Lin Hung-Yi, Lee Wan-Ju Annabelle
Medical Education Center, Chi Mei Medical Center, Tainan, Taiwan.
Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan.
Front Med (Lausanne). 2022 Jun 29;9:843050. doi: 10.3389/fmed.2022.843050. eCollection 2022.
This study aimed to report a case who was treated with corticosteroids and anti- parasitic agents for ocular toxoplasmosis, but who progressed to acute retinal necrosis, and finally retinal detachment.
A 42-year-old man presented to the ophthalmology clinic with a 1-month history of progressive blurred vision and floaters in his right eye. His best visual acuity (VA) was 20/20 in both eyes. The anterior segment was unremarkable. Funduscopic examination of the right eye revealed active lesions of whitish foci of chorioretinitis with surrounding edema along the superonasal vessels, and retinal vasculitis with perivascular sheathing. Serologic testing was positive for IgM and IgG, but negative for other virus- and syphilis infections. Ocular toxoplasmosis was diagnosed. Corticosteroids and anti-parasitic agents were given simultaneously, but his right eye VA became 20/100. Funduscopic examination revealed retinal necrosis with localized retinal breaks. We immediately performed focal photocoagulation, however, his right eye progressed to retinal detachment and required vitrectomy.
Early administration of systemic corticosteroids in patients with acquired acute ocular toxoplasmosis may lead to complications that impair vision. Intensive observation should be arranged after corticosteroid use.
本研究旨在报告一例接受皮质类固醇和抗寄生虫药物治疗眼部弓形虫病，但病情进展为急性视网膜坏死，最终导致视网膜脱离的病例。
一名42岁男性因右眼进行性视力模糊和飞蚊症1个月就诊于眼科门诊。他双眼的最佳视力（VA）均为20/20。眼前节无异常。右眼眼底检查发现沿鼻上血管有脉络膜视网膜炎白色病灶的活动性病变，周围有水肿，以及视网膜血管炎伴血管周围鞘膜。血清学检测IgM和IgG呈阳性，但其他病毒和梅毒感染检测为阴性。诊断为眼部弓形虫病。同时给予皮质类固醇和抗寄生虫药物治疗，但他右眼的视力降至20/100。眼底检查发现视网膜坏死并伴有局限性视网膜裂孔。我们立即进行了局部光凝治疗，然而，他的右眼进展为视网膜脱离，需要进行玻璃体切除术。
获得性急性眼部弓形虫病患者早期应用全身性皮质类固醇可能导致损害视力的并发症。使用皮质类固醇后应安排密切观察。
