| مستخلص: |
Background: Ocular toxoplasmosis (OT) is the most common cause of infectious uveitis worldwide, including Thailand. This study describes the clinical presentation, visual acuity (VA) outcomes, and factors associated with VA loss in patients with active OT following antiparasitic treatment. Methodology/Principal findings: A retrospective chart review of patients with active OT treated with antiparasitic drugs between 2010 and 2020 was performed. Outcome measures included clinical characteristics, interval VA, and predictive factors associated with loss of VA ≤ 20/50 at 6 months post-treatment. Ninety-two patients (95 eyes) were enrolled. The median follow-up time was 10.9 months (IQR 4.9–31.8 months). The median age at presentation was 35.9 years, 51% were male, and 92.4% had unilateral OT. Eleven patients (12%) were immunocompromised (HIV infection, eight patients; receiving immunosuppressive agents, three patients). Patients mainly presented with primary retinitis without previous scar (62%), posterior pole lesion (56%), and lesion size of ≤ 2–disc area (75%). Immunocompromised patients showed a significantly larger size of retinitis than immunocompetent patients. Oral trimethoprim/sulfamethoxazole monotherapy was the primary short-term antiparasitic drug prescribed (85%). At the final visit, 21% of all affected eyes suffered VA ≤ 20/200. The cumulative incidence of recurrent OT at three years was 33.9% (95% CI, 19.7%–54.2%). Immunocompromised patients [adjusted odds ratio (aOR) 4.9, p = 0.041], macular lesion (aOR 5.4, p = 0.032), and initial VA ≤ 20/200 (aOR 9.1, p = 0.014) were predictive of having VA ≤ 20/50 at 6 months post-treatment. Conclusions: Ocular toxoplasmosis mainly presents as unilateral primary retinitis within the posterior pole. Severe VA loss was observed in one-fifth of eyes following treatment with lesion resolution. Immunocompromised patients, eyes with macular lesions, and poor initial VA were associated with poor VA outcomes. Author summary: Ocular toxoplasmosis (OT) is the most common cause of infectious uveitis worldwide, including Thailand. Vision loss is common despite receiving antiparasitic treatment because of the development of ocular complications. Little is known about the Thai population's demographics, clinical presentations, and visual outcomes. We conducted a retrospective cohort study to examine the clinical presentation and visual acuity outcomes of this group of patients, including both immunocompetent and immunocompromised patients, at the largest tertiary center in southern Thailand. Patients with active OT in our cohort mainly presented with unilateral, focal retinitis without associated scar, and central lesions. Our findings support those of previous studies, in which immunocompromised patients exhibited significantly larger lesion sizes with poorer visual acuity recovery than immunocompetent patients. A significant proportion (21%) of all affected eyes showed severe vision loss following antiparasitic treatment, in which oral trimethoprim/sulfamethoxazole monotherapy was mainly used. Education on Toxoplasma gondii infection and transmission should be provided to communities to decrease the risk of infection and ocular toxoplasmosis disease burden. [ABSTRACT FROM AUTHOR] |
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