Clinical Pattern of Toxoplasmic Retinochoroiditis in a Spanish Referral Center

Abstract

Background/Aims: To analyze the clinical pattern of ocular toxoplasmosis in a referral center in Spain. Methods: The medical records of consecutive patients with ocular toxoplasmosis admitted from a single referral center for uveitis in Barcelona (Spain) were retrospectively analyzed between January 2005 and January 2011. Results: One hundred and thirteen eyes from 113 patients (74 Spanish and 39 South American) with active ocular toxoplasmosis were analyzed with a 12-month follow-up. Final BCVA ≤20/200 was found in 30 eyes (26.5%). The most frequent complications were macular edema (16.8%) and epiretinal membrane (11.5%). Anterior chamber cell scores of ≥2+ (p = 0.003), vitreous cell scores of ≥2+ (p = 0.001), and the presence of cataracts (p = 0.047) or serous retinal detachment (p = 0.008) were more common among the South American than Spanish cohort. Active macular lesions (p < 0.001) with an initial BCVA ≤20/200 (p < 0.001) and advanced age (p = 0.019) were predictors for final BCVA ≤20/200, whereas female gender (p = 0.021) and an initial BCVA ≤20/200 (p = 0.045) were predictors for ocular complications. Moreover, a BCVA ≤20/200 (p < 0.001) and a vitreous cell score of ≥2+ (p = 0.045) at the initial examination were predictors of an eventual need for ocular surgery. Conclusion: The clinical features of ocular toxoplasmosis in Spanish patients differ from those of South American patients. In general, active macular lesions with an initial BCVA ≤20/200 and advanced age were shown to be predictors for final BCVA ≤20/200 in our patient cohort.

Risk factors for recurrences and visual impairment in patients with ocular toxoplasmosis: A systematic review and meta-analysis

“…Of these, 39 were included in the meta-analysis, of which 14 were conducted in South America, 13 in Europe, four in Asia, three multinational, two in North America, two Central America, and only one in Africa. In total, 4,200 patients with OT were analyzed, mean age ranged from 7.3 to 65.1 year of age [Range 1 week to 87 years] ( S3 Table ) [ 7 , 9 , 12 , 25 – 30 , 32 , 33 , 35 , 37 – 43 , 48 , 51 – 53 , 55 , 56 , 62 – 64 , 67 – 70 , 72 , 73 , 78 – 80 , 83 , 85 ]. The remaining 53 articles were included in the qualitative summary, divided into clinical and environmental factors ( Table 1 ), parasite factors ( Table 2 ), and treatment-related factors ( Table 3 ).…”

“…The development of blindness, as reactivations and visual impairment, was affected by the location of the lesion. It was estimated that central lesions raise 8.95 to 68.6 times the risk of blindness compared to a lesion located outside the macula [ 7 , 27 , 35 , 37 , 64 ]. Additionally, an age ≥50 years and the presence of lesions size >1 disc diameter (DD) had an OR of 3.27 (95% CI 1.22–8.8) and 6.30 (95% CI 2.28–22.46) for blindness, respectively [ 7 , 27 , 64 ].…”

“…It was estimated that central lesions raise 8.95 to 68.6 times the risk of blindness compared to a lesion located outside the macula [ 7 , 27 , 35 , 37 , 64 ]. Additionally, an age ≥50 years and the presence of lesions size >1 disc diameter (DD) had an OR of 3.27 (95% CI 1.22–8.8) and 6.30 (95% CI 2.28–22.46) for blindness, respectively [ 7 , 27 , 64 ]. Other associated factors are a history of scarring, recurrences during follow-up, and a VA <20/200 at admission [ 32 , 35 , 64 ].…”

Toxoplasmosis ocular reporte de caso y revisión de la literatura

“…La incidencia de afectación ocular durante la infección temprana por T. gondii suele ser mayor entre los ancianos. Pueden haber formas de presentación atípicas las cuales incluyen toxoplasmosis punteada externa de la retina, vasculitis retiniana, oclusiones vasculares retinianas, desprendimiento de retina, retinopatía pigmentaria unilateral simulando la retinitis pigmentosa, neurorretinitis, y otras formas de neuropatía óptica, necrosis de la retina periférica, y escleritis (Rey et al, 2013).…”

Perfil de reposta imunológica em lactentes: uso no diagnóstico, prognóstico e monitoração pós-terapêutica da toxoplasmose congênita

“…Os eventos fisiopatológicos associados ao desenvolvimento da lesão ocular na TC envolvem mecanismos multifatoriais, sendo a lise celular mediada pelo parasita relatada como a principal causa de destruição tecidual. Além disso, as respostas inflamatórias exacerbadas também podem contribuir para a gravidade da doença ocular (DODDS et al, 2008;REY et al, 2013) e eventos modulatórios, capazes de contrabalançar a resposta inflamatória exacerbada, são relevantes para controlar os danos causados pela infecção (CALABRESE et al, 2008, CORDEIRO et al, 2017. Alguns estudos apoiam que diferentes microambientes imunológicos nos estágios iniciais da TC estão associados a estados distintos de lesões retinocoroidais .…”