Intravitreal Clindamycin and Dexamethasone for Zone 1 Toxoplasmic Retinochoroiditis at Twenty-four Months

Lasave, Andrés F.; Díaz-Llopis, M.; Muccioli, Cristina; Belfort, Rubens; Arévalo, J. Fernando

doi:10.1016/j.ophtha.2010.01.028

Cited by 60 publications

(38 citation statements)

References 23 publications

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“…Twelve patients required a single intravitreal injection of clindamycin and dexamethasone for disease control and four required two injections. Therefore, the total number of injections required in this study was fewer than reported numbers in the majority of previous reports ranging from two to six injections (11,22,24) and similar to the number of injections required in a trial with comparable inclusion criteria (25) . Recurrence was observed in one patient who responded to a repeated intravitreal injection.…”

Section: Discussionsupporting

confidence: 49%

“…One eye developed cataract progression, a common complication of ocular inflammatory disease, during the follow-up period. The safety of intravitreal administration of clindamycin and dexamethasone has been reported by a number of studies (10,11,(22)(23)(24)(25)(26) . Only one case report has documented a case of hypersensitivity reaction, presenting as a generalized erythematous rash following intravitreal clindamycin, in a patient with ocular toxoplasmosis (27) .…”

Section: Discussionmentioning

confidence: 96%

“…Wong et al (23) reported the case of a patient with an atypical presentation of ocular toxoplasmosis (optic disc swelling and hemispherical retinal vein occlusion) successfully treated with two injections of intravitreal clindamycin and systemic prednisolone without concomitant systemic antibiotics. In contrast, Lasave et al (24) reported the use of intravitreal clindamycin and dexamethasone in 12 patients with zone 1 TRC, with eight patients receiving combined systemic antitoxoplasmic therapy, and reported resolution of retinochoroiditis with a mean number of 3.6 injections (3-6 injections) and a mean interval of 15.5 days. In a recent trial, Soheilian et al (25) studied 68 patients with active toxoplasmosis randomly assigned to receive intravitreal treatment with clindamycin and dexamethasone injections or conventional oral combination therapy of pyrimethamine, sulfadiazine, and prednisolone.…”

Section: Discussionmentioning

confidence: 98%

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Local treatment of toxoplasmic retinochoroiditis with intravitreal clindamycin and dexamethasone

Zamora¹,

Arantes²,

Reis³

et al. 2015

Arquivos Brasileiros De Oftalmologia

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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

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

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Local treatment of toxoplasmic retinochoroiditis with intravitreal clindamycin and dexamethasone

Zamora¹,

Arantes²,

Reis³

et al. 2015

Arquivos Brasileiros De Oftalmologia

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“…Local therapy with intravitreal clindamycin with dexamethasone has also been found to be effective. [ 63,64 ] Adjunctive treatment includes topical prednisolone acetate drops for the anterior uveitis component, and oral prednisone after initiation of anti-infective agent(s).…”

Section: Toxoplasmosis Retinochoroiditismentioning

confidence: 99%

Infectious Uveitis

Lin

2015

Curr Ophthalmol Rep

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Infectious uveitis is one of the most common and visually devastating causes of uveitis in the US and worldwide. This review provides a summary of the identification, treatment, and complications associated with certain forms of viral, bacterial, fungal, helminthic, and parasitic uveitis. In particular, this article reviews the literature on identification and treatment of acute retinal necrosis due to herpes simplex virus, varicella virus, and cytomegalovirus. While no agreed-upon treatment has been identified, the characteristics of Ebola virus panuveitis is also reviewed. In addition, forms of parasitic infection such as Toxoplasmosis and Toxocariasis are summarized, as well as spirochetal uveitis. Syphilitic retinitis is reviewed given its increase in prevalence over the last decade. The importance of early identification and treatment of infectious uveitis is emphasized. Early identification can be achieved with a combination of maintaining a high suspicion, recognizing certain clinical features, utilizing multi-modal imaging, and obtaining specimens for molecular diagnostic testing.

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“…24,25 Third, intravitreal clindamycin, with or without intravitreal dexamethasone, can play an important role in the treatment of OT, especially when the macula or optic disc are either threatened or involved, or when there is limited response or intolerance to systemic antimicrobial therapy. [26][27][28][29][30][31] And fourth, the recurrence of OT one month after uncomplicated cataract surgery begs the question of whether the surgical procedure itself played any role in causing disease reactivation. Whereas BoschDriessen et al observed reactivation of OT following cataract surgery in 5 of 15 eyes (33.3%) -all within four months of survery, 32 a more recent analysis by Heringer et al of 69 patients who underwent intraocular sugery reported reactivation in four eyes (5.8%), only one of which occurred within four months of the procedure (1.4%).…”

mentioning

confidence: 99%