Pleyer Uwe, Ness Thomas, Garweg Justus
Universitäts-Augenklinik, Charité, Campus Virchow-Klinik, Berlin.
Universitäts-Augenklinik, Universitätsklinikum Freiburg.
Klin Monbl Augenheilkd. 2020 May;237(5):599-604. doi: 10.1055/a-1141-3812. Epub 2020 May 20.
Ocular toxoplasmosis (OT) leads to permanent visual disturbances in a high proportion of patients. A combination of antibiotics and corticosteroids may reduce the risk of permanent visual impairment and may delay recurrence. In this overview, we summarise the current state of knowledge regarding the recurrence prophylaxis of OT.
The basis of this review is a literature search in PubMed with the key words (MeSH terms) "human ocular toxoplasmosis" or "retinochoroiditis" and "recurrence" and "prophylaxis" or "prevention". The resulting publications included case series with more than 20 patients, prospective clinical studies and meta-analyses published within the last 25 years, as well as other publications mentioned therein, and was evaluated on the basis of the experience of the authors.
The frequency of recurrences does not differ between Latin America, North America and Europe, and is around 12 - 15% in the first two years and then decreases, with recurrences observed up to 49 years after an active infection. According to two placebo-controlled double-blind studies from Brazil, where particularly serious relapses occur, antibiotic prophylaxis with 160 mg trimethoprim combined with 800 mg sulfamethoxazole three times a week for 12 months can reduce the occurrence of relapses from 22 to 3% for up to three years. After that, the likelihood of recurrence is as high as in patients who have never received prophylaxis.
Relapses can be effectively prevented, if this is medically indicated. Among other considerations are central location of the lesion, insufficient immune competence and frequent relapses. Prophylaxis should be carried out for at least 12 months, since the risk of recurrence is highest in the first two years.
眼部弓形虫病（OT）会导致很大一部分患者出现永久性视力障碍。抗生素和皮质类固醇联合使用可能会降低永久性视力损害的风险，并可能延缓复发。在本综述中，我们总结了目前关于OT复发预防的知识现状。
本综述的基础是在PubMed上进行文献检索，关键词（医学主题词）为“人类眼部弓形虫病”或“视网膜脉络膜炎”以及“复发”和“预防”或“防止”。所得出版物包括过去25年内发表的超过20例患者的病例系列、前瞻性临床研究和荟萃分析，以及其中提及的其他出版物，并根据作者的经验进行评估。
拉丁美洲、北美和欧洲的复发频率没有差异，头两年约为12%-15%，之后下降，在活动性感染后49年仍有复发情况。根据巴西的两项安慰剂对照双盲研究（当地会发生特别严重的复发），每周三次服用160毫克甲氧苄啶联合800毫克磺胺甲恶唑进行12个月的抗生素预防，可将复发率从22%降低至3%，长达三年。之后，复发可能性与从未接受预防的患者一样高。
如果有医学指征，复发可以有效预防。其他需要考虑的因素包括病变的中心位置、免疫能力不足和频繁复发。预防应至少进行12个月，因为头两年复发风险最高。
