Perspective
An update on current practices in the management of ocular toxoplasmosis1, 2,

This work was presented in part at the annual Fall meeting of the American Uveitis Society, New Orleans, Louisiana, November 12, 2001.
https://doi.org/10.1016/S0002-9394(02)01526-XGet rights and content

Abstract

PURPOSE: To update information that was published by the american journal of ophthalmology in 1991 about treatment practices for ocular toxoplasmosis by uveitis specialists.

DESIGN: Physician survey.

METHODS: A written questionnaire was distributed to all physician-members (n = 147) of the American Uveitis Society. The questionnaire was modeled after a similar device used to survey uveitis specialists in 1991. Information contained on 96 returned questionnaires was tabulated.

RESULTS: Among 79 respondents who evaluate and manage patients with ocular toxoplasmosis, 15% treat all cases regardless of clinical findings (in contrast to 6% in 1991). The major indications for treatment among other respondents were severe inflammatory responses and proximity of retinal lesions to the fovea and optic disk. The majority of clinical factors considered in five categories (vision, lesion location, lesion size, lesion characteristics, and vitreous inflammatory reaction) were identified to be relative or absolute indications for treatment by a greater proportion of respondents in the current survey than in the 1991 survey. A total of nine drugs (or commercially available combinations) were used in 24 different regimens as treatments of choice for typical cases of recurrent toxoplasmic retinochoroiditis, with the combination of pyrimethamine, sulfadiazine, and prednisone being the most commonly used regimen (29% of respondents).

CONCLUSIONS: Uveitis specialists appear to be more likely to treat patients with ocular toxoplasmosis in 2001 than in 1991. Although the majority of survey respondents adhere to a traditional approach to the management of toxoplasmic retinochoroiditis (a discrete course of systemic drug treatment during active disease using multiple antiparasitic drugs with or without corticosteroids), there is still no consensus regarding the choice of antiparasitic agents for treatment regimens. Survey results provide useful information for treating physicians and for clinical investigators interested in therapy.

Section snippets

Questionnaire

Only those recipients who treat patients with ocular toxoplasmosis were asked to complete the questionnaire. These recipients were asked whether they treated all cases of typical ocular toxoplasmosis regardless of ocular findings. A case of typical ocular toxoplasmosis was defined as an immunocompetent adult man or nonpregnant woman with a focus of recurrent toxoplasmic retinochoroiditis at the border of a preexisting scar that is not involving the fovea or optic disk, but could affect those

Respondents

The American Uveitis Society includes clinicians and laboratory scientists with a special interest in ocular inflammation. For membership in the American Uveitis Society, physicians must have had fellowship training in uveitis or have been in practice for at least 3 years after residency training, with 25% of their patient-care time spent in the treatment of patients with intraocular inflammation; alternatively, they must be engaged in full-time laboratory research dealing with inflammatory

Survey results

Some respondents did not answer every question. The proportion of respondents providing a given answer was calculated by dividing the number of respondents giving that answer by the number of respondents answering the corresponding question. Information cited from the 1991 survey was taken either from the publication describing its results1 or from data summaries that had been archived in the Jules Stein Eye Institute Clinical Research Center.

To justify the use of current results as a new

Discussion

T. gondii infection is worldwide in distribution and toxoplasmic retinochoroiditis is the most common form of posterior uveitis in otherwise healthy individuals, both in tertiary referral and in community-based practices of comprehensive ophthalmology.26 Ocular toxoplasmosis can lead to severe vision loss in some patients. Appropriate treatment is therefore a subject of great importance.

This survey was not intended as a scientific sampling of all clinicians who evaluate and treat patients with

Acknowledgements

Bette L. Okeya, Pharm. D. of the Drug Information Service (UCLA Medical Center, Los Angeles, CA) provided information about the commercial availability of antiparasitic agents. Robert E. Engstrom, Jr., MD (Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles, CA), Douglas A. Jabs, MD, MBA (Wilmer Ophthalmologic Institute, Johns Hopkins University School of Medicine, Baltimore, MD), and Robert B. Nussenblatt, MD (National Eye Institute, National Institutes of Health, Bethesda, MD),

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This work was supported in part by Research to Prevent Blindness, Inc., New York, NY, the Skirball Foundation, Los Angeles, CA, and the David May II Endowed Professorship (G.N.H.). Dr. Holland is recipient of a Research to Prevent Blindness, Inc., Lew R. Wassermann Merit Award.

1

InternetAdvance publication at ajo.com April 12, 2002.

2

Additional information is available online at ajo.com.

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