Current Treatment of Toxoplasma Retinochoroiditis: An Evidence-Based Review

Objective. To perform an evidence-based review of treatments for Toxoplasma retinochoroiditis (TRC). Methods. A systematic literature search was performed using the PubMed database and the key phrase “ocular toxoplasmosis treatment” and the filter for “controlled clinical trial” and “randomized clinical trial” as well as OVID medline (1946 to May week 2 2014) using the keyword ‘‘ocular toxoplasmosis’’. The included studies were used to evaluate the various treatment modalities of TRC. Results. The electronic search yielded a total of 974 publications of which 44 reported on the treatment of ocular toxoplasmosis. There were 9 randomized controlled studies and an additional 3 comparative studies on the treatment of acute TRC with systemic or intravitreous antibiotics or on reducing the recurrences of TRC. Endpoints of studies included visual acuity improvement, inflammatory response, lesion size changes, recurrences of lesions, and adverse effects of medications. Conclusions. There was conflicting evidence as to the effectiveness of systemic antibiotics for TRC. There is no evidence to support that one antibiotic regimen is superior to another so choice needs to be informed by the safety profile. Intravitreous clindamycin with dexamethasone seems to be as effective as systemic treatments. There is currently level I evidence that intermittent trimethoprim-sulfamethoxazole prevents recurrence of the disease

Subepidermal calcified nodules

Subepidermal calcified nodules (SCNs) are uncommon, benign lesions usually presenting in childhood which occasionally involve the eyelids. Only a handful of cases have been reported in the ophthalmologic literature. We present 2 cases, one in a 7-year-old Hispanic boy, the other in a 13-year-old African American boy, with eyelid lesions which were clinically thought to be possible juvenile xanthogranuloma, but which on histopathologic examination showed the characteristic features of SCNs. Copyright © 2005 S. Karger AG

Autoimmune Retinopathy And Optic Neuropathy In A patient With Anti-GAD And Other Retinal Antibodies

"Autoimmune retinopathy (AIR) is a spectrum of rare acquired retinal diseases, including cancer-associated retinopathy (CAR), melanoma-associated retinopathy (MAR), and presumed non-paraneoplastic autoimmune retinopathy (npAIR). Autoimmunerelated retinopathy and optic neuropathy (ARRON) syndrome is characterized by the presence of antibodies against retinal or optic nerve antigens in the absence of cancer. We report a case of acquired autoimmune cone dystrophy and optic neuropathy in a patient without cancer involving an abnormal immunologic reactivity against a 20-kDa optic nerve antigen and 40-kDa and 62-kDa retinal antigens and anti- glutamic acid decarboxylase (GAD) antibodies.

Etanercept monotherapy induces complete resolution of cystoid macular edema in a patient with intermediate uveitis

There is controversy on whether etanercept, an anti-tissue necrosis factor agent, shares infliximab's purported efficacy in the treatment of intermediate uveitis and, in particular, intermediate uveitis-associated cystoid macular edema. Interventional case report. A 29-year-old patient with decreased vision bilaterally secondary to cystoid macular edema complicating chronic idiopathic intermediate uveitis refractory to oral corticosteroids, methotrexate (17.5 mg weekly), and cyclosporine (100 mg daily) started etanercept monotherapy with rapid and complete resolution of cystoid macular edema and dramatic improvement in visual acuity. Etanercept may have a role in the treatment of refractory intermediate uveitis and intermediate uveitis-associated cystoid macular edema

Adjunct Intravitreous Triamcinolone Acetonide in the Treatment of Diabetic Macular Edema with Anti-VEGF Agents

Aims. To compare visual and anatomic outcomes of adjunct intravitreous (IVT) triamcinolone acetonide to antivascular endothelial growth factor (VEGF) injections to IVT anti-VEGF injections alone for center-involving diabetic macular edema (DME) in treatment-naïve eyes. Methods. Retrospective study of treatment-naïve eyes with center-involving DME. The primary outcome was the change in best corrected visual acuity (BCVA) in eyes receiving only IVT anti-VEGF (group 1) and eyes receiving IVT anti-VEGF and adjunct IVT-TA (group 2). Results. Included were 192 eyes. The mean change in BCVA was +3.5 letters in group 1 compared to −3.5 letters in group 2 (p=0.048). Final macular thickness improved by −94 μm in group 1 versus −68 μm in group 2 (p=0.26). In group 1, 5/150 eyes compared to 9/42 eyes in group 2 (3.3% versus 21%, p=0.0005) had a IOP >10 mmHg increase. Six of 126 phakic eyes in group 1 versus 12/33 phakic eyes in group 2 underwent cataract surgery (4.7% versus 36.3%, p=0.00009). Conclusions. IVT-TA results in no additional benefit in eyes treated with anti-VEGF agents for DME