Syed Mohd Khomsah Syarifah Nur Humaira, Muhammed Julieana, Wan Hitam Wan-Hazabbah
Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS.
Cureus. 2023 Feb 4;15(2):e34617. doi: 10.7759/cureus.34617. eCollection 2023 Feb.
Ocular toxoplasmosis has multiple devastating complications with possible recurrence. A potentially blinding complication of ocular toxoplasmosis is macular pucker. Here, we report a case of macular pucker in ocular toxoplasmosis treated with azithromycin and prednisolone. A 35-year-old woman complained of central scotoma for six days, which was associated with fever, headache, joint pain, and myalgia. Her visual acuity was counting finger OD and 6/18 OS. Her right eye optic nerve function test was impaired. Fundoscopy showed bilateral optic disc swelling that progressed to retinal fibrosis over papillomacular bundle and macular pucker over the right eye. CT scan of the brain and orbit was normal. Toxoplasma titer was positive. She was diagnosed to have a right eye macular pucker secondary to ocular toxoplasmosis. Oral azithromycin and oral prednisolone (on a tapering dose) were administered for six weeks. Fundoscopy showed resolved optic disc swelling. However, her vision in the right eye remained poor. Ocular toxoplasmosis may progress to macular pucker which can lead to poor vision and legal blindness. Reduced vision-related quality of life notably in the younger population as a complication of ocular toxoplasmosis is difficult to prevent. However, therapy with azithromycin and prednisolone may reduce the negative consequences of inflammation and shrink lesions, especially when the lesions are located at the macula or near the optic disc. Vitrectomy is an alternative treatment for complications such as macular pucker in selected cases.
眼部弓形虫病有多种严重并发症且可能复发。黄斑皱襞是眼部弓形虫病一种潜在致盲的并发症。在此，我们报告一例用阿奇霉素和泼尼松龙治疗的眼部弓形虫病合并黄斑皱襞的病例。一名35岁女性主诉中央暗点6天，伴有发热、头痛、关节痛和肌痛。她的右眼视力为眼前指数，左眼视力为6/18。右眼视神经功能测试受损。眼底检查显示双侧视盘肿胀，在视乳头黄斑束处进展为视网膜纤维化，右眼出现黄斑皱襞。脑部和眼眶CT扫描正常。弓形虫滴度呈阳性。她被诊断为继发于眼部弓形虫病的右眼黄斑皱襞。口服阿奇霉素和口服泼尼松龙（逐渐减量）治疗6周。眼底检查显示视盘肿胀消退。然而，她右眼的视力仍然很差。眼部弓形虫病可能进展为黄斑皱襞，这可能导致视力不佳和法定失明。作为眼部弓形虫病的一种并发症，尤其是在年轻人群中，视力相关生活质量下降难以预防。然而，阿奇霉素和泼尼松龙治疗可能会减少炎症的负面影响并缩小病变，特别是当病变位于黄斑或靠近视盘时。在某些病例中，玻璃体切除术是治疗黄斑皱襞等并发症的一种替代疗法。
