1. Clinical manifestations and visual outcomes associated with ocular toxoplasmosis in a Brazilian population.
- Author
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Arruda S, Vieira BR, Garcia DM, Araújo M, Simões M, Moreto R, Rodrigues MW Jr, Belfort R Jr, Smith JR, and Furtado JM
- Subjects
- Adolescent, Adult, Age Factors, Aged, Antibodies, Protozoan blood, Antiprotozoal Agents therapeutic use, Blindness drug therapy, Blindness immunology, Blindness parasitology, Brazil, Female, Humans, Immunoglobulin G blood, Immunoglobulin M blood, Male, Middle Aged, Pyrimethamine therapeutic use, Recurrence, Retina drug effects, Retina immunology, Retina parasitology, Retina pathology, Risk Factors, Sulfadiazine therapeutic use, Toxoplasma drug effects, Toxoplasma growth & development, Toxoplasmosis drug therapy, Toxoplasmosis immunology, Toxoplasmosis parasitology, Treatment Outcome, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Uveitis, Posterior drug therapy, Uveitis, Posterior immunology, Uveitis, Posterior parasitology, Vision, Ocular drug effects, Visual Acuity drug effects, Blindness pathology, Toxoplasma pathogenicity, Toxoplasmosis pathology, Uveitis, Posterior pathology
- Abstract
Ocular toxoplasmosis is the leading cause of posterior uveitis worldwide. We conducted an observational study of 262 consecutive individuals (n = 344 eyes) with ocular toxoplasmosis who were followed over a 34-month period. Most subjects were T. gondii IgG + /IgM- (n = 242; 92.4%; 317 eyes), and 140 eyes (40.7%) had active lesions. For eyes in which retinal lesions were active at recruitment and best-corrected visual acuity (BCVA) could be measured (n = 133), 21.0% (n = 28) remained blind (BCVA below 20/400) after inflammation resolved. In these eyes, atypical ocular toxoplasmosis (OR 4.99; 95% CI 1.14-22.85; p = 0.0330), macular lesion (OR 9.95; 95% CI 2.45-47.15; p = 0.0019) and any complication (OR 10.26; 95% CI 3.82-30.67; p < 0.0001) were associated with BCVA below 20/200. For eyes with only inactive lesions at recruitment and BCVA measured (n = 178), 28.1% (n = 50) were blind. In these eyes, having at least one lesion larger than one disc-diameter (OR 6.30; 95% CI 2.28-22.46; p = 0.0013) and macular lesion (OR 5.69; 95% CI 2.53-13.54; p < 0.0001) were associated with BCVA below 20/200. Older age (OR 1.02; 95% CI 1.00-1.05; p = 0.0493) and active disease at presentation (OR 4.74; 95% CI 1.95-12.91; p = 0.0011) were associated with recurrences. Additional clinical attention should be directed towards patients with risk factors for poor visual outcome.
- Published
- 2021
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