Intravitreal clindamycin and dexamethasone for zone 1 toxoplasmic retinochoroiditis at twenty-four months

Andrs F. Lasave, Manuel Daz-Llopis, Cristina Muccioli, Rubens Belfort, J Fernando Arevalo

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1831-1838
Number of pages8
JournalOphthalmology
Volume117
Issue number9
DOIs
StatePublished - Sep 2010

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Clindamycin
Dexamethasone
Visual Acuity
Optical Coherence Tomography
Diabetic Retinopathy
Therapeutics
Pregnancy
Intravitreal Injections
Injections
Fluorescein Angiography
Optic Disk
Disclosure
Cicatrix
Medical Records
Outcome Assessment (Health Care)
Inflammation
Recurrence

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Intravitreal clindamycin and dexamethasone for zone 1 toxoplasmic retinochoroiditis at twenty-four months. / Lasave, Andrs F.; Daz-Llopis, Manuel; Muccioli, Cristina; Belfort, Rubens; Arevalo, J Fernando.

In: Ophthalmology, Vol. 117, No. 9, 09.2010, p. 1831-1838.

Research output: Contribution to journalArticle

Lasave, Andrs F. ; Daz-Llopis, Manuel ; Muccioli, Cristina ; Belfort, Rubens ; Arevalo, J Fernando. / Intravitreal clindamycin and dexamethasone for zone 1 toxoplasmic retinochoroiditis at twenty-four months. In: Ophthalmology. 2010 ; Vol. 117, No. 9. pp. 1831-1838.
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AU - Arevalo, J Fernando

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