Our Results of Follow-up and Treatment in Ocular Toxoplasmosis

Abstract

Purpose: To evaluate the importance of clinical findings and treatment modalities in ocular toxoplasmosis. Materials and Methods: We retrospectively evaluated 20 patients who were diagnosed oculer toxoplasmosis between 2003-2009 in Fırat univercity eye clinic. The diagnosis was determined according to the fundus examination and serological findings. Results: Twelve (%60) female and 8 (%40) male of 20 patients were involved and the mean of the patients age was 25 (13-48) years. The mean follow up time was 30 (8-62) months. Twelve (%60) patients had active retinochoroiditis and 8 (%40) patients had retinochoroidal skar. Twelve (%60) patients who had active retinochoroiditis were treated with antiparasitic drugs for 4-6 weeks. Four (%33) of the patients in this grup had foveal lesions and 8 (%66) had foveal lesions as well as peripheral retinal involvement. Ocular findings were observed anterior chamber reaction and keratic precipitates in 12 (%60) patients, posterior synechia in 4 (%20) patients and posterior subcapsuler cataract in 2 (%10) patients. Topical steroid and sikloplejik terapy were aplicated to the twelve (%60) patients who had anterior chamber reaction. Recurrence was observed in 4 (%20) patients. The mean improvement of the visual acuity was 1.8 lines in snellen chart. The anterior chamber reaction and size of the lesion were decreased after the treatment. Conclusion: The diagnosis of oculer toxoplasmosis was determined with clinical and serological findings. Ocular toxoplasmosis can be taken under control by the correct diagnosis and effective treatment. Visual prognosis might be better after the treatment. Key words: Ocular Toxoplasmosis; Treatment; Prognosis.

Keywords

• Ocular Toxoplasmosis; Treatment; Prognosis.

Oküler Toksoplazmoziste Takip ve Tedavi Sonuçlarımız

Öz

Amaç: Oküler toksoplazmozis tanısında klinik bulguların önemini vurgulamak ve tedavi yaklaşımlarını değerlendirmek. Gereç-Yöntem: 2003-2009 tarihleri arasında Fırat Üniversitesi Hastanesi Göz Hastalıkları kliniğinde Oküler toksoplazmozis tanısıyla takip edilen 20 hastanın kayıtları retrospektif olarak incelendi. Tanı serolojik testler ve fundus muayenesinde bulguların varlığı ile konuldu. Bulgular: Çalışmaya dahil edilen 12 (%60) kadın, 8 (%40) erkek hastanın yaş ortalaması 25 (13-48) yıldı. Ortalama takip süreleri 30 (8-62) aydı. On iki (%60) hastada aktif retinokoroidit, 8 (%40) hastada retinokoroidal skar mevcuttu. Aktif retinokoroidit düşünülen 12 (%60) hastaya 4-6 hafta süreyle antiparazitik tedavi uygulandı. Bu hastaların 4 (%33)' ünde foveal tutulum, 8 (%66)'inde foveal tutulumla birlikte periferik retinada tutulum saptandı. Olgularımızın retina dışı göz bulguları incelendiğinde; 12 (%60) hastada değişen derecelerde ön kamara reaksiyonu ve keratik presipitatlar, 4 (%20) hastada posterior sineşi, 2 (%10) hastada arka subkapsüler katarakta rastlanıldı. Ön kamara reaksiyonu olan 12 (%60) hastaya topikal steroid ve sikloplejik damla tedaviye eklendi. Dört (%20) hastada takip sürecinde nüks gözlendi. Tedavi sonrası görme keskinliği snellen eşeline göre ortalama 1,8 sıra arttı ve tüm olgularda ön kamara reaksiyonunda azalma, lezyon çapında küçülme saptandı. Tartışma: Oküler toksoplazmozis tanısı klinik ve serolojik bulgularla konulmaktadır. Doğru tanı ve tedavi yaklaşımı ile oküler toksoplazmozis kontrol altına alınabilir, görme prognozu üzerindeki olumsuz etkisi azaltılabilir. Anahtar kelimeler: Oküler Toksoplazmozis; Tedavi; Prognoz.

Anahtar Kelimeler

• Oküler Toksoplazmozis; Tedavi; Prognoz.

Kaynakça

1. Jones JL, Kruszon-Moran D, Wilson M, et al. Toxoplasma gondii infection in the United States: seroprevalence and risk factors. Am J Epidemiol 2001; 154: 357-65.
2. Holland GN. Ocular toxoplasmosis in the immunocompramides host. Int Ophthalmol 1989; 13: 399-402.
3. Balıkoğlu M, Özdemir P, Özdal P, et al. Prognostic factors for final visual acuity and recurrence in active ocular toxoplasmosis. J Retina Vitreous 2009; 17: 255-62.
4. Scherrer J, Iliev ME, Halberstadt M, et al. Visual function in human ocular toxoplasmosis. Br J Ophthalmol 2006;91:233-26.
5. Bosch-Driessen LE, Berendschot TT, Ongkosuwito JV, et al. Ocular toxoplasmosis: clinical features and prognosis of 154 patients. Ophthalmology 2002; 109: 869-78.
6. Holland GN. Ocular toxoplasmosis: a global reassessment. Part I: epidemiology and course of disease. Am J Ophthalmol 2003; 136: 973-88.
7. Yanoff M, Duker JS, editors Ophthalmology Ocular toxoplazmosis. 2 nd. Edition, Louis, MO: Morsby 2004; 1167-8.
8. Karakaş N, Şenerkek E, Yaşar T, et al. Our results of follow up and treatment in ocular toxoplasmosis. J Retina Vitreous 1995; 3: 60-3.

9. Akbatur H. Oküler Toxoplazmozis. Türkiye Oftalmoloji Gazetesi 1993; 2:2.
10. Kanski JJ. Toksoplazmoz. 4 th edition, Butterworth-Heinemann 2004; 295-7.
11. Garweg JG, Scherrer JN, Halberstadt M. Recurrence Characteristics in Europan patients with ocular toxoplasmosis. Br J. Ophthalmol 2008; 92: 1253-56.
12. Friedmann CT, Knox DL. Variations in recurrent active toxoplasmic retinochoroiditis.Arch Ophthalmol. 1969; 81: 481- 93.
13. Mc Auley J, Boyer KM, Patel D, et al. Early and longitudinal evaluations of treated infants and children and untreated historical patients with congenital toxoplasmosis: the Chicago Collaborative Treatment Trial. Clin Infect Dis 1994; 18: 38-72.
14. Rothova A, Buitenhuis HJ, Menken J: Therapy of ocular toxoplasmosis. Int Ophthalmol 1989; 13: 415-9.
15. Swanson MW: Association of antibody titer and chorioretinal scarring in toxoplasmosis retinochoroiditis. Am J Ophthalmol A, 1989; 60: 735-40.
16. Gilbert RE, Dunn DT, Lightman S, et al. Incidence of symptomatic toxoplasma eye disease: etiology and public health implications. Epidemiol Infect 1999; 123: 283-9.
17. Atmaca LS, Simsek T, Batioglu F. Clinical features and prognosis in ocular toxoplasmosis. Jpn J Ophthalmol. 2004; 48: 386-91.
18. Engstrom RE, Holland GN, Nussenblatt RB, Jabs DA. Current practives in the management of ocular toxoplasmosis. Am J Ophthalmol 1991; 111: 601-10.
19. Nicholson DH, Wolchok EB. Ocular toxoplasmosis in an adult receiving long-term corticosteroid therapy. Arch Ophthalmol 1976; 94: 248-54.
20. Sacks JJ, Roberto RR, Brooks NF. Toxoplasmosis infection associated with raw goat’s milk. JAMA 1962; 248: 1728-32.
21. Holland GN, Ingstrom RE, Glasgow BJ, et al. Ocular toxoplasmosis in patients with the acquried immunodeficieny syndrome. Am J Ophthalmol 1988; 106: 653-7.