Although ocular toxoplasmosis is a leading cause of posterior uveitis worldwide, there is scarce information about the real-life frequency of ocular lesions, visual outcomes, and risk factors for poor prognosis. We conducted a community-based cross-sectional study with 721 adults living in Cássia dos Coqueiros, Southeast Brazil, consisted of visual acuity measurement, dilated ocular examination, a risk-factor questionnaire, and peripheral blood collection for anti-T. gondii serology. Presumed toxoplasmic lesions were recorded on video and analyzed by experienced and masked ophthalmologists. Ocular toxoplasmosis was determined if at least one suspected lesion was appointed by two graders in the presence of positive anti-T. gondii serology. Forty-eight eyes (n = 42 participants; 6.7% among those with positive anti-T. gondii serology) with ocular toxoplasmosis were found. Most lesions were single (n = 28; 58.3%), peripheral (n = 34; 77.1%) and unilateral (85.7% of participants); no active lesions were found. Older age was associated with lesions larger than one-disc diameter (p = 0.047), and lower social stratum (OR: 2.89; CI 1.2–6.97; p = 0.018) was associated with the presence of toxoplasmic lesions. Although there were no differences in visual acuity between participants and eyes with or without ocular lesions (p > 0.05), unilateral blindness associated with ocular toxoplasmosis was identified in a reduced number of individuals.

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Frequência de anticorpos anti-Toxoplasma gondii e de lesões oculares causadas pelo parasita, e fatores de risco associados à toxoplasmose ocular em Cássia dos Coqueiros, São Paulo. 2020. 71f. Tese

BackgroundUveitis is an ocular inflammatory disease that may lead to irreversible blindness if not treated early and properly. May be induced by infectious and non-infectious diseases (autoimmune diseases, especially juvenile idiopathic arthritis), or “masquerade” causes. Some uveitis are termed “idiopathic” although autoinflammatory evidence. Treatment effectiveness depends on the accuracy of the ophthalmologic evaluation and the appropriate management, especially when immunosuppressive medications are necessary. (1, 2) ObjectivesTo describe the first year experience of the Integrated Ophthalmology and Pediatric Rheumatology Outpatient Clinic in the management of pediatric patients with autoimmune uveitis.MethodsRetrospective chart review study of twenty-four patients followed up from June 2017 to October 2018. The patients clinical evolution at 0, 3, 6, 9 and 12 months was analyzed.ResultsIn this group, 62% were female, and mean age at first appointment and at symptoms onset were 11.7 (2.9 to 17. 5) and 7.3 (1.1 to 12.6) years, respectively. Anterior uveitis was present in 70.8% of the cases, and in 65.6% it was bilateral; cataract or glaucoma was observed in 20.5%. The identified diagnosis during follow-up were: idiopathic autoimmune uveitis in 45.8%, juvenile idiopathic arthritis in 41.6% (20.8% oligoarticular, 16.6% polyarticular, 4.1% associated with enthesitis) and juvenile systemic lupus erythematosus, Kawasaki Disease and Vogt-Koyanagi-Harada syndrome one case of each. Antinuclear antibodies were present in 41% and inflammatory markers in 28.7% patients. At first appointment, 20.5% presented ocular inflammatory activity and 53.3% had sequelae when examined in slit lamp or indirect ophthalmoscopy. Medications used were: topical corticosteroids (61.6%), topical mydriatic (49.2%), oral corticosteroid (41%), methotrexate (41%), etanercept (12.3%), adalimumab (28.7%) and periocular injections of triamcinolone, cyclosporin, tocilizumab, azathioprine (4.1% each). The comparison of the data at inclusion and during follow-up is reported in Table:Table –Uveitis activity and medication use at the beginning and during follow-upAt inclusion3 months6 months9 months12 monthsOcular inflammation(%)20.524.612.312.312.3Topical Corticosteroid(%)61.632.816.48.220.5Topical Mydriatic (%)4124.628.720.520.5Oral Corticosteroid (%)73.820.512.312.320.5Metotrexate (%)12.353.349.236.928.7Etanercept (%)12.34.14.14.14.1Adalimumab (%)20.520.516.416.416,4Others (%)12.34.14.14.14,1No medication (%)4.18.28.28.24,1At the end of 12 months, only 12.3% of the patients still had active uveitis. We have also observed a reducing in 66.6% of topical corticosteroids and 72.2% of oral corticosteroids use during the treatment of uveitis over 12 monthsConclusionConsidering that before the inclusion, patients were followed independently in each clinic, there was optimization of the treatment and reduction in number of medical appointments after the creation of the integrated outpatient clinic. The interprofessional management teams should be the standar...