Ocular Toxoplasmosis When to treat ..!???
• lesions threaten disc, macula, or papillomacular bundle.
• lesions threatening a major vessel.
• Marked vitritis.
Ocular Toxoplasmosis How to treat ..!??
• Systemic: ≥4wk of prednisolone
• co-trimoxazole oR clindamycin/ sulfadiazine oR pyrimethamine/sulfadiazine/folinic acid (weekly
FBC required) or atovaquone.
• Steroids must not be used without effective anti-toxoplasmosis therapy and should not be given if immunosuppressed.
• For maternal infection acquired during pregnancy, use spiramycin (named-patient basis) to reduce transplacental spread.
• Atovaquone may reduce recurrences, as it is active against bradyzoites as well as tachyzoites.
• Azithromycin is used in some centres.
• immunocompetent patients, the disease is self-limiting and hence does not require treatment unless sight-threatening.
• Recurrence is common , education is key for prevention
Ocular Toxoplasmosis when and how to treat power point presentations:
Ocular toxoplasmosis by Dr. Md. Mominul Islam Fellow (Vitreo-Retina) Ispahani Islamia Eye Institute And Hospital Dhaka Bangladesh
1. Ocular toxoplasmosis Dr. Md. Mominul Islam
2. Introduction Common zoonosis Caused by Toxoplasma Gondii Life threatening disease (newborn and immnosuprresed patients) Asymptomatic in immuno competent patient Congenital or Acquired Both eye may affected
3. Epidemiology Represent with posterior uveitis 50-85% in Brazil 25% in USA Prevalence: (not well determind) 0.6-2% in USA 10-17.7% in Brazil
4. Transmission Beef Undercooked lamb , pork, chicken Environment contaminated by feces of infected cats family Organ transplantation Blood transfusion Water
5. Biology And Life Cycle Obligate , intracellular protozoan Both sexual and asexual reproduction Definitive host – Members of cat family Intermediate host- Hundreds of species including mammals, birds Host tissue – Muscle – Retina – Nervous tissue – Body fluid
6. Contd Three forms Oocyte Trachyzoite Bradyzoit (tissue cyst)
7. Genetics Type- I • Very virulent • Postnatal acquired ocular infection Type-II • Less virulent • Congenital infection and toxoplasmic encephalitis Type-III • Less virulent
8. Pathogenesis In immunocompetent patients is characterized histologically by Foci of granulomatous chorioretinal inflammation Coagulative necrosis of the retina with sharply demarcated borders Inflammatory changes can be widespread in the eye and involve choroid, iris, and trabecular meshwork
9. Contd In Immunosuppressed Have both tachyzoites and tissue cysts in areas of retinal necrosis and within retinal pigment epithelial cells. Parasites can occasionally be found in the iris, choroid, vitreous, and optic nerve
10. Ocular presentation Symptoms Floaters Blurring or loss of vision Sign (The hallmarks) necrotizing retinochoroiditis Satellite lesion adjacent to old hyperpigmented scars Vitreous inflammation Anterior uveitis Retinal vasculitis is also present (occationally)
11. Contd New or Acute lesion • Intensely white • Focal lesion overlying vitreous inflammatory haze (head light in the fog) • Acute anterior uveitis Healed lesion • Border become more defined • Hyperpigmented after several months • Large scar will have atrophic center (devoid of all choroidal retinal elements)
12. Investigation Serological test PCR
13. Differential Diagnosis Infectious: Rubella Cytomegalovirus Syphilis Herpes simplex Tuberculosis Toxocariasis.
Ocular Toxoplasmosis
Vitrectomy in the treatment of ocular toxoplasmosis (german) – YouTube
Ocular Toxoplasmosis when and how to treat Videos:
Vitrectomy in the treatment of ocular toxoplasmosis (german) – YouTube
Ocular Toxoplasmosis when and how to treat
