ABSTRACT
To compare the efficacy of intravitreal clindamycin and dexamethasone with classic treatment for ocular toxoplasmosis. In this prospective, randomized single-masked clinical trial a total of 68 patients with active ocular toxoplasmosis were assigned randomly to 2 treatment groups: 34 in the intravitreal clindamycin plus dexamethasone [IVCD] group and 34 in the classic treatment [CT] group. The IVCD group received 1 to 3 injection[s] of 1 mg intravitreal clindamycin and 400 microg dexamethasone, and the CT group received 6 weeks of treatment with pyrimethamine and sulfadiazine plus prednisolone. Antitoxoplasmosis antibodies [immunoglobulin [Ig] M and IgG] were measured using an enzyme-linked immunosorbent assay. The mean number of injections in the IVCD group was 1.6. Lesion size reduction was statistically significant after treatment in both IVCD and CT groups [P< 0.001 and P: 0.009, respectiveiy]. The difference in mean percentage of reduction at 6 weeks was not significant: 57 +/- 27.6% in the IVCD group versus 58.4 +/- 29.3% in the CT group. In comparison to baseline, VA increased by 0.44 +/- 0.24 and 0.29 +/- 0.19 logarithm of the minimum angle of resolution units in the IVCD and CT groups, respectively [P< 0.001]; however, the difference in VA improvement between the groups was not significant. The interaction effect of IgM and treatment group on lesion size reduction was significant [P= 0.002]; this indicated that IgM-positive cases responded better to CT and IgM-negative cases responded better to IVCD treatment. Vitreous inflammation reduction was comparable between the groups. Within 2 years, 4 eyes [2 in each group] had 1 episode of recurrence. Adverse drug reactions occurred in 2 patients in the CT group. No major injection-related complication was encountered in the IVCD group. Intravitreal injection of clindamycin and dexamethasone may be an acceptable alternative to classic treatment in ocular toxoplasmosis. It may offer more convenience, a safer systemic profile, greater availability, and fewer follow-up visits and hematologic evaluations
ABSTRACT
We assessed the validity of computed tomography [CT] in the diagnosis of complicated chronic otitis media [COM]. The findings obtained from a pre-operative high resolution CT of temporal bone including coronal and axial views of 20 patients with complicated COM were compared to their intraoperative findings. In our study, CT was helpful in determining the anatomy of the mastoid and could accurately predict the mastoid air cell aeration, size and status of ossicles, presence of lateral semicircular canal [SCC] fistula and post-auricular fistula [All sensitivities equal to 100%]. But it overdiagnosed the erosion of tegmen [positive predictive value of 50%]. CT was unable to distinguish between cholesteatoma and fluid [abscess or effusion] and granulation tissue or polyps and was also unable to correctly reveal the facial nerve dehiscence and had a low sensitivity for showing erosion of facial canal [50%] and sigmoid sinus [60%] Because most complications resulting from cholesteatoma are caused by bony erosions, CT is helpful in determining the complications of COM. CT can accurately predict the extent of disease and is helpful in detection of some complications such as fistula of Lateral Semicircular Canal [LSC], erosions of dural plate and ossicular erosions. However, it is unable to distinguish between cholesteatoma, mucosal disease and fluid, and little it did contribute to detecting the facial nerve course and dehiscence. It cannot also be used for the diagnosis of the sigmoid sinus problems which could be related to no contrast administration in our study