New findings useful for clinical practice using swept-source optical coherence tomography angiography in the follow-up of active ocular toxoplasmosis

Abstract

Background: Ocular toxoplasmosis is one of the most common causes of intraocular inflammation and posterior uveitis in immunocompetent patients. This paper aims to investigate swept-source optical coherence tomography angiography (SS-OCTA) findings in eyes with active toxoplasmic retinochoroiditis. Methods: This case series was conducted from November 2017 through October 2019 in two Brazilian centers. 15 eyes of 15 patients with active toxoplasmic retinochoroiditis were included, and were imaged at baseline and after at least 4 weeks of follow-up. All patients underwent ophthalmic examinations and multimodal imaging including SS-OCT and SS-OCTA before and after treatment of ocular toxoplasmosis. The differential diagnoses included toxoplasmosis, syphilis, and human immunodeficiency virus, which were eliminated through serologic and clinical evaluations. Results: All 15 patients presented with positive anti-Toxoplasma gondii immunoglobulin G titers and three also presented with positive anti-T. gondii immunoglobulin M titers. The mean age at examination was 32.4 years ± 12.7 years (range 15-59 years). Sixty percent of the patients were female. In all eyes, the inner retinal layers were abnormally hyperreflective with full-thickness disorganization of the retinal reflective layers at the site of the active toxoplasmic retinochoroiditis. At baseline, 80% of eyes had focal choroidal thickening beneath the retinitis area, and all eyes had a choroidal hyporeflective signal. Before treatment, SS-OCTA showed no OCTA decorrelation signal next to the lesion site in all eyes, and flow signal improvement was noticed after treatment. Three eyes presented with intraretinal vascular abnormalities during follow-up. SS-OCTA showed retinal neovascularization in one patient and a presumed subclinical choroidal neovascular membrane in another patient. Conclusions: SS-OCT and SS-OCTA are useful for assessing unexpected structural and vascular retinal and choroidal changes in active and post-treatment toxoplasmic retinochoroiditis and these findings are useful for clinical practice.

Posterior segment findings by spectral-domain optical coherence tomography and clinical associations in active toxoplasmic retinochoroiditis

“…Recently, SD-OCT-angiography has been used for evaluation of active TRC, showing hyporeflective signals at the level of superficial and deep capillary retinal plexus, as well as in choriocapillaris and Sattler layers, corresponding to nonperfused or hypoperfused areas 20 . Partial blood flow recovery occurs in most cases following resolution of an active lesion 32 . Intraretinal vascular abnormalities 32 , 33 , retinal 32 and choroidal neovascularization 20 also are reported SD-OCT-angiographic features of TRC.…”

“…Partial blood flow recovery occurs in most cases following resolution of an active lesion 32 . Intraretinal vascular abnormalities 32 , 33 , retinal 32 and choroidal neovascularization 20 also are reported SD-OCT-angiographic features of TRC.…”

Treatment Strategy in Human Ocular Toxoplasmosis: Why Antibiotics Have Failed

“…Together, they allow a better quantification of the retinal and in particular choroidal changes. Beyond their suitability for substantiate treatment effects, OCT/OCT-A findings may also contribute substantially to therapeutic decisions [ 88 , 89 , 90 , 91 ]. Antibiotic treatments aim at controlling parasite proliferation, which cannot readily be quantified in the clinical setting and has to be differentiated from the immune response, which is driving the severity of inflammation, time to recovery and lesion size reduction.…”

Measurement of the active toxoplasma retinochoroiditis lesion size during the disease course with swept-source optical coherence tomography angiography: A retrospective image analysis

“…OCTA ndings in toxoplasma retinochoroiditis has been studied in several papers previously. [13][14][15][16][17]. Park et al [14] in a case, detected many collateral vascular branches surrounding the lesion and diffuse choroidal dilation at four weeks after commencing the treatment.…”

“…In inactive lesions, OCTA demonstrated a homogenous and equally attenuated grayish hyposignal of the super cial and deep capillary plexi and a partial restoration of the nonperfused choroidal areas. de Oliveira Dias et al [13] studied the 15 eyes of 15 patients with active toxoplasmic retinochoroiditis at baseline and after at least four weeks of follow up with SS-OCTA. At baseline, SS-OCTA showed no OCTA decorrelation signal next to the lesion site in all eyes and ow signal improvement was noted following the treatment.…”