College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
Br J Ophthalmol. 2023 Jul;107(7):973-979. doi: 10.1136/bjophthalmol-2022-321091. Epub 2022 Feb 23.
Ocular toxoplasmosis is common across all regions of the world. Understanding of the epidemiology and approach to diagnosis and treatment have evolved recently. In November 2020, an international group of uveitis-specialised ophthalmologists formed the International Ocular Toxoplasmosis Study Group to define current practice.
192 Study Group members from 48 countries completed a 36-item survey on clinical features, use of investigations, indications for treatment, systemic and intravitreal treatment with antiparasitic drugs and corticosteroids, and approach to follow-up and preventive therapy.
For 77.1% of members, unilateral retinochoroiditis adjacent to a pigmented scar accounted for over 60% of presentations, but diverse atypical presentations were also reported. Common complications included persistent vitreous opacities, epiretinal membrane, cataract, and ocular hypertension or glaucoma. Most members used clinical examination with (56.8%) or without (35.9%) serology to diagnose typical disease but relied on intraocular fluid testing-usually PCR-in atypical cases (68.8%). 66.1% of members treated all non-pregnant patients, while 33.9% treated selected patients. Oral trimethoprim-sulfamethoxazole was first-line therapy for 66.7% of members, and 60.9% had experience using intravitreal clindamycin. Corticosteroid drugs were administered systemically by 97.4%; 24.7% also injected corticosteroid intravitreally, almost always in combination with an antimicrobial drug (72.3%). The majority of members followed up all (60.4%) or selected (35.9%) patients after resolution of acute disease, and prophylaxis against recurrence with trimethoprim-sulfamethoxazole was prescribed to selected patients by 69.8%.
Our report presents a current management approach for ocular toxoplasmosis, as practised by a large international group of uveitis-specialised ophthalmologists.
眼弓形体病在世界各地区都很常见。对其流行病学、诊断和治疗方法的理解最近已经发生了变化。2020 年 11 月，一个由专门从事葡萄膜炎研究的国际眼科医生组成的国际眼弓形体病研究小组成立，旨在确定当前的实践方法。
来自 48 个国家的 192 名研究小组成员完成了一项关于临床特征、检查使用、治疗指征、抗寄生虫药物和皮质类固醇的全身和玻璃体内治疗以及随访和预防治疗方法的 36 项调查。
77.1%的成员中，单侧视网膜脉络膜炎紧邻色素性瘢痕，占 60%以上，但也有多种不典型表现。常见的并发症包括持续性玻璃体混浊、视网膜前膜、白内障和眼内压升高或青光眼。大多数成员使用临床检查（56.8%）或不使用（35.9%）血清学来诊断典型疾病，但在不典型病例中依赖于眼内液检测——通常是 PCR（68.8%）。66.1%的成员治疗所有非孕妇患者，而 33.9%的成员选择治疗部分患者。口服复方磺胺甲噁唑是 66.7%成员的一线治疗药物，60.9%的成员有使用玻璃体内克林霉素的经验。皮质类固醇药物全身给药的占 97.4%；24.7%的成员也进行玻璃体内皮质类固醇注射，几乎总是与抗菌药物联合使用（72.3%）。大多数成员在急性疾病缓解后对所有（60.4%）或部分（35.9%）患者进行随访，69.8%的成员对选择的患者开具复方磺胺甲噁唑预防复发。
我们的报告介绍了一种由大型国际葡萄膜炎眼科医生组成的小组目前对眼弓形体病的管理方法。
