Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
PLoS Negl Trop Dis. 2024 Jun 6;18(6):e0012232. doi: 10.1371/journal.pntd.0012232. eCollection 2024 Jun.
Ocular toxoplasmosis (OT) is the most common cause of infectious uveitis worldwide, including Thailand. This study describes the clinical presentation, visual acuity (VA) outcomes, and factors associated with VA loss in patients with active OT following antiparasitic treatment.
METHODOLOGY/PRINCIPAL FINDINGS: A retrospective chart review of patients with active OT treated with antiparasitic drugs between 2010 and 2020 was performed. Outcome measures included clinical characteristics, interval VA, and predictive factors associated with loss of VA ≤ 20/50 at 6 months post-treatment. Ninety-two patients (95 eyes) were enrolled. The median follow-up time was 10.9 months (IQR 4.9-31.8 months). The median age at presentation was 35.9 years, 51% were male, and 92.4% had unilateral OT. Eleven patients (12%) were immunocompromised (HIV infection, eight patients; receiving immunosuppressive agents, three patients). Patients mainly presented with primary retinitis without previous scar (62%), posterior pole lesion (56%), and lesion size of ≤ 2-disc area (75%). Immunocompromised patients showed a significantly larger size of retinitis than immunocompetent patients. Oral trimethoprim/sulfamethoxazole monotherapy was the primary short-term antiparasitic drug prescribed (85%). At the final visit, 21% of all affected eyes suffered VA ≤ 20/200. The cumulative incidence of recurrent OT at three years was 33.9% (95% CI, 19.7%-54.2%). Immunocompromised patients [adjusted odds ratio (aOR) 4.9, p = 0.041], macular lesion (aOR 5.4, p = 0.032), and initial VA ≤ 20/200 (aOR 9.1, p = 0.014) were predictive of having VA ≤ 20/50 at 6 months post-treatment.
Ocular toxoplasmosis mainly presents as unilateral primary retinitis within the posterior pole. Severe VA loss was observed in one-fifth of eyes following treatment with lesion resolution. Immunocompromised patients, eyes with macular lesions, and poor initial VA were associated with poor VA outcomes.
眼弓形体病（OT）是全球最常见的感染性葡萄膜炎病因，包括泰国。本研究描述了接受抗寄生虫治疗后活动性 OT 患者的临床表现、视力（VA）结果以及与 VA 丧失相关的因素。
方法/主要发现：对 2010 年至 2020 年间接受抗寄生虫药物治疗的活动性 OT 患者进行了回顾性图表审查。主要转归包括临床特征、VA 间隔时间以及与治疗后 6 个月 VA 丧失≤20/50 相关的预测因素。共纳入 92 例患者（95 只眼）。中位随访时间为 10.9 个月（IQR 4.9-31.8 个月）。发病时的中位年龄为 35.9 岁，51%为男性，92.4%为单侧 OT。11 例（12%）为免疫功能低下（HIV 感染 8 例；接受免疫抑制剂治疗 3 例）。患者主要表现为无先前瘢痕的原发性视网膜炎（62%）、后极病变（56%）和病变面积≤2 个视盘面积（75%）。免疫功能低下患者的视网膜炎大小明显大于免疫功能正常患者。口服复方磺胺甲噁唑是主要的短期抗寄生虫药物（85%）。末次随访时，21%的受累眼视力≤20/200。三年内复发性 OT 的累积发生率为 33.9%（95%CI，19.7%-54.2%）。免疫功能低下患者[调整后的优势比（aOR）4.9，p=0.041]、黄斑病变（aOR 5.4，p=0.032）和初始 VA≤20/200（aOR 9.1，p=0.014）是治疗后 6 个月 VA≤20/50 的预测因素。
眼弓形体病主要表现为后极单侧原发性视网膜炎。五分之一的眼在病变消退后视力严重丧失。免疫功能低下患者、黄斑病变患者和初始 VA 较差与较差的 VA 结果相关。
