Corticosteroids as adjuvant therapy for ocular toxoplasmosis

Abstract

Background Ocular infestation with Toxoplasma gondii, a parasite, may result in inflammation in the retina, choroid, and uvea and consequently lead to complications such as glaucoma, cataract, and posterior synechiae. Objectives The objective of this systematic review was to assess the effects of adjunctive use of corticosteroids for ocular toxoplasmosis. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to October 2012), EMBASE (January 1980 to October 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to October 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We searched the reference lists of included studies for any additional studies not identified by the electronic searches. We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 11 October 2012. Selection criteria We planned to include randomized and quasi-randomized controlled trials. Eligible trials would have enrolled participants of any age who were immunocompetent and were diagnosed with active ocular toxoplasmosis. Included trials would have compared anti-parasitic therapy plus corticosteroids versus anti-parasitic therapy alone, or different doses or times of initiation of corticosteroids. Data collection and analysis Two authors independently screened titles and abstracts retrieved from the electronic searches. We retrieved full-text articles of studies categorized as ‘unsure’ or ‘include’ after review of the abstracts. Two authors independently reviewed each full-text article. Discrepancies were resolved through discussion. Main results The electronic searches retrieved 368 titles and abstracts. We reviewed 20 full-text articles. We identified no trials eligible for inclusion in this systematic review. Authors' conclusions Although research has identified wide variation in practices regarding use of corticosteroids, our systematic review did not identify evidence from randomized controlled trials for the role of corticosteroids in the management of ocular toxoplasmosis. Several questions remain unanswered by well-conducted randomized trials in this context, including whether use of corticosteroids is more effective than use of anti-parasitic therapy alone, when corticosteroids should be initiated in the treatment regimen (early versus late course of treatment), and which dosage and duration of steroid use is best. These questions are easily amenable to research using a randomized controlled design and they are ethical due to the absence of evidence to support or discourage use of corticosteroids for this condition. The question of foremost...

Choroidoretinal granuloma in a young female patient

“…Systemic prednisone 1 mg/kg is prescribed to reduce chorioretinal destruction and may be offered in the presence of severe ocular inflammation or in the presence of macula infection; however, the risk of steroid-induced complications should be weighed, especially in a teenager, as there is no strong evidence of benefit 18 19…”

Current Therapy of Acquired Ocular Toxoplasmosis: A Review

“…However, if the central foveal region has not been injured, once the ocular infestation is controlled, the associated inflammatory reaction usually resolves and VA returns to normal. 33 In elderly or immunosuppressed patients, OT may be bilateral and multifocal and tends to be more aggressive. For example, the incidence of ocular involvement during early state T. gondii infection is often higher among the elderly.…”

“…Thus, the usefulness of steroids in the treatment of OT remains uncertain. 33 On the other hand, it should be noted that the administration of steroids alone can result in fulminant toxoplasmosis. 78,79 In patients with frequent recurrence, long-term treatment with 1 tablet of sulfamethoxazole (800 mg) and trimethoprim (160 mg) 3 times a week reduced the recurrence rate from 23.8% to 6.6%.…”

Clinical Features and Treatment of Ocular Toxoplasmosis

“…Two Cochrane reviews have been established for ocular toxoplasmosis [35,36]. The first review examined whether antibiotics are effective in the treatment of toxoplasmic retinochoroiditis [35].…”

“…The first review examined whether antibiotics are effective in the treatment of toxoplasmic retinochoroiditis [35]. A recent further Cochrane review assessed the effect of steroid administeration locally or systemically, with or without use of antibiotics [36]. The Cochrane reviews were justified because there is a controversy regarding the use of antibiotics in the peripheral lesions.…”