Both oral and intraocular routes have been recommended for medication administration in toxoplasmic retinochoroiditis; however, available data, in support or against, are scarce. The objective of this study was to compare the efficacy of intravitreal clindamycin plus dexamethasone (IVCD) and conventional oral therapy (COT) including pyrimethamine, sulfadiazine, folinic acid and prednisone in active toxoplasmic retinochoroiditis. In this prospective randomized single-blind clinical trial, patients with active toxoplasmic retinochoroiditis received either IVCD (n = 32), or COT (n = 34) for 6 weeks. Changes of best-corrected visual acuity, retinal lesion size, and vitreous inflammation before and after treatment, as well as complications/side-effects and recurrence rate within at least 2 years of follow-up were compared between groups. Although all the variables improved significantly at 6 weeks within each group, changes were comparable between the IVCD and COT receivers. There was only one case with hepatotoxicity in the COT group which responded favorably to drug change. No injection-related complication was observed. Recurrence rates were 12.5 and 14.7 % in the IVCD and COT groups, respectively (p = 0.54). In conclusion, both IVCD and COT are equally effective against active toxoplasmic retinochoroiditis but the former is apparently safer and more convenient.

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BackgroundDiabetic retinopathy is a serious microvascular disorder of the retina. Vascular endothelial growth factor (VEGF) expression, induced by high glucose levels and hypoxia, is a main feature in retinopathy. The aim of this study was to evaluate the relationship between vitreous and serum VEGF levels and control of diabetes and microalbuminuria in patients with proliferative diabetic retinopathy.MethodsSixty-five patients were enrolled in this case-control study, comprising 30 patients with proliferative diabetic retinopathy (cases) and 35 patients with nonproliferative diabetic retinopathy (controls). The vitreous VEGF level was compared with the serum VEGF level in both groups. Glycosylated hemoglobin (HbA1c), microalbuminuria, serum creatinine, and stage of nephropathy and retinopathy were also measured in patients with proliferative diabetic retinopathy, and the relationship between these parameters and serum and vitreous VEGF levels was investigated.ResultsMean vitreous and serum VEGF levels were significantly higher in cases compared with controls (P = 0.001, P = 0.011, respectively). There was also a significant correlation between vitreous and serum VEGF levels (P = 0.012, r = 0.453). VEGF levels in patients with well controlled blood glucose (P = 0.039), on drug treatment (P = 0.045) and at an early stage of nephropathy (P = 0.042) were significantly lower. There was a significant correlation between VEGF and albumin to creatinine ratio (P = 0.017, r = 0.432).ConclusionSerum and vitreous VEGF levels was significantly lower in patients on oral therapy, in those with well controlled glycemia, and in those with early-stage retinopathy. Administration of anti-VEGF had a good effect in reducing the progression of proliferative diabetic retinopathy.

Purpose:To evaluate the effects of vitrectomy and internal limiting membrane peeling for treatment of macular edema secondary to retinal vein occlusion (RVO).Methods:Nine cases of visual loss due to macular edema caused by central retinal vein occlusion or branch retinal vein occlusion underwent pars plana vitrectomy with removal of the preretinal hyaloid, peeling of the internal limiting membrane stained with indocyanine green dye, air–fluid exchange, and postoperative prone positioning. Best-corrected visual acuity (BCVA) and central foveal thickness by optical coherence tomography were measured pre- and postoperatively then compared to assess the outcome of surgery.Results:In all cases intraretinal blood and retinal thickening diminished within 2 months of surgery. Visual acuity improved in all of the central retinal vein occlusion cases and 3/6 branch retinal vein occlusion cases. The decrease in macular thickness was statistically significant (mean postoperative macular thickness 361 ± 61.1 versus mean preoperative macular thickness 563.9 ± 90.0, P = 0.001, t-test). The improvement in BCVA was not statistically significant (mean preoperative BCVA in LogMAR 1.23 ± 0.29 versus mean postoperative BCVA in LogMAR 1.06 ± 0.49, P = 0.09, t-test).Conclusion:In eyes with macular edema secondary to RVO, pars plana vitrectomy with internal limiting membrane peeling can resolve macular edema, but the improvement in BCVA was not statistically significant in this study.