TY - JOUR
T1 - Intravitreal clindamycin and dexamethasone for zone 1 toxoplasmic retinochoroiditis at twenty-four months
AU - Lasave, Andrs F.
AU - Daz-Llopis, Manuel
AU - Muccioli, Cristina
AU - Belfort, Rubens
AU - Arevalo, J. Fernando
N1 - Funding Information:
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.
PY - 2010/9
Y1 - 2010/9
N2 - 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: 25 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.
AB - 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: 25 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.
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U2 - 10.1016/j.ophtha.2010.01.028
DO - 10.1016/j.ophtha.2010.01.028
M3 - Article
C2 - 20471684
AN - SCOPUS:77956343927
SN - 0161-6420
VL - 117
SP - 1831
EP - 1838
JO - Ophthalmology
JF - Ophthalmology
IS - 9
ER -