Hudde T, Althaus C, Schimkat M, Sundmacher R
Augenklinik der medizinischen Einrichtungen der Heinrich-Heine-Universität Düsseldorf.
Klin Monbl Augenheilkd. 1996 Oct;209(4):232-6. doi: 10.1055/s-2008-1035309.
In Central Europe ocular toxoplasmosis is the leading cause of posterior uveitis. It is a major cause of severe visual loss and blindness in young people. Drugs for treatment of active lesions (tachyzoites) have been available for decades but are seen controversial especially because of sometimes serious side effects. These drugs don't seem to shorten the active inflammation nor the recurrence rate, in particular because of the poor effect on the cystic form (bradyzoites). Atovaquone (hydroxynaphthoquinone) is well tolerated systemically and is effective against tachyzoites and bradyzoites of Toxoplasma gondii so that we hope to reduce the recurrence rate. PATIENT HISTORY AND CLINICAL FINDINGS: Two immunocompetent patients with the first and respective second symptomatic recurrence of unilateral active toxoplasmic retinochorioiditis located within the major temporal vascular arcades were treated with Atovaquone and Fluorocortolone because of an impending loss of central visual function.
Under the treatment with Atovaquone (3 x 750 mg/day) for three weeks and tapering of the Fluorocortolone the active lesions healed quickly. After a few weeks, atrophic and remarkably little pigmented scars remained. No side effects were observed. After a period of 7 and respective 11 months no recurrence occurred.
Atovaquone is an effective and well tolerated drug for the treatment of active ocular toxoplasmosis in immunocompetent patients. Its efficacy against tachyzoites and cysts of Toxoplasma gondii relative to other drugs remains to be determined by further clinical trials.
在中欧，眼部弓形虫病是后葡萄膜炎的主要病因。它是年轻人严重视力丧失和失明的主要原因。治疗活动性病变（速殖子）的药物已存在数十年，但存在争议，尤其是因为有时会有严重的副作用。这些药物似乎无法缩短活动性炎症或降低复发率，特别是对囊合子形式（缓殖子）效果不佳。阿托伐醌（羟基萘醌）全身耐受性良好，对刚地弓形虫的速殖子和缓殖子均有效，因此我们希望降低复发率。
两名免疫功能正常的患者，分别为首次和第二次出现症状性单侧活动性弓形虫性视网膜脉络膜炎复发，病变位于主要颞侧血管弓内，因即将丧失中心视觉功能，接受了阿托伐醌和氟可的索治疗。
接受阿托伐醌（3×750毫克/天）治疗三周，并逐渐减少氟可的索用量后，活动性病变迅速愈合。几周后，留下萎缩且色素沉着极少的瘢痕。未观察到副作用。7个月和11个月后均未复发。
阿托伐醌是治疗免疫功能正常患者活动性眼部弓形虫病的有效且耐受性良好的药物。相对于其他药物，其对刚地弓形虫速殖子和包囊的疗效仍有待进一步临床试验确定。
