Intraocular Inflammation Associated with Ocular Toxoplasmosis: Relationships at Initial Examination

• Published in: American journal of ophthalmology 2008-12, Vol.146 (6), p.856-865.e2
• Main Authors: Dodds, Emilio M, Holland, Gary N, Stanford, Miles R, Yu, Fei, Siu, Willie O, Shah, Kayur H, ten Dam-van Loon, Ninette, Muccioli, Cristina, Hovakimyan, Anna, Barisani-Asenbauer, Talin
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anterior Chamber - immunology; Anterior Chamber - pathology; Antiprotozoal Agents - therapeutic use; Biological and medical sciences; Child; Chorioretinitis - diagnosis; Chorioretinitis - drug therapy; Confidence intervals; Cross-Sectional Studies; Disease; Drug Therapy, Combination; Female; Human protozoal diseases; Humans; Immunosuppressive Agents - therapeutic use; Infectious diseases; Inflammation - diagnosis; Inflammation - drug therapy; Intraocular Pressure; Male; Medical sciences; Middle Aged; Miscellaneous; Ocular Hypertension - diagnosis; Ophthalmology; Parasitic diseases; Protozoal diseases; Retrospective Studies; Standard deviation; Studies; Toxoplasmosis; Toxoplasmosis, Ocular - diagnosis; Toxoplasmosis, Ocular - drug therapy; Vitreous Body - immunology; Vitreous Body - pathology; Young Adult
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2008.09.006

Purpose To describe characteristics of intraocular inflammation in eyes with active ocular toxoplasmosis and to identify relationships between signs of inflammation, complications (including elevated intraocular pressure [IOP]), other disease features, and host characteristics. Design Multicenter, retrospective, cross-sectional study. Methods We reviewed the medical records of 210 patients with toxoplasmic retinochoroiditis at seven international sites (North America, South America, and Europe) for information from the first examination at each site during which patients had active retinal lesions. Signs of inflammation included anterior chamber (AC) cells and flare and vitreous humor cells and haze. Retinal lesion characteristics included size (≤1 disc area [DA] or >1 DA) and presence or absence of macular involvement. Results AC cells and flare were related to vitreous inflammatory reactions ( P ≤ .041). One or more signs of increased inflammation were related to the following factors: older patient age, larger retinal lesions, and extramacular location. In 30% of involved eyes, there was evidence of elevated IOP (despite use of glaucoma medications by some patients); other complications were uncommon. IOP of more than 21 mm Hg was associated with both increased AC cells and elevated flare (both P ≤ .001) and with macular involvement ( P = .009). Inflammation seemed to be more severe among patients in Brazil than among those at other sites. Conclusions There is substantial variation between patients in the severity of intraocular inflammation associated with ocular toxoplasmosis, attributable to multiple host- and disease-related factors. Results suggest that disease characteristics also vary in different areas of the world. Elevated IOP at initial examination reflects the severity of inflammation.