Toxoplasmosis retinochoroiditis after photodynamic therapy and intravitreal triamcinolone for a supposed choroidal neovascularization: a case report

Abstract

The purpose is to report a complication after photodynamic therapy (PDT) and intravitreal triamcinolone for a presumed choroidal neovascularization in age-related macular degeneration. Photodynamic therapy and intravitreal triamcinolone were used in an 84-year-old man with choroidal neovascularization in the left eye. Forty-five days after therapy, the patient returned with a severe necrotizing uveitis in the posterior pole and vitritis. Laboratory investigation disclosed a high anti-Toxoplasma IgG titer. Therapy with pyrimethamine, sulfadiazine and folinic acid resulted in total lesion healing although central vision was lost. Intravitreal triamcinolone may have had an influence on the exacerbation of retinochoroiditis in the posterior pole of the patient. Although rare, this complication may not be disregarded in the cases that require intraocular corticosteroids for treatment of several conditions, especially in patients who had previously suffered from toxoplasmosis infection.

An update on inflammatory choroidal neovascularization: epidemiology, multimodal imaging, and management

“…The authors observed stable/improved visual acuity and stabilized CNV diameters after PDT at 4 years’ follow-up [ 124 ]. In other case reports, PDT has been combined with either bevacizumab or with intravitreal triamcinolone acetonide in the treatment of CNV associated with toxoplasmosis [ 125 , 126 ].…”

Fulminant toxoplasmic retinochoroiditis following intravitreal triamcinolone administration

“…[8] This may be explained by the absence of appropriate anti-toxoplasmic coverage. However, Backhouse et al ., described a case of fulminant toxoplasmic retinochoroiditis following IVTA despite simultaneous anti-toxoplasmic coverage, which led to a vitrectomy with silicone oil placement for cosmetic globe preservation similar to our second case.…”

Current approach in the diagnosis and management of posterior uveitis

“…[1516] Pars plana vitrectomy is performed to treat persistent vitreous opacities or vitreoretinal traction. A newer fluoroquinolone, trovafloxacin, has potent anti-Toxoplasma activity and appears promising.…”