Fundus topographical distribution patterns of ocular toxoplasmosis

BACKGROUND: To establish topographic maps and determine fundus distribution patterns of ocular toxoplasmosis (OT) lesions. METHODS: In this retrospective study, patients who presented with OT to ophthalmology clinics from four countries (Argentina, Turkey, UK, USA) were included. Size, shape and location of primary (1°)/recurrent (2°) and active/inactive lesions were converted into a two-dimensional retinal chart by a retinal drawing software. A final contour map of the merged image charts was then created using a custom Matlab programme. Descriptive analyses were performed. RESULTS: 984 lesions in 514 eyes of 464 subjects (53% women) were included. Mean area of all 1° and 2° lesions was 5.96±12.26 and 5.21±12.77 mm2, respectively. For the subset group lesions (eyes with both 1° and 2° lesions), 1° lesions were significantly larger than 2° lesions (5.52±6.04 mm2 vs 4.09±8.90 mm2, p=0.038). Mean distances from foveola to 1° and 2° lesion centres were 6336±4267 and 5763±3491 µm, respectively. The majority of lesions were found in temporal quadrant (p<0.001). Maximum overlap of all lesions was at 278 µm inferotemporal to foveola. CONCLUSION: The 1° lesions were larger than 2° lesions. The 2° lesions were not significantly closer to fovea than 1° lesions. Temporal quadrant and macular region were found to be densely affected underlining the vision threatening nature of the disease

Acute syphilitic posterior placoid chorioretinopathy: An infectious or autoimmune disease?

Purpose: To report a case of acute syphilitic posterior placoid chorioretinopathy (ASPPC) that demonstrated partial resolution with immunosuppressive therapy secondary to a misdiagnosis as Behçet's disease followed by a relapse which was successfully treated with the appropriate treatment. Observations: A 34-year-old female patient presented to our service with complaints of decreased vision in the left eye (OS). She initially developed similar symptoms seven months prior to presentation and was diagnosed as Behçet's disease based on the clinical picture of papillitis, vasculitis and placoid chorioretinitis in the posterior pole of OS. She was started on daily oral prednisone 60 mg and weekly methotrexate 10mg by her rheumatologist. The patient's ocular symptoms improved one month prior to presentation with resolution of the placoid lesion but persistence of vasculitis and papillitis. At that time, the dose of the prednisone was decreased to 30 mg which resulted in a relapse of the placoid chorioretinal lesions and worsened visual acuity at the time of presentation to us. Extensive laboratory workup demonstrated positive serology for syphilis. A diagnosis of syphilitic placoid chorioretinitis was made and the patient was treated with intravenous penicillin G for 2 weeks. The vitritis, papillitis, and placoid chorioretinitis resolved along with improvement in vision following the treatment. Conclusions and importance: Ocular findings in syphilis are heterogeneous and may mimic variety of ocular diseases. ASPPC is a rare ocular manifestation of syphilis and its natural course and underlying pathophysiology is not well understood. However, irrespective of the underlying mechanism of the disease, all patients with ASPPC should receive treatment to prevent recurrence and long-term functional damage. Keywords: Uveitis, Syphilis, Acute syphilitic posterior placoid chorioretinopathy, Immunosuppressio

Fundus Topographical Distribution Patterns of Ocular Toxoplasmosis

Background: To establish topographic maps and determine fundus distribution patterns of ocular toxoplasmosis (OT) lesions.Methods: In this retrospective study, patients who presented with OT to ophthalmology clinics from four countries (Argentina, Turkey, UK, USA) were included. Size, shape and location of primary (1°)/recurrent (2°) and active/inactive lesions were converted into a two-dimensional retinal chart by a retinal drawing software. A final contour map of the merged image charts was then created using a custom Matlab programme. Descriptive analyses were performed.Results: 984 lesions in 514 eyes of 464 subjects (53% women) were included. Mean area of all 1° and 2° lesions was 5.96±12.26 and 5.21±12.77 mm2, respectively. For the subset group lesions (eyes with both 1° and 2° lesions), 1° lesions were significantly larger than 2° lesions (5.52±6.04 mm2 vs 4.09±8.90 mm2, p=0.038). Mean distances from foveola to 1° and 2° lesion centres were 6336±4267 and 5763±3491 µm, respectively. The majority of lesions were found in temporal quadrant (p<0.001). Maximum overlap of all lesions was at 278 µm inferotemporal to foveola.Conclusion: The 1° lesions were larger than 2° lesions. The 2° lesions were not significantly closer to fovea than 1° lesions. Temporal quadrant and macular region were found to be densely affected underlining the vision threatening nature of the disease.Keywords: Choroid; Imaging; Infection; Inflammation; RetinaFil: Hasanreisoglu, Murat. Koc University School of Medicine; Turquía. Gazi University School of Medicine; TurquíaFil: Halim, Muhammad Sohail. Ocular Imaging Research and Reading Center; Estados UnidosFil: Cakar Ozdal, Pinar. University of Health Sciences Ankara Ulucanlar Eye Training and Research Hospital; TurquíaFil: Ormaechea, Maria Soledad. Universidad Catolica de Las Misiones. Facultad de Cs. de la Salud; ArgentinaFil: Kesim, Cem. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; ArgentinaFil: Ozdemir, Huseyin Baran. Universidad Austral. Hospital Universitario Austral. Departamento de Cirugía. Servicio de Oftalmologia.; ArgentinaFil: Uludag, Gunay. University of Stanford; Estados UnidosFil: Sredar, Nripun. University of Stanford; Estados UnidosFil: Cankurtaran, Mahmut. University of Health Sciences Ankara Ulucanlar Eye Training and Research Hospital; TurquíaFil: Liu, Xiaoxuan. University Hospitals Birmingham NHS Foundation Trust; Reino Unido. University Of Birmingham; . Moorfields Eye Hospital NHS Foundation Trust; Reino UnidoFil: Denniston, Alastair Keith. University Hospitals Birmingham NHS Foundation Trust; Reino Unido. University Of Birmingham; . Moorfields Eye Hospital NHS Foundation Trust; Reino UnidoFil: Rudzinski, Marcelo Nicolas. Universidad Catolica de Las Misiones; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Colombero, Daniel N.. Universidad Nacional de Rosario; ArgentinaFil: Schlaen, Bernardo Ariel. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Keane, Pearse Andrew. Moorfields Eye Hospital NHS Foundation Trust; Estados UnidosFil: Pavesio, Carlos. Moorfields Eye Hospital NHS Foundation Trust; Estados Unidos. University of Lincoln; Reino UnidoFil: Nguyen, Quan Dong. University of Stanford; Estados Unido