Purpose: To report a case of unilateral retinal detachment with a large subretinal macrocyst, representing an atypical presentation of OCULAR TOXOPLASMOSIS. Case Report: A healthy 30‑ year‑ old woman presented with a two month history of progressive visual loss in her right eye. Funduscopy revealed vitreous condensations, total retinal detachment with a large subretinal orange‑ red cystic mass and multiple retinal breaks sealed with surrounding retinal scars. B‑ scan echography showed a large subretinal cyst with non‑ homogenous tissue echogenicity. Pars plana deep vitrectomy and complete cyst removal were performed. Histopathologic examination of the excised cyst revealed intraretinal toxoplasma cysts containing bradyzoites. Analysis of intraOCULAR fluids by polymerase chain reaction (PCR) and serologic tests also supported the diagnosis. After six months, the retina was completely attached with no signs of inflammation. Conclusion: Toxoplasma retinochoroiditis should be considered in the differential diagnoses of retinal detachment with subretinal cyst.

Purpose: To compare the efficacy of the standard treatment of OCULAR TOXOPLASMOSIS (pyrimethamine, sulfadiazine, and predinsolone) with a regimen consisting of trimethoprim sulfamethoxazole (TMP/SMX) plus predinsolone.Methods: In a prospective randomized single-blind clinical trial, 59 patients were randomly assigned to treatment groups: 29 in the pyrimethamine/ sulfadiazine group and 30 patients to the TMP/SMX group. Treatment consisted of six weeks of antibiotics plus steroids, and patients were followed weekly with measurements of visual acuity and examination of the anterior vitreous and fundus for signs of inflammation ELISA measurements of anti- TOXOPLASMOSIS antibodies (IgM and IgG) were undertaken. The main outcome measure consisted of change in size of the retinochoroidal lesion on fundus photography, obtained at initiation and completion of treatment.Results: No significant difference was found in the amount of decrease in retinochoroidal lesion between the two treatment groups (61% reduction in the classic treatment group ND 59% in the TMP/SMX regimen, P = 0.69). Similarly no significant difference was found in visual acuity after treatment between the two groups (mean visual acuity after treatment 0.11 Log MAR in both groups, P = 0.41). Adverse treatment effects were similar in both groups, with one patient in each suffering from any significant drug side effects. The rate of recurrence with an average of 14 months follow up was 6.8% with no significant difference between treatment groups (P = 0.48). Conclusions: The efficacy in terms of decrease in retinal lesion and improvement in visual acuity was similar between a regimen of TMP/SMX plus steroid and the standard treatment of OCULAR TOXOPLASMOSIS with pyrimethamine and sulfadiazine plus steroids. Therapy with TMP/SMX appears to be an acceptable alternative for the treatment of OCULAR TOXOPLASMOSIS. A prospective randomized clinical trial, which would match patients in terms of size of retinal lesions, is recommended for stronger conclusion.

OCULAR TOXOPLASMOSIS may result from either congenital or acquired TOXOPLASMOSIS. The infection is commonly diagnosed by ophthalmologic examination and the empiric therapy instituted against the organism may confirm the clinical findings. But in some patients the clinical presentation is not diagnostic and in some others the response to the treatment is inadequate. Amplipification of parasite DNA can be used to support or confirm the diagnosis of Toxoplasma Gondii as the causative agent of OCULAR TOXOPLASMOSIS. In this study the utility of polymerase chain reaction (PCR) for diagnosis of OCULAR TOXOPLASMOSIS in a patient with sever inflammation and retinal detachment is demonstrated.

Purpose: To compare the effects of short-term and long-term systemic corticosteroids in the treatment of confirmed OCULAR TOXOPLASMOSIS.Methods: This randomized comparative clinical trial was performed on 69 patients with confirmed active OCULAR TOXOPLASMOSIS with typical clinical manifestations. The subjects were randomly assigned to receive either 10 days (group A, 33 cases) or 4-6 weeks (group B, 36 cases) of systemic corticosteroids in addition to classic antibiotic therapy. All patients were visited and followed weekly until complete improvement of vision. Mean visual acuity, inflammatory cell countin the vitreous, lesion size and severity of the condition were compared between the two groups.Results: There was no statistically significant difference between the two group, regarding mean values of visual acuity in Log MAR (before; group A: 0.24±0.6, group B: 0.280±0.07, P=0.43 and after; group A: 0.11±0.08, group B: 0.06±0.07, P=0.09), vitreal inflammatory cell count (before; group A: 1.8±0.56, group B: 1.9±0.60, P=0.45 and after; group A: 1.5±0.65, group B: 1.5±0.5, p=0.94), and size of the lesions in disc diameter (before; group A: 0.94±0.37, group B: 1.03±0.37, P=0.49 and after; group A: 0.94±0.44, group B: 1.12±0.38, P=0.4).Conclusion: The study revealed that there is no significant difference between the effects of short term and long-term systemic corticosteroid therapy in the treatment of OCULAR TOXOPLASMOSIS. It is reasonable to perform an equivalence trial study on this issue.

Purpose: To determine response to treatment and to identify risk factors of recurrence in OCULAR TOXOPLASMOSIS in Yazd.Materials and methods: This study is a case series of 164 congenital OCULAR toxoplamosis patients who had been diagnosed clinically by ophthalmologists and referred to us consecutively for treatment from 1988 to 2001. Fundus examination was done by indirect ophthalmoscopy and 3 mirror lens after routine OCULAR examination. Weekly eye examination was done after 2 weeks of treatment including sulfadiazine and pyrimethamine and prednisolone. Complete blood counts and platelet counts were obtained every 4 to 10 days. Treatment was continued until a scar was formed and intraOCULAR inflammation had disappeared and 4 days had passed from steroid tapering. Results: Mean age of patients at the first episode was 20.3± 7.3 years. Among 189 episodes in 164 patients, 134 patients had only active lesions and 30 had both scar and active lesions. Mean and median of improvement were 21 days. Bilateral involvement was seen in 9.1% of the cases. Lesions were more frequent in the posterior pole and superior temporal region. Visual loss in one third of cases was due to peripheral lesions. Before therapy visual acuity of less than 3/10 occurred in 15 patients including 4 legal blindness cases, while after therapy 2 patients had the same visual loss with no legal blindness. Patients with mean duration of therapy of 38 days experienced more relapses than those with mean treatment duration of 42 days. Most relapses occurred within the first year. Delay in diagnosis did not lead to prolonged activity of the disease. One-third of patients needed more than 6 weeks of treatment.Conclusion: Peripheral lesions should receive enough attention regarding visual loss. Duration of treatment should not be less than 42 days. All patients should better be evaluated at the end of 6 weeks of treatment to detect those who need to receive longer therapy. Vision improves with treatment and all patients need to be followed for at least one year to detect recurrences.

Background: TOXOPLASMOSIS is a parasitic disease caused by Toxoplasma gondii that can affect various parts of the body and it is most prevalent in Asian countries. There are various methods for detection of visual impairment in patients with TOXOPLASMOSIS. One of these non-invasive methods is electrooculogram (EOG) which evaluates visual function in patients with TOXOPLASMOSIS. This study was performed to determine the prevalence of OCULAR complications of TOXOPLASMOSIS by EOG. Materials and methods: In this cross-sectional study, 50 subjects referred to Qods Clinic from 2011 to 2012 including 25 case with OCULAR TOXOPLASMOSIS and 25 control subjects without TOXOPLASMOSIS were enrolled and the EOG results were compared among two groups. Results: The mean (± standard deviation) Arden indices were 1.35±0.25 and 2.3±0.31 in control and case group, respectively (P=0.0001).Conclusion: According to our results and comparison with other studies, it may be concluded that OCULAR complications of TOXOPLASMOSIS is more prevalent compared with control group according to EOG technique.

Purpose: To determine the clinical features and risk factors of presumed OCULAR TOXOPLASMOSIS (POT) in patients affected with the condition at Irrua, Nigeria.Methods: The study included 69 patients with POT, and 69 age and sex matched subjects who served as the control group. Data was obtained using interviewer administered questionnaires. Examination included measurement of visual acuity (VA), intraOCULAR pressure (IOP), slit lamp examination, gonioscopy and dilated fundus examination.Results: Mean age of cases and control subjects was 57.16 ± 18.69 and 56.09 ± 16.01 years respectively. The peak age group in patients with POT was 60 years and above. The most common presenting complaint was blurred vision occurring in 100% of cases. Drinking unfiltered water in 58 (84.1%) patients was the most common risk factor. Other risk factors included post cataract surgery status in 32 (46.4%) subjects, ingestion of poorly cooked meat in 30 (43.5%) cases and exposure to cats in 9 (13.0%) patients. All risk factors were more common in POT patients (P<0.05). Out of 69 patients, 62 (89.9%) had unilateral while 7 (10.1%) had bilateral involvement. Out of 76 eyes with uveitis, 53 (69.7%) were blind. Active disease was significantly more common with increasing age (P<0.05).Conclusion: Patients with POT were rather old and some risk factors were modifiable, therefore health education for preventing the transmission of TOXOPLASMOSIS and provision of sanitary water may help reduce the incidence of OCULAR TOXOPLASMOSIS.

Background: Toxoplasma gondii (T. gondii) is the most common parasite that can lead to a disease called TOXOPLASMOSIS. In this study, serological and molecular complementary tests have been conducted to detect or diagnose this parasite. Methods: A total of 71 patients with clinical symptoms of OCULAR TOXOPLASMOSIS and 20 patients with other OCULAR infections were evaluated. Serum and buffy coat samples were collected and tested using enzyme-linked immunosorbent assay (ELISA) and nested polymerase chain reaction (nPCR) assessments. Superficial T. gondii B1 gene was evaluated in PCR. The OCULAR TOXOPLASMOSIS patients were followed-up 2 weeks after the first sampling and 4 weeks following the first laboratory testing. The main outcome measures were the efficiency of the diagnostic procedure and positive and negative predictive values (PPV and NPV). Results: Overall, of the samples, 69% were PCR+, IgG+, and IgM-, and 4. 2% showed PCR+, IgG+, and IgM+. In the first follow-up, after 2 weeks, from the 41 referred patients, 29 (70%) showed PCR+, IgG+, and IgM-, which confirmed the results of the first sampling. In the second follow-up, 9 (47%) patients were PCR+, IgG+, and IgM-. A correlation was observed between the first referral and the follow-ups. Also, from 71 patients, diagnosed clinically as OCULAR TOXOPLASMOSIS, the disease was confirmed in 73. 2% and 26. 8% of those suffering from other OCULAR infections. Of the 20 control group samples, 55% showed PCR-, IgG+, and IgM-. The sensitivity, specificity, negative and positive predictive values, and negative and positive likelihoods were analyzed for IgG and IgM antibodies and for PCR using ELISA method. Conclusion: As the ophthalmologic signs of T. gondii may be mimicked by other infections, clinical methods may be complemented by laboratory approaches for a definite diagnosis. This would assist clinicians to achieve timely diagnosis and successful therapy and to control the infection.