy for patients with ocular toxoplasmosis varies greatly. In a survey by Holland and Lewis [58], 17% of physicians reported using oral corticosteroid for all immunocompetent patients with ocular toxoplasmosis regardless of clinical findings. Corticosteroids were started simultaneously with antiparasitic drugs by 36% of respondents in this survey, while 64% deferred the start of corticosteroid therapy 1-7 days after starting antiparasitic therapy, with the majority waiting only 1-3 days for steroid initiation.…”

Section: Treatment and Managementmentioning

confidence: 99%

“…Most ophthalmologists prefer topical steroids for ocular toxoplasmosis patients. In the survey by Holland and Lewis [58], 82% of physicians reported giving topical steroids for immunocompetent patients with ocular toxoplasmosis. The main indications for use of topical corticosteroids are ocular pain, redness, photophobia, moderate to severe anterior chamber inflammation, and elevated intraocular pressure [16,58].…”

Section: Treatment and Managementmentioning

confidence: 99%

See 4 more Smart Citations

Recent Developments in the Diagnosis and Treatment of Ocular Toxoplasmosis

Özgönül

Besirli²

2016

Ophthalmic Res

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Ocular toxoplasmosis, a chorioretinal infection with Toxoplasma gondii, is the most common etiology of posterior uveitis in many countries. Accurate diagnosis depends heavily on the characteristic clinical features of this disease, but atypical presentations, especially in immunocompromised patients, may create diagnostic challenges and lead to misdiagnosis and inappropriate treatment. Molecular biology techniques to diagnose ocular toxoplasmosis have been available for many years and are now accessible as standard laboratory tests in many countries. Aqueous humor or vitreous evaluation to detect parasite DNA by polymerase chain reaction or specific antibody may provide definitive evidence for rapid diagnosis. Oral pyrimethamine and sulfadiazine plus systemic corticosteroids are an effective therapy for ocular toxoplasmosis. Recent data supports the use of other treatment approaches, including intravitreal antibiotics. The aim of the present review is to discuss briefly the new diagnostic tools and treatment options for ocular toxoplasmosis.

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Section: Treatment and Managementmentioning

confidence: 99%

Section: Treatment and Managementmentioning

confidence: 99%

Section: Treatment and Managementmentioning

confidence: 99%

Section: Treatment and Managementmentioning

confidence: 99%

Section: Treatment and Managementmentioning

confidence: 99%

See 3 more Smart Citations

Recent Developments in the Diagnosis and Treatment of Ocular Toxoplasmosis

Özgönül

Besirli²

2016

Ophthalmic Res

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A Retinal Detachment After International Travel

2022

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Corticosteroids as adjuvant therapy for ocular toxoplasmosis

Jasper

Vedula

John

et al. 2013

Cochrane Database of Systematic Reviews

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Background Ocular infestation with Toxoplasma gondii, a parasite, may result in inflammation in the retina, choroid, and uvea and consequently lead to complications such as glaucoma, cataract, and posterior synechiae. Objectives The objective of this systematic review was to assess the effects of adjunctive use of corticosteroids for ocular toxoplasmosis. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to October 2012), EMBASE (January 1980 to October 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to October 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We searched the reference lists of included studies for any additional studies not identified by the electronic searches. We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 11 October 2012. Selection criteria We planned to include randomized and quasi-randomized controlled trials. Eligible trials would have enrolled participants of any age who were immunocompetent and were diagnosed with active ocular toxoplasmosis. Included trials would have compared anti-parasitic therapy plus corticosteroids versus anti-parasitic therapy alone, or different doses or times of initiation of corticosteroids. Data collection and analysis Two authors independently screened titles and abstracts retrieved from the electronic searches. We retrieved full-text articles of studies categorized as ‘unsure’ or ‘include’ after review of the abstracts. Two authors independently reviewed each full-text article. Discrepancies were resolved through discussion. Main results The electronic searches retrieved 368 titles and abstracts. We reviewed 20 full-text articles. We identified no trials eligible for inclusion in this systematic review. Authors' conclusions Although research has identified wide variation in practices regarding use of corticosteroids, our systematic review did not identify evidence from randomized controlled trials for the role of corticosteroids in the management of ocular toxoplasmosis. Several questions remain unanswered by well-conducted randomized trials in this context, including whether use of corticosteroids is more effective than use of anti-parasitic therapy alone, when corticosteroids should be initiated in the treatment regimen (early versus late course of treatment), and which dosage and duration of steroid use is best. These questions are easily amenable to research using a randomized controlled design and they are ethical due to the absence of evidence to support or discourage use of corticosteroids for this condition. The question of foremost...

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An update on current practices in the management of ocular toxoplasmosis 1, 2 1InternetAdvance publication at ajo.com April 12, 2002. 2Additional information is available online at ajo.com.

Cited by 156 publications

References 32 publications

Recent Developments in the Diagnosis and Treatment of Ocular Toxoplasmosis

Recent Developments in the Diagnosis and Treatment of Ocular Toxoplasmosis

A Retinal Detachment After International Travel

Corticosteroids as adjuvant therapy for ocular toxoplasmosis

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