Elsevier

Ophthalmology

Volume 117, Issue 9, September 2010, Pages 1831-1838
Ophthalmology

Original article
Intravitreal Clindamycin and Dexamethasone for Zone 1 Toxoplasmic Retinochoroiditis at Twenty-four Months

Presented in part at: the Joint Meeting of the American Academy of Ophthalmology and the Pan-American Association of Ophthalmology, October 2009, San Francisco, California.
https://doi.org/10.1016/j.ophtha.2010.01.028Get rights and content

Purpose

To report the anatomic and functional outcomes of intravitreal clindamycin and dexamethasone for the treatment of zone 1 toxoplasmic retinochoroiditis (TRC). Patients had 1 or more of the following indications for local therapy: intolerance to oral medication, contraindication to oral medication because of pregnancy, lack of response despite oral antimicrobial treatment, or treatment with concomitant oral and local therapy to avoid or limit foveal or optic disc involvement.

Design

Noncomparative, retrospective, multicentric interventional case series.

Participants

We reviewed the medical records of 12 consecutive patients (eyes) with posterior pole (zone 1) TRC who were treated weekly or every 4 weeks (during pregnancy) with intravitreal injections of clindamycin (1.5 mg/0.1 ml) and dexamethasone (400 μg/0.1 ml).

Methods

Ophthalmic evaluation included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA); assessment of central macular thickness (CMT); resolution of inflammation by optical coherence tomography (OCT), clinical examination, and fluorescein angiography; and assessment of adverse events. Patients were followed for 24 months.

Main Outcome Measures

Resolution of TRC, changes in BCVA, and OCT.

Results

Resolution of TRC was achieved in all cases with a mean number of injections of 3.6 (range: 2–5 injections) with a mean interval of 15.5±4 days. At 24 months a significant reduction in CMT by OCT was observed, from 387.6±70.1 μm to 185.2±44.7 μm (P = 0.0004). Baseline BCVA was logarithm of the minimal angle of resolution (logMAR) 1±0.4 (20/200), which improved to 0.5±0.4 (20/63) (P = 0.002) at the end of follow-up. Ten eyes (83.3%) improved ≥2 ETDRS lines of BCVA, and 2 eyes (20%) remained stable at 24 months. One patient's vision was limited because of macular scarring. No ocular or systemic adverse events were observed. No recurrences at 24 months of follow-up were observed.

Conclusions

The combination of intravitreal clindamycin and dexamethasone was associated with resolution of zone 1 TRC and functional and anatomic improvement in patients who did not tolerate, had contraindications to, or did not respond to oral medications.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

This is a noncomparative, retrospective, and multicentric interventional study performed at 3 centers in Brazil, Spain, and Venezuela between May 2002 and May 2007. Twelve patients (12 eyes) with active TRC in zone 1 (posterior pole)21 (Fig 1) were treated weekly or every 4 weeks (during pregnancy) with intravitreal injections of clindamycin (1.5 mg /0.1 ml) and dexamethasone (400 μg/0.1 ml) until TRC resolved. Institutional review board/ethics committee approval and patients' informed consent

Results

A total of 12 eyes (12 consecutive patients) with a follow-up of 24 months were included for this analysis. Our patients had a mean age of 31.9±11.3 years (range: 21–61 years). Nine patients (75%) were women. All eyes had TRC in zone 1 and received 1 intravitreal injection of clindamycin (1.5 mg /0.1 ml) and dexamethasone (400 μg/0.1 ml) weekly or every 4 weeks (during pregnancy) until resolution of TRC.

Three patients (25%) had contraindication to oral treatment because of pregnancy (2 were at

Discussion

The current study evaluates the anatomic and functional outcomes of intravitreal clindamycin and dexamethasone to treat zone 1 TRC in 12 consecutive patients (eyes) who had 1 or more of the following indications for local therapy: contraindication to oral medications because of pregnancy, disease progression despite systemic therapy, or lesions located at or near the fovea or optic disc. Intravitreal clindamycin and dexamethasone was associated with control of TRC and resolution of inflammation

Study Limitations

The study was nonrandomized and retrospective in nature, had a small number of cases (∼300 subjects are needed to find 1% unexpected severe adverse events), and had no control group. The outcome evaluations were not masked to the observers, and the follow-up was relatively short term to accurately assess recurrence rates.

In conclusion, intravitreal clindamycin and dexamethasone was associated with resolution of zone 1 TRC in patients who did not tolerate, had contraindications to, or did not

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    Manuscript no. 2009-1349.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Supported in part by the Arevalo-Coutinho Foundation for Research in Ophthalmology, Caracas, Venezuela.

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