Clinical manifestations and visual outcomes associated with ocular toxoplasmosis in a Brazilian population

Abstract

Ocular toxoplasmosis is the leading cause of posterior uveitis worldwide. We conducted an observational study of 262 consecutive individuals (n = 344 eyes) with ocular toxoplasmosis who were followed over a 34-month period. Most subjects were T. gondii IgG + /IgM- (n = 242; 92.4%; 317 eyes), and 140 eyes (40.7%) had active lesions. For eyes in which retinal lesions were active at recruitment and best-corrected visual acuity (BCVA) could be measured (n = 133), 21.0% (n = 28) remained blind (BCVA below 20/400) after inflammation resolved. In these eyes, atypical ocular toxoplasmosis (OR 4.99; 95% CI 1.14–22.85; p = 0.0330), macular lesion (OR 9.95; 95% CI 2.45–47.15; p = 0.0019) and any complication (OR 10.26; 95% CI 3.82–30.67; p < 0.0001) were associated with BCVA below 20/200. For eyes with only inactive lesions at recruitment and BCVA measured (n = 178), 28.1% (n = 50) were blind. In these eyes, having at least one lesion larger than one disc-diameter (OR 6.30; 95% CI 2.28–22.46; p = 0.0013) and macular lesion (OR 5.69; 95% CI 2.53–13.54; p < 0.0001) were associated with BCVA below 20/200. Older age (OR 1.02; 95% CI 1.00–1.05; p = 0.0493) and active disease at presentation (OR 4.74; 95% CI 1.95–12.91; p = 0.0011) were associated with recurrences. Additional clinical attention should be directed towards patients with risk factors for poor visual outcome.

Posterior segment findings by spectral-domain optical coherence tomography and clinical associations in active toxoplasmic retinochoroiditis

“…Informed consent was obtained from all adults and the legal guardians of those under 18 years of age. A detailed clinical description of patients and their ocular disease has been reported 15 . For this study, the inclusion criterion was active TRC in retinal zone 1 or 2, and the exclusion criteria were co-existing retinal pathology and media opacity preventing visualization of the posterior segment.…”

Toxoplasmosis ocular.

“…El Toxoplasma gondii es un parásito intracelular que afecta a todos los mamíferos (2). El T. gondii infecta a un estimado del 25% al 30% de la población humana, manteniendo una prevalencia entre el 10% al 80% según la región (9,12). Aproximadamente el 2% de los infectados desarrollan lesiones en la retina (12).…”

“…La infección adquirida post-natal es más frecuente que la infección congénita, como se creía anteriormente, siendo más frecuente en niños que en adultos (2,3,7). La forma congénita se presenta en ambos ojos hasta en el 85 % de los casos (3,9). La presencia de malas condiciones higiénicas aumenta el riesgo de adquirir la enfermedad (3,9).…”

“…La forma congénita se presenta en ambos ojos hasta en el 85 % de los casos (3,9). La presencia de malas condiciones higiénicas aumenta el riesgo de adquirir la enfermedad (3,9). En recién nacidos, la incidencia de retinocoroiditis en toxoplasmosis congénita es de hasta un 80% (1,9).…”

Manifestações oculares de doenças sistêmicas: uveítes, Oftalmopatia de Graves e Síndrome de Sjögren

“…O prognóstico dos pacientes vai depender de vários fatores como a presença de complicações oculares e do local de acometimento das lesões oculares. Lesões localizadas na retina central (mácula) causam maior acometimento visual 11,12 .…”