Multifocal Necrotizing Chorioretinitis Following Phacoemulsification Surgery

Abstract

Introduction: Toxoplasma chorioretinitis is a leading cause of infectious posterior uveitis worldwide. Methods: We report an atypical presentation of Toxoplasma chorioretinitis presenting after uneventful cataract surgery in an 81-year-old male, with known hypernephroma and rheumatoid arthritis, treated with prednisolone and methotrexate. Results: He was treated for acute retinal necrosis and cytomegalovirus retinitis before Toxoplasma chorioretinitis was confirmed by vitreous biopsy 11 months after presentation. He developed a secondary rhegmatogenous retinal detachment, treated successfully with pars plana vitrectomy, silicone oil and endolaser. Visual acuity at discharge was 6/12 following silicone oil removal. Discussion: Necrotising chorioretinitis in immunosuppressed or elderly patients may present with an atypical phenotype. Clinical diagnosis in this context remains challenging. We discuss the clinical reasoning behind investigation and management of this patient group in whom viral and Toxoplasma retinitis may be clinically indistinguishable. The significance of vitreous PCR results in clinical decision making in the context of infectious posterior uveitis is discussed.

Multifocal Toxoplasma Retinochoroiditis in a Nonimmunosuppressed Elderly Patient: Case Report and Brief Review of the Literature

“…As such, ophthalmologists need to be vigilant in rapidly detecting and treating ocular toxoplasmosis before it leads to loss of vision. In the nonimmunosuppressed host, toxoplasma retinitis typically presents as a unifocal lesion with rapid-onset vision loss; in immunosuppressed patients, toxoplasma retinitis can be multifocal, mimicking viral retinitis (2-3-4). We present an atypical case of multifocal toxoplasma retinochoroiditis in a 77-year-old man without known immunosuppression, and describe the diagnosis and treatment course for this case.…”

Ocular Toxoplasmosis

“…1 Ocular involvement has been estimated to occur in approximately 2% of those infected and is associated with a lifelong risk of recurrence and vision loss. [2][3][4][5][6][7][8][9][10][11][12] This issue of Ocular Immunology & Inflammation (OII) contains an original article, 13 a letter to the editor, 14 and a companion editorial with original data, 15 each of which addresses important aspects of ocular toxoplasmosis (OT).…”