OSLI Retina

October 2016

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896 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina Practical Retina T. gondii immunoglobulin (Ig) G, an equivocal T. gondii IgM, and a negative HIV. Historic fundus photos obtained by the patient from 5 years earlier demonstrated a large area of extramacular atrophy, consistent with a toxoplasmosis scar. The patient reported a remote mild allergic reac- tion to sulfa so she received an intravitreal injection of clindamycin. After consultation with an infec- tious disease specialist, the patient began a regimen of pyrimethamine (Daraprim; Turing Pharmaceuti- cals, New York, NY) (50 mg daily), folinic acid (5 mg three times per week), sulfadiazine (1 mg daily), and prednisone. At 3 months' follow-up, BCVA in the right eye was 20/60 and examination was significant for 2+ anterior chamber cells, 1+ vitreous cell, and persistent retinitis superotemporally. Opti- cal coherence tomography in the right eye revealed an epiretinal membrane with mild cystoid macular ede- ma. The patient subsequently underwent a sub-Ten- on's triamcinolone acetonide injection. At 6 months' follow-up, BCVA in the right eye was 20/40, the an- terior chamber and vitreous were quiet, and the areas of retinitis had improved with evidence of scar forma- tion. PATHOGENESIS During initial T. gondii infection and subsequent flares, the host immune response relies on activated T lymphocytes and proinflammatory molecules, including IFN-γ, TNF-α, IL-1β, IL-6, IL-10, and various chemokines to suppress parasite replication, force conversion to the bradyzoite cyst form, and induce a latent chronic infection. 1 In immunosuppressed patients, or for unknown reasons in immunocompetent Figure. Historic fundus photo of the patient's right eye taken 5 years prior to presentation showing superotemporal lesion consistent with ocular toxoplasmosis (top left). Widefield scanning laser image of the right fundus at presentation demonstrating vitritis, preretinal hemorrhage, diffuse vascular attenuation, 360° of panretinal photocoagulation, and superotemporal retinal whitening with overlying vitre- ous haze (top right). Widefield scanning laser image of the right fundus at 3 months after presentation (bottom left) and at 6 months after presentation (bottom right).

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