Intravitreal Clindamycin in the Treatment of Unresponsive Zone One Toxoplasmic Chorioretinitis: A Case Report

Abstract

Introduction:The current study aimed to report a case of toxoplasma chorioretinitis resistant to standard treatments that dramatically responded to intravitreal clindamycin injection.Case Presentation:A 23-year-old woman with the diagnosis of ocular toxoplasmosis in the left eye was initially treated by oral pyrimethamine, sulfadiazine, azithromycin and oral prednisolone. Since the treatment was unsuccessful intravitreal clindamycin (1 mg/ 0.1 mL) was injected. Responding dramatically, visual acuity improved from hand motion to 20/60 and 20/20, after seven days and six weeks, respectively. Anterior chamber and vitreous reactions were resolved.Conclusions:Intravitreal injection of clindamycin may be an acceptable alternative to the classic treatment in cases with refractory ocular toxoplasmosis. It may offer the patient more convenience, a safer systemic side effect profile, greater availability, and fewer follow-up visits and hematologic evaluations. Moreover, since it responds dramatically, it would be helpful in cases with involvement of macula or closeness to the optic nerve.

<p>Intravitreal Clindamycin as First-Line Therapy for Toxoplasmic Retinochoroiditis: A Case Series</p>

“…2 Though the disease is commonly self-limited, the vision may be affected due to optic nerve or macular involvement and/ or severe vitritis. 2,3 Hence, early and adequate treatment is usually indicated for such lesions to avoid profound visual impairment. The conventional systemic medications include sulfadiazine, pyrimethamine with folinic acid, clindamycin, and trimethoprimsulfamethoxazole double-strength (TMP-SMZ DS).…”

“…Other antimicrobials, such as azithromycin and atovaquone, have also been used effectively. [2][3][4] However, some patients are intolerant, allergic, or have infections resistant to systemic therapy. 1,4 Intravitreal injections can deliver a high concentration of drug to the intraocular tissues, bypassing the ocular barriers, thereby acting directly on the target site.…”

“…1,4 Intravitreal injections can deliver a high concentration of drug to the intraocular tissues, bypassing the ocular barriers, thereby acting directly on the target site. 3 Intravitreal clindamycin alone or in combination with dexamethasone had been previously reported as an alternative treatment for ocular toxoplasmosis. 2,3,[5][6][7][8][9][10][11][12][13] However, the use of intravitreal clindamycin alone as the first-line therapy for toxoplasmic retinochoroiditis is not commonly practised.…”

“…3 Intravitreal clindamycin alone or in combination with dexamethasone had been previously reported as an alternative treatment for ocular toxoplasmosis. 2,3,[5][6][7][8][9][10][11][12][13] However, the use of intravitreal clindamycin alone as the first-line therapy for toxoplasmic retinochoroiditis is not commonly practised. We report our experience with intravitreal clindamycin as first-line treatment in four patients of toxoplasmic retinochoroiditis.…”

Early diagnosis and successful treatment of acquired toxoplasmosis infectious retinochoroiditis

“…[ 1 ] Although posterior uveitis is usually a self-limited disease, it may reduce vision secondary to the optic nerve or macular involvement and/or severe vitreous inflammation. [ 2 ] Atypical cases of ocular toxoplasmosis consist of multifocal lesions and large areas of retinal necrosis or retinochoroiditis. [ 3 ] Such cases might require a combination of periocular and oral treatment to control the inflammation.…”