Original articleIntravitreal Clindamycin and Dexamethasone for Zone 1 Toxoplasmic Retinochoroiditis at Twenty-four Months
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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Intravitreal clindamycin injection in toxoplasma retinochoroiditis: About 9 cases in the ophthalmology department of the CHU de Bordeaux
2021, Journal Francais d'OphtalmologiePathogenesis of ocular toxoplasmosis
2021, Progress in Retinal and Eye ResearchCitation Excerpt :Active retinochoroiditis is commonly treated with a course of oral antimicrobial drugs that target the parasite, including pyrimethamine/sulphadiazine and trimethoprim/sulphamethoxazole, frequently with corticosteroid to limit the host inflammatory response (Casoy et al., 2020). For patients who do not tolerate or have contraindications to systemic treatment, an alternative is the intravitreal injection of clindamycin or trimethoprim/sulphamethoxazole, along with dexamethasone (Lasave et al., 2010; Souza et al., 2018). However, in which patients and how these drugs are used vary considerably between ophthalmologists, even within the same country.
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2020, Toxoplasma Gondii: The Model Apicomplexan - Perspectives and MethodsOcular changes during pregnancy
2018, Journal of Current OphthalmologyCitation Excerpt :Although sulfadiazine and pyrimethamine are potentially teratogenic, they are used by many clinicians in combination with spiramycin and oral steroids from the second trimester onward for treatment of toxoplasmosis. Moreover, intravitreal injection of clindamycin and dexamethasone are recommended to avoid systemic toxicity.49 Diabetic retinopathy can progress quickly during pregnancy.
CHALLENGES OF OCULAR TOXOPLASMOSIS TREATMENT IN MULTIPLE DRUG INTOLERANCE SYNDROME: A CASE REPORT AND LITERATURE REVIEW
2023, Journal of Health and Translational Medicine
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.