Skip to main content

Advertisement

Log in

Vitreal, retinal, and choroidal findings in active and scarred toxoplasmosis lesions: a prospective study by spectral-domain optical coherence tomography

  • Inflammatory Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

The aim of our study was to investigate vitreal, retinal, and choroidal morphologic changes in active and scarred toxoplasmosis lesions using spectral-domain optical coherence tomography (SD-OCT).

Methods

In this prospective study, 19 eyes of 15 consecutive patients with ocular toxoplasmosis were included. Complete ophthalmologic examination and SD-OCT were done at the initial visit and during follow-up. Retina and choroid SD-OCT protocols directed to macular area and lesions observed on clinical examination were used.

Results

Seventeen active lesions and 56 retinochoroidal scars were studied. In the acute phase, disruption, thickening, and hyper-reflectivity of the neurosensory retina with photoreceptor (PR) interruption and retinal pigment epithelial (RPE) elevation were found. The choroid became thickened and hyporeflective. During follow-up, neurosensory retinal layers thinning and disorganization, PR interruption, and RPE elevation and/or atrophy were demonstrated. The choroid returned to normal thickness and became more hyperreflective. Five active lesions presented with hyperreflective oval deposits within the vitreoretinal interface, adjacent to or far away from the lesions. During follow-up, the deposits became smaller, entered into the inner retina layers and faded with time until complete resolution. Multiple hyperreflective dots in the vitreous cavity, compatible with vitritis, and posterior hyaloid thickening were demonstrated in the acute phase, with complete resolution and detachment of the posterior hyaloid during follow-up. Four types of scars were specified according to outer retina–choroid interface changes; atrophic, elevated, deep, and combined (atrophic & elevated). Epiretinal membrane segments were found over active and scarred lesions.

Conclusions

SD-OCT imaging showed toxoplasmic retinochoroidal lesions and scars to be complex and characterized acutely by thickening and disorganization of both the retina and underlying choroid, and following scar formation by varying degrees of thinning, often in conjunction with irregularity of the outer retinal layers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Rothova A (2003) Ocular manifestations of toxoplasmosis. Curr Opin Ophthalmol 14:384–388

    Article  PubMed  Google Scholar 

  2. Bonfioli AA, Orefice F (2005) Toxoplasmosis. Semin Ophthalmol 20:129–141

    Article  PubMed  Google Scholar 

  3. Holland GN (2003) Ocular toxoplasmosis: a global reassessment. Part I: epidemiology and course of disease. Am J Ophthalmol 136:973–988

    Article  PubMed  Google Scholar 

  4. Rathinam SR, Ashok KA (2010) Ocular manifestations of systemic disease: ocular parasitosis. Curr Opin Ophthalmol 21:478–484

    Article  PubMed  Google Scholar 

  5. Smith JR, Cunningham ET Jr (2002) Atypical presentations of ocular toxoplasmosis. Curr Opin Ophthalmol 13:387–392

    Article  PubMed  Google Scholar 

  6. Finamor LP, Muccioli C, Belfort R Jr (2005) Imaging techniques in the diagnosis and management of uveitis. Int Ophthalmol Clin 45:31–40

    Article  PubMed  Google Scholar 

  7. Atmaca LS, Simsek T, Atmaca Sonmez P, Sonmez K (2006) Fluorescein and indocyanine green angiography in ocular toxoplasmosis. Graefes Arch Clin Exp Ophthalmol 244:1688–1691

    Article  PubMed  Google Scholar 

  8. Lieb DF, Scott IU, Flynn HW Jr, Davis JL, Demming SM (2004) Acute acquired toxoplasma retinitis may present similarly to unilateral acute idiopathic maculopathy. Am J Ophthalmol 137:940–942

    Article  PubMed  Google Scholar 

  9. Blaise P, Comhaire Y, Rakic JM (2005) Giant macular hole as an atypical consequence of a toxoplasmic chorioretinitis. Arch Ophthalmol 123:863–864

    Article  PubMed  Google Scholar 

  10. Oréfice JL, Costa RA, Campos W, Calucci D, Scott IU, Oréfice F (2006) Third-generation optical coherence tomography findings in punctate retinal toxoplasmosis. Am J Ophthalmol 142:503–505

    Article  PubMed  Google Scholar 

  11. Guagnini AP, De Potter P, Levecq L, Kozyreff A (2007) Atypical spherical deposition on vitreoretinal interface associated with toxoplasmic chorioretinitis. Graefes Arch Clin Exp Ophthalmol 245:158–160

    Article  PubMed  Google Scholar 

  12. Oréfice JL, Costa RA, Oréfice F, Campos W, da Costa-Lima D, Jr SIU (2007) Vitreoretinal morphology in active ocular toxoplasmosis: a prospective study by optical coherence tomography. Br J Ophthalmol 91:773–780

    Article  PubMed  Google Scholar 

  13. Gallagher MJ, Yilmaz T, Cervantes-Castañeda RA, Foster CS (2007) The characteristic features of optical coherence tomography in posterior uveitis. Br J Ophthalmol 91:1680–1685

    Article  PubMed  CAS  Google Scholar 

  14. Chung H, Kim JG, Choi SH, Lee SY, Yoon YH (2008) Bilateral toxoplasma retinochoroiditis simulating cytomegalovirus retinitis in an allogeneic bone marrow transplant patient. Korean J Ophthalmol 22:197–200

    Article  PubMed  Google Scholar 

  15. Garg S, Mets MB, Bearelly S, Mets R (2009) Imaging of congenital toxoplasmosis macular scars with optical coherence tomography. Retina 29:631–637

    Article  PubMed  Google Scholar 

  16. de Souza EC, Casella AM (2009) Clinical and tomographic features of macular punctate outer retinal toxoplasmosis. Arch Ophthalmol 127:1390–1394

    Article  PubMed  Google Scholar 

  17. Monnet D, Averous K, Delair E, Brézin AP (2009) Optical coherence tomography in ocular toxoplasmosis. Int J Med Sci 6:137–138

    Article  PubMed  Google Scholar 

  18. Kiernan DF, Mieler WF, Hariprasad SM (2010) Spectral-domain optical coherence tomography: a comparison of modern high-resolution retinal imaging systems. Am J Ophthalmol 149:18–31

    Article  PubMed  Google Scholar 

  19. Branchini L, Regatieri CV, Flores-Moreno I, Baumann B, Fujimoto JG, Duker JS (2012) Reproducibility of choroidal thickness measurements across three spectral domain optical coherence tomography systems. Ophthalmology 119:119–123

    Article  PubMed  Google Scholar 

  20. Singh M, Chee CK (2009) Spectral domain optical coherence tomography imaging of retinal diseases in Singapore. Ophthalmic Surg Lasers Imaging 40:336–341

    Article  PubMed  Google Scholar 

  21. Sheets CW, Grewal DS, Greenfield DS (2009) Ocular toxoplasmosis presenting with focal retinal nerve fiber atrophy simulating glaucoma. J Glaucoma 18:129–131

    Article  PubMed  Google Scholar 

  22. Cho DY, Nam W (2012) A case of ocular toxoplasmosis imaged with spectral domain optical coherence tomography. Korean J Ophthalmol 26:58–60

    Article  PubMed  Google Scholar 

  23. Diniz B, Regatieri C, Andrade R, Maia A (2011) Evaluation of spectral domain and time domain optical coherence tomography findings in toxoplasmic retinochoroiditis. Clin Ophthalmol 5:645–650

    Article  PubMed  Google Scholar 

  24. Khairallah M, Kahloun R, Ben Yahia S, Jelliti B (2011) Clinical, tomographic, and angiographic findings in patients with acute toxoplasmic retinochoroiditis and associated serous retinal detachment. Ocul Immunol Inflamm 19:307–310

    Article  PubMed  Google Scholar 

  25. Oréfice JL, Costa RA, Scott IU, Calucci D, Oréfice F, on behalf of the Grupo Mineiro de Pesquisa em Doenças Oculares Inflamatórias (MINAS) (2012) Spectral optical coherence tomography findings in patients with ocular toxoplasmosis and active satellite lesions (MINAS Report 1). Acta Ophthalmol. doi:10.1111/j.1755-3768.2012.02531

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dafna Goldenberg.

Additional information

The authors have full control of all primary data, and agree to allow Graefe's Archive for Clinical and Experimental Ophthalmology to review their data upon request.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goldenberg, D., Goldstein, M., Loewenstein, A. et al. Vitreal, retinal, and choroidal findings in active and scarred toxoplasmosis lesions: a prospective study by spectral-domain optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 251, 2037–2045 (2013). https://doi.org/10.1007/s00417-013-2334-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-013-2334-3

Keywords

Navigation