Follow-up and Treatment Results in Ocular Toxoplasmosis

Abstract

ÖzetAmaç: Oküler toksoplazmozis tan›s› alm›fl olan hastalar›n klinik özelliklerini, takip ve tedavi sonuçlar›n› incelemek. Gereç ve Yöntem: 1996 -2007 y›llar› aras›nda S.B. ‹stanbul E¤itim ve Araflt›rma Hastanesi Göz Klini¤i Uvea Birimi'nde aktif oküler toksoplazmozis tan›s› alm›fl olan 57 hasta (ilk atak ve/veya rekürrens) retrospektif olarak de¤erlendirildi. Hastalar›n ortalama takip süresi 5,2 y›ld›. Hastalar›n görme dereceleri, göz içi bas›nçlar› (G‹B) kaydedildi. Biomikroskobik muayeneleri yap›larak ön ve arka segment bulgular› de¤erlendirildi. Klinik görünümü oküler toksoplazmozis ile uyumlu hastalarda toksoplazma spesifik IgG ve IgM antikor testleri birer hafta arayla 2 kez tekrarland›. Sonuçlar: Hastalar›n yafl ortalamalar› 29,7 (16-50) yafl, K/E oran› 33/24 idi. K›rk üç hasta primer (%75,86), 14 hasta rekürren aktivasyon (%24,14) olarak de¤erlendirildi. On iki hastada makula tutulumu (%20,7), 14 hastada periferik tutulum (%24,14) mevcuttu. Sekiz hastada atipik oküler toksoplazmozis (%15,5) bulgular› vard›. Klinik görünümü oküler toksoplazmozis ile uyumlu ve serolojik testleri pozitif olan olgulara primetamin + sulfadiazin + kortikosteroid (makula ve arka kutup yerleflimli görmeyi tehdit eden olgularda) üçlü tedavisi 4-6 hafta süreyle uyguland›. Results: The average age of the patients was 29.7 (range: 16-50) years and the female/male ratio was 33/24. 43 patients (75.86%) had first attack, while 14 patients (24.14%) had recurrence of ocular toxoplasmosis. In 12 patients (20.7%), the macular retina and in 14 patients (24.14%), the peripheral retina was involved. 9 patients (15.5%) had atypical signs of ocular toxoplasmosis. Patients with clinical appearance compatible with ocular toxoplasmosis and positive serological tests have been given triple therapy consisting of pyrimethamine + sulfadiazine + corticosteroid (only for cases with vision-threatening macular and posterior pole involvement) for 4-6 weeks. Discussion: Ocular toxoplasmosis is the most common form of posterior uveitis that can lead to vision loss. The establishment of diagnosis is often based on clinical view and serological tests are helpful in the diagnostic process. The disease is self-limiting in immunocompetent people. The purpose of the treatment is to prevent complications and recurrence. (TJO 2010; 40: 289-94)