Successful Treatment of Toxoplasmosis-Associated Choroidal Neovascular Lesions With Bevacizumab and Antiparasitic Therapy

Abstract

Oral trimethoprim/sulfamethoxazole is an effective and less expensive antibiotic against Toxoplasma gondii. Intravitreal bevacizumab injection appears to be a well-tolerated treatment for toxoplasmosis-associated CNV and has the potential as an adjuvant therapy to improve final vision. More cases and further studies are required.

Neuroretinitis and Juxtapapillary Retinochoroiditis as Atypical Presentations of Ocular Toxoplasmosis

“… 11 , 12 Management options for CNV in healed toxoplasma chorioretinitis include observation, laser photocoagulation, photodynamic therapy, corticosteroids and intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents. 13 Because the optic nerve involvement was active and coexisted with a healed chorioretinitis with CNV, the patient was treated with a combination of anti-VEGF and antiparasitic drugs, with favorable outcome. Functional improvement following bevacizumab intravitreal injection for CNV in toxoplasmosis has been reported in the literature.…”

“…Functional improvement following bevacizumab intravitreal injection for CNV in toxoplasmosis has been reported in the literature. 13 The use of antiparasitic drugs at the same time as anti-VEGF treatment is to prevent inflammation reactivation that can be induced by the intravitreal anti-VEGF agent. 13 , 14 It would have been more informative to perform OCT angiography (OCTA) in our patients.…”

Papillitis and Neuroretinitis as Atypical Presentations of Ocular Toxoplasmosis

“…In our patient, the combination of a past history of toxoplasma chorioretinitis evidenced by the scar in conjunction with CNV, a recent 2-month history of blurred vision, and papilledema is consistent with in ammation reactivation. Management options for CNV in healed toxoplasma chrorioretinitis include observation, laser photocoagulation, photodynamic therapy, corticosteroids and intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents [13]. Because the optic nerve involvement was active and coexisted with a healed chorioretinal with CNV, the patient was treated with a combination of anti-VEGF and antiparasitic drugs, with favorable outcome.…”

“…Because the optic nerve involvement was active and coexisted with a healed chorioretinal with CNV, the patient was treated with a combination of anti-VEGF and antiparasitic drugs, with favorable outcome. Functional improvement following bevacizumab intravitreal injection for CNV in toxoplasmosis has been reported in the literature [13]. The combination was meant for the antiparasitic drugs to prevent in ammation reactivation that can be induced by the intravitreal anti-VEGF agent used to treat CNV while, at the same time, acting on the parasite [13,14].…”

“…Optic nerve toxoplasmosis is a less common presentation and is believed to occur in 5. [3][4][5][6][7][8][9][10][11][12][13][14][15][16].5% of all OT. 5 Involvement of the optic nerve typically occurs next to or far from an active retinochoroiditis lesion.…”