Toxoplasmosis congénita con enfermedad neurológica severa en un hospital de referencia del Perú / Congenital toxoplasmosis with severe neurological disease in a referral hospital in Peru

RESUMEN El propósito del presente estudio fue describir las características epidemiológicas, clínicas, y terapéuticas de pacientes con diagnóstico de toxoplasmosis congénita (TC) con enfermedad neurológica severa. Se revisaron las historias clínicas de los pacientes menores de 1 año con serología IgM positiva para Toxoplasma gondii y compromiso encefálico, ocular y/o auditivo. El estudio se realizó en el Instituto Nacional de Salud del Niño San Borja (INSN-SB) en Lima, Perú. Se evaluaron a 21 pacientes con diagnóstico de TC, el 57,1% fueron del sexo femenino y la mediana de edad al momento del diagnóstico fue 3,1 meses (RIC: 1,7-7,3). Las principales manifestaciones del sistema nervioso central fueron hidrocefalia (76,2%), calcificaciones intracraneales (52,4%), microcefalia (42,9%), y convulsiones (25,6%); la manifestación ocular más frecuente fue la coriorretinitis (38,1%). En conclusión, 64% de los casos de TC tuvieron una o más manifestaciones de enfermedad neurológica severa.

ABSTRACT The aim of this study was to describe the epidemiological, clinical, and therapeutic characteristics of patients diagnosed with congenital toxoplasmosis (CT) with severe neurological disease. We reviewed the medical records of patients under 1 year of age with positive IgM test for Toxoplasma gondii and brain, eye, and/or hearing involvement. This study was carried out at the Instituto Nacional de Salud del Niño San Borja (INSNSB), Lima, Peru. Twenty-one patients diagnosed with CT were evaluated; 57.1% were female, and the median age at diagnosis was 3.1 months (IQR: 1.7-7.3). The main central nervous system manifestations were hydrocephalus (76.2%), intracranial calcifications (52.4%), microcephaly (42.9%), and convulsions (25.6%); the most frequent ocular manifestation was chorioretinitis (38.1%). In conclusion, 64% of CT cases had one or more manifestations of severe neurological disease.

Pars plana vitrectomy and visual stimulation for treatment of vitreomacular traction secondary to toxoplasmosis retinochoroiditis in a 5-year-old child / Vitrectomia via pars plana e estimulação visual para tratamento da tração vitreomacular secundária à retinocoroidite por toxoplasmose em criança de 5 anos

ABSTRACT Objective: A unusual case of ocular toxoplasmosis with significant vitreomacular traction is reported. The patient improved significantly following pars plana vitrectomy combined with visual stimulation and occlusion therapy. Methods: The case of a 5-year-old girl with significant unilateral vision loss associated with vitreous condensation and macular traction is described. Results: Pars plana vitrectomy was carried out for vitreomacular traction release. This was followed by visual stimulation and occlusion therapy. Significant improvement was observed. Conclusion: Despite structural damage, the combination of properly indicated surgery and amblyopia management strategies allowed the achievement of maximum vision goals in this case, suggesting structural damage may be associated with functional amblyopia.

RESUMO Objetivo: Relata-se um caso de apresentação atípica de toxoplasmose ocular, com importante tração vitreomacular. A paciente apresentou melhora significativa após vitrectomia via pars plana, com estimulação visual e oclusão. Métodos: Descreve-se o caso de uma menina de 5 anos, com importante perda de visão unilateral associada à condensação vítrea e à tração macular. Resultados: Foi realizada vitrectomia via pars plana para alívio da tração vitreomacular, seguida de estimulação visual e oclusão. Foi observada melhora significativa. Conclusão: Apesar dos danos estruturais, a combinação de cirurgia bem indicada com estratégias de tratamento da ambliopia permitiu alcançar o máximo do potencial visual nesta paciente, sugerindo que os danos estruturais podem estar associados à ambliopia funcional.

Uncommon progression of toxoplasmic papillitis: patient perception and case report / Papilite por toxoplasmose ocular com evolução incomum: percepção do paciente e relato de caso

ABSTRACT Ocular toxoplasmosis frequently presents as necrotizing retinochoroiditis and, less often, as peripapillary chorioretinitis and/or papillitis. The progression from papillitis to peripapillary retinochoroiditis has been rarely described. We report the case of a 52-year-old patient living in southern Brazil, who developed papillitis in the right eye and was treated with systemic corticosteroids (prednisone 0.6 mg/kg/day and pulse therapy with methylprednisolone 15 mg/kg/day, for 3 days). After 14 days, the patient developed peripapillary retinochoroiditis with vitritis and decreased visual acuity (20/60), and was immediately initiated on the classic oral treatment for toxoplasmosis, consisting of pyrimethamine (50 mg/day), sulfadiazine (4 g/day), folinic acid (15 mg every 3 days) and prednisone (0.6 mg/kg/day). The visual acuity of the right eye normalized after treatment (20/20), which lasted approximately 70 days, but scotomas were detected on visual field examination, especially in the lower nasal quadrant. Although two studies mentioned this presentation, our report emphasizes the possible manifestation of ocular toxoplasmosis as papillitis in the initial phase, with progression to peripapillary retinochoroiditis and permanent visual field defects, which justifies early treatment for toxoplasmosis in suspected cases, especially in endemic regions.

RESUMO A toxoplasmose ocular manifesta-se com maior frequência por um quadro de retinocoroidite necrotizante e, com menor frequência, por coriorretinite justapapilar e/ou papilite. A evolução de papilite para retinocoroidite justapapilar raramente foi descrita. Apresenta-se o relato de caso de uma paciente de 52 anos, habitante da Região Sul do Brasil, que iniciou com quadro de papilite em olho direito, sendo tratada com corticoides sistêmicos (prednisona 0,6/mg/kg ao dia e pulsoterapia com metilprednisolona 15mg/kg ao dia, por 3 dias), mas, após 14 dias, evoluiu para retinocoroidite justapapilar, com vitreíte e diminuição de acuidade visual (20/60), sendo imediatamente instituído o tratamento via oral clássico para toxoplasmose, com pirimetamina (50 mg ao dia), sulfadiazina (4 g ao dia) e ácido folínico (15 mg a cada 3 dias), e mantida a prednisona (0.6 mg/kg/dia). A acuidade visual do olho direito normalizou após o tratamento (20/20), que durou em torno de 70 dias, porém desenvolveu escotomas ao exame de campo visual, sobretudo de quadrante nasal inferior. Embora tenham sido encontrados dois trabalhos que mencionam essa forma de apresentação, o presente relato destaca-se por enfatizar a possibilidade de manifestação da toxoplasmose ocular por meio de papilite na fase inicial, que evolui com retinocoroidite justapapilar, causando defeito permanente de campo visual, justificando que se avalie a instituição de tratamento precoce para toxoplasmose dos casos suspeitos, sobretudo em região endêmica.

Ultrasonographic characteristics of active ocular toxoplasmosis / Achados ultrassonográficos em toxoplasmose ocular ativa

ABSTRACT Purpose: To evaluate ophthalmic ultrasonographic findings associated with active ocular toxoplasmosis. Methods: Forty-seven eyes with active ocular toxoplasmosis in 47 patients were subjected to ocular ultrasonography using the transpalpebral technique (10-MHz transducer) and fundus photography. Patient medical records were retrospectively reviewed. Results: Ocular ultrasonography revealed vitritis, posterior vitreous detachment, retinal wall thickening, and non-rhegmatogenous retinal detachment in 47 (100%), 36 [76.6%; partial in 12 (25.5%) and total in 23 (48.9%)], 12 (25.5%), and 5 eyes (10.6%). Thirty-five of the 36 eyes with posterior vitreous detachment (97.2%) exhibited posterior hyaloid thickening; moreover, adhesion to the exudative lesion and vitreoschisis were observed in 4 (11.1%) and 12 eyes (25.5%), respectively. Ultrasonography detected the location of the exudative focus in 12 eyes (25.5%). Conclusion: Ultrasonography is helpful for detecting important intraocular findings of acute ocular toxoplasmosis that can be hindered by medial opacity or posterior synechiae.

RESUMO Objetivo: Avaliar os achados da ultrassonografia na toxoplasmose ocular ativa. Métodos: Quarenta e sete olhos com toxoplasmose ocular ativa em 47 pacientes foram submetidos à ultrassonografia ocular pela técnica transpalpebral (transdutor de 10 MHz) e fundo de olho. Os prontuários médicos foram revistos retrospectivamente. Resultados: A ultrassonografia ocular revelou vitreíte, descolamento vítreo posterior, espessamento da parede da retina e descolamento de retina não regmatogênico em 47 (100%), 36 [76,6%; parcial em 12 (25,5%) e total em 23 (48,9%)], 12 (25,5%) e 5 olhos (10,6%). Trinta e cinco dos 36 olhos com descolamento vítreo posterior (97,2%) exibiram espessamento hialoide posterior; além disso, a adesão à lesão exsudativa e vitreosquise foi observada em 4 (11,1%) e 12 (25,5%), respectivamente. A ultrassonografia detectou a localização do foco exsudativo em 12 olhos (25,5%). Conclusão: A ultrassonografia é útil na detecção de importantes achados intra-oculares de toxoplasmose ocular aguda que podem ser prejudicados pela opacidade medial ou sinéquia posterior.

Fulminant Toxoplasmic Chorioretinitis Following Intravitreal Dexamethasone Implantation

PURPOSE: To report a case of fulminant toxoplasmic chorioretinitis following intravitreal dexamethasone implantation monotherapy in a stabilized toxoplasmic chorioretinitis patient with initial treatment. CASE SUMMARY: A 60-year-old healthy female presented with decreased visual acuity in the left eye. On fundus examination, focal chorioretinitis and yellow-white infiltration were observed. Laboratory work-up, including blood chemistry, complete blood count, and serum serology, was negative; however, toxoplasmic chorioretinitis could not be ruled out. The primary lesion improved with antibiotics and prednisolone treatment. However, the patient did not come in for her follow-up visit, as she had already received an intravitreal dexamethasone implant for recurrent vitreous inflammation elsewhere. On her return, she presented with necrotic retinitis with extensive infiltration. She underwent diagnostic vitrectomy and implant removal. A diagnosis of toxoplasma antigen was confirmed by polymerase chain reaction analysis; the lesions stabilized after anti-toxoplasmic therapy. CONCLUSIONS: Intravitreal dexamethasone implant monotherapy with stabilized toxoplasmic chorioretinitis without systemic antibiotics can lead to fulminant toxoplasmic chorioretinitis and should be used with caution.

Aicardi syndrome: a case report / Síndrome de Aicardi: relato de caso

Abstract Introduction: the Aicardi syndrome (SA) is characterized as a rare syndrome identified in the presence of three classic characteristics: corpus callosum agenesis, chorioretinal lacunaeand infantile spasms. Description: data collection involved information reported by the mother and the accompanying physiotherapist describing the patient's clinical history andmajor complications according to clinical evolution, treatment, and therapeutic response. At two months of age, the child presented a delayed neuropsychomotor development and infantile spasms.However,the diagnosis of the syndrome was only performed at six months of life, involving brain magnetic resonance imaging where corneal body agenesis was observed. A multidisciplinary treatment was assembledwith a neuropediatrician, a physiotherapist, a psychologist, a nutritionistand a speech therapist, besides drug treatment with baclofen and phenobarbital. Discussion: through the established treatment, the child displayedmotor gain, cervical control, improvement of the respiratory condition, and no need forhospital admissions;these outcomescharacterizea good clinical evolution associated with the physiotherapeutic intervention focused on prevention and minimization of respiratory alterationsthatare frequently associated with morbidity and mortality in these cases. The results obtained point out the fundamental role of multidisciplinary intervention in coping with this condition.

Resumo Introdução: a Síndrome de Aicardi (SA), caracteriza-se como uma síndrome rara identificada na presença das três características clássicas: agenesia de corpo caloso, lacunas coriorretinianas e espamos infantis. Descrição: a coleta de dados envolveu informações relatadas pela genitora e pelo fisioterapeuta acompanhante da paciente, descrevendo assim a história clínica da paciente, as principais complicações de acordo com a evolução clínica, o tratamento e resposta terapêutica. Aos dois meses de idade a criança apresentou atraso no desenvolvimento neuropsicomotor e espasmos infantis, porém o diagnóstico da síndrome foi realizado somente aos seis meses de vida envolvendo um exame de ressonância magnética de encéfalo onde foi observada agenesia de corpo caloso, iniciando-se tratamento multidisciplinar com neuropediatra, fisioterapeuta, psicólogo, nutricionista e fonoaudiólogo, além do tratamento medicamentoso com baclofeno e fenobarbital. Discussão: através do tratamento estabelecido, a criança obteve ganho motor, controle cervical, melhora da condição respiratória e sem internações hospitalares, caracterizando uma boa evolução associada particularmente à intervenção fisioterapêutica que teve enfoque na prevenção e minimização de alterações respiratórias frequentemente associadas à morbidades e mortalidade nestes casos. Os resultados obtidos apontam o papel fundamental da intervenção multidisciplinar para o enfrentamento desta condição.

Eccentric fixation patterns, clinical findings, and reading speed in patients with bilateral toxoplasmic macular retinochoroiditis / Padrões de fixação excêntrica, achados clínicos e velocidade de leitura em pacientes com retinocoroidite macular bilateral por toxoplasmose

ABSTRACT Purpose: To study visual acuity, refractive errors, eccentric fixation, and reading performance in patients with toxoplasmic macular retinochoroiditis. Methods: Twenty-three participants with bilateral toxoplasmic macular retinochoroiditis and 4 with toxoplasmic macular retinocho­roiditis in their unique eye were evaluated. Participants reported their eye dominance, confirmed by the Portus and Miles test. Best corrected visual acuity, spherical equivalent refraction, magnification need, and reading speed were measured. Microperimetry (MAIA, Centervue - Padova, Italy) recorded the preferred retinal locus and fixation stability by means of the bivariate contour ellipse area. Fourteen eyes from 14 normally sighted subjects served as controls. Results: Mean ± SD best corrected visual acuity was better in the dominant eye than in the nondominant eye: 0.9 ± 0.2 (logMAR 0.5 to 1.4) vs. 1.2 ± 0.3 (logMAR 0.6 to 1.7) (p<0.0001, paired t-test). Spherical equivalent myopia of -4.00 or higher was present in 42% of the eyes. Microperimetry was performed in 42 eyes. Eccentric fixation was observed in all examined eyes. In 14 eyes (33%), the preferred retinal locus was placed (in the retina) superior temporal to the macular lesion, in 10 (24%) superior nasal, in 6 (14%) inferior temporal, and in 12 (28%) inferior nasal. There was no significant difference in the distribution of the preferred retinal locus position between dominant and nondominant eyes (p=0.85, Pearson test). There was no correlation between reading speed and the distance between the preferred retinal locus and the estimated original foveal position (r=-0.09; p=0.73), the bivariate contour ellipse area (r=-0.19; p=0.44), or best corrected visual acuity (r=0.024; p=0.92). Conclusions: Myopia is more prevalent in patients with toxoplasmic macular retinochoroiditis. Reading speed is not dependent on preferred retinal locus position, stability, or visual acuity. Nevertheless, documentation of fixation provides new data on the impact of visual impairment in these patients and may be useful for rehabilitation efforts.

RESUMO Objetivo: Estudar a acuidade visual, erros de refração, fixação excêntrica e desempenho de leitura em pacientes com retinocoroidite macular por Toxoplasmose. Métodos: Vinte e três pacientes com retinocoroidite macular por Toxoplasmose bilateral e quatro com retinocoroidite macular por Toxoplasmose no seu único olho foram avaliados. Os participantes relataram sua dominância ocular, confirmada pelo teste de Portus e Miles. A acuidade visual melhor corrigida, refração em equivalente esférico, magnificação necessária e velocidade de leitura foram medidas. A microperimetria (MAIA, Centervue - Padova, Italy) registrou a estabilidade preferida do locus e da fixação da retina por meio da área da elipse de con­torno bivariada. Quatorze olhos de 14 pacientes com boa visão serviram como controles. Resultados: A média ± DP da acuidade visual melhor corrigida foi melhor no olho do­minante do que no não dominante: 0,9 ± 0,2 (logMAR 0,5 a 1,4) vs. 1,2 ± 0,3 (logMAR 0,6 a 1,7) (p<0,0001, teste t pareado). Miopia em equivalente esférico de -4,00 ou maior estava presente em 42% dos olhos. Microperimetria foi realizada em 42 olhos. Fixação excêntrica foi observada em todos os olhos examinados. Em 14 olhos (33%), o locus retiniano preferencial estava localizado, na retina, na região súpero-temporal à lesão macular, em 10 (24%) súpero-nasal, em 6 (14%) ínfero-temporal, e em 12 olhos (29%) ínfero-nasal. Não houve diferença significativa na distribuição da posição do locus retiniano preferencial entre olhos dominantes e não dominantes (p=0,85, teste de Pearson). Não houve correlação entre velocidade de leitura e distância entre o locus retiniano preferencial e a posição foveal original estimada (r=-0,09; p=0,73), a área bivariada de contorno elipsóide (r=-0,19; p=0,44) ou acuidade visual melhor corrigida (r=0,024; p=0,92). Conclusões: A miopia é mais prevalente em pacientes com retinocoroidite macular por Toxoplasmose. A velocidade de leitura não é dependente da posição do locus retiniano preferencial, da estabilidade ou da acuidade visual. A documentação do padrão de fixação excêntrica, entretanto, oferece novos dados no impacto da deficiência visual nesses pacientes e pode ser útil em estratégias de reabilitação.

La endoftalmitis endógena por Candida, un marcador pronóstico / Endogenous Candida endophthalmitis, a prognostic marker

La candidiasis es la causa más común de endoftalmitis endógena. La afectación ocular se produce entre los 3 y los 15 días siguientes a la fungemia. Las dos formas características de presentación son la coriorretinitis candidiásica, que afecta a la coroides y a la retina sin afectar claramente al vítreo, y la endoftalmitis candidiásica, con presencia de lesiones vítreas redondeadas, de aspecto algodonoso (perlas vítreas), características de esta infección. Los síntomas visuales precoces más habituales son la visión borrosa y los flotadores. Se recomienda entonces realizar fondo de ojo en las 2 primeras semanas del diagnóstico de candidemia para prevenir complicaciones oculares y usar la afectación ocular como indicador de probable infección fúngica invasiva. La anfotericina B, el fluconazol, el voriconazol, el posaconazol y el ravuconazol, así como las equinocandinas entre las que se encuentran la caspofungina han demostrado su utilidad en el tratamiento de la coriorretinitis, pero la efectividad disminuye en los casos de afectación vítrea si no se asocian a vitrectomía(AU)

Candidiasis is the most common cause of endogenous endophthalmitis. Ocular damage occurs within 3 and 15 days after fungemia. The two characteristic forms of presentation are Candida chorioretinitis, affecting the choroid and the retina with no clear impact on the vitreous, and Candida endophthalmitis, with the presence of rounded cottony vitreous lesions (vitreous pearls), characteristic of this infection. The most common early visual symptoms are blurred vision and floaters. It is thus recommended to perform funduscopy within the first two weeks after the candidemia diagnosis to prevent ocular complications and use the ocular damage as an indicator of probable invasive fungal infection. Amphotericin B, fluconazole, voriconazole, posaconazole and ravuconazole, as well as echinocandins, among them caspofungin, have proven useful in the treatment of chorioretinitis, but effectiveness is lower in vitreous damage cases when they are not associated to vitrectomy(AU)

Chorioretinitis sclopetaria caused by an intraorbital metallic foreign body / Coriorretinite esclopetária causada por um corpo estranho metálico intraorbitário

ABSTRACT A 44-year-old man was referred for evaluation of pain and temporal floaters after receiving a rebounded bullet impact to his right eye. Typical funduscopic findings, together with the confirmed presence of an intraorbital metallic foreign body, led to the diagnosis of chorioretinitis sclopetaria. Conservative management was performed as no severe symptoms were observed. The favorable clinical outcome was confirmed in subsequent reviews. Chorioretinitis sclopetaria is characterized by a proliferative chorioretinal inflammation as a consequence of the expansive wave caused by the entrance of a bullet between the eyeball and the orbit.

RESUMO Um homem de 44 anos foi encaminhado para avaliação de dor e flutuadores temporais após receber um impacto de bala ressaltado em seu olho direito. Achados fundoscópicos típicos, juntamente com a presença confirmada de um corpo estranho metálico intraorbitário, levaram ao diagnóstico de coriorretinite esclopetária. O manejo conservador foi realizado, pois não foram observados sintomas graves. O desfecho clínico favorável foi confirmado em revisões subsequentes. A coriorretinite esclopetária é caracterizada por uma inflamação coriorretiniana proliferativa como consequência da onda expansiva causada pela entrada de uma bala entre o globo ocular e a órbita.

The First Report on Clinical Manifestation of Cryopyrin-Associated Periodic Syndrome in Korean Children

PURPOSE: The aim of this study was to evaluate the clinical characteristics of children diagnosed as cryopyrin-associated periodic syndrome (CAPS) in Korea. METHODS: Diagnosis was made based on clinical features and confirmed by a mutation in the cold-induced autoinflammatory syndrome 1 (CIAS1) gene. Especially, osteocartilaginous overgrowth in the patella or distal femur was so characteristic that its presence warranted a diagnosis of chronic infantile neurologic cutaneous and articular/NOMID. RESULTS: We observed the clinical features of 9 Korean CAPS patients. All the patients suffered from an urticarial rash with recurrent fever. Among the 9 patients, 6 presented with rash and 4 with fever on the 1st or 2nd days of birth. Eight patients showed myalgia, and 7 patients showed arthralgia in the joints, and 6 patients showed radiologic findings of arthropathy including cupping of the metaphysis, excessive growth of the epiphysis, osteopenia or overgrowth of the cartilage. Four patients showed brain atrophy, enlarged ventricles or leptomeningeal enhancement on magnetic resonance imaging. Intellectual disability was observed in 1 patient. Five patients had eye involvement as conjunctivitis, uveitis, chorioretinitis, avascular area or papillary edema, and 3 patients showed progressive hearing loss. All 9 patients showed increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). CONCLUSIONS: All the patients carried a mutation on exon 3 of the CIAS1 gene. After the anakinra (interleukin-1 receptor antagonist) therapy, the fever and rash immediately disappeared, and CRP and ESR were improved.

Optic neuritis and chorioretinitis as ocular manifestations of borreliosis in Brazil: three cases reported / Neurite óptica e coriorretinite como manifestações oculares da borreliose no Brasil: três casos relatados

Abstract Lyme disease is a systemic infection caused by a tick bite and transmission of the Borrelia burgdorferi spirochete. Species of tick vectors of the disease infest mainly wild or rural animals and rodents that may be asymptomatic reservoirs of the bacteria. Characteristic of the northern hemisphere, Lyme disease in Brazil takes on different characteristics, complicating diagnosis. This paper aims to describe three cases of Lyme-like disease in a city in the state of Bahia, Brazil, with ophthalmologic findings.

Resumo A doença de Lyme é uma infecção sistêmica causada pela picada do carrapato e transmissão da espiroqueta Borrelia burgdorferi. As espécies de carrapatos vetores da doença infestam, principalmente, animais silvestres, rurais e roedores que podem ser reservatórios assintomáticos da bactéria. Característica do hemisfério norte, a doença de Lyme no Brasil assume características distintas, dificultando seu diagnóstico. Esse trabalho tem por objetivo, descrever três casos da doença Lyme símile do Brasil, com achados oftalmológicos, em município do Estado da Bahia.

Toxoplasmosis ocular recurrente. Presentación de 3 casos y revisión de la literatura / RECURRENT OCULAR TOXOPLASMOSIS: REPORT OF 3 PATIENTS AND REVISION OF THE LITERATURE

La toxoplasmosis ocular recurrente es la forma más común de toxoplasmosis ocular. Las lesiones se localizan adyacentes a una cicatriz coriorretinal resultado de una infección previamente adquirida. La retinitis por toxoplasma provoca una respuesta inflamatoria variable, ocasionando vasculitis, vitreítis, coroiditis y uveítis anterior. El diagnóstico se realiza examinando el fondo de ojo, y su etiología debe considerarse cuando en un adulto joven inmunocompetente, se observa en la fundoscopía la presencia de una lesión retinal focal, asociada a una cicatriz coriorretinal. La retinografía permite documentar los hallazgos observados en el fondo de ojo. El examen serológico para identificar anticuerpos anti toxoplasma de clase IgM e IgG solo confirma la exposición al parásito pero no constituyen pruebas diagnósticas confirmatorias. Se presentan 3 casos de toxoplasmosis ocular recurrente en pacientes adultos cuyos diagnósticos se realizaron mediante el examen fundoscópico y la retinografía.

Recurrent ocular toxoplasmosis is the most common form of ocular toxoplasmosis. Lesions are located adjacent to a chorioretinal scar as a result of a previously acquired infection. Toxoplasma retinitis produces a variables inflammatory response, leading to vasculitis, vitreitis, choroiditis and anterior uveities. Diagnosis is performed by fundoscopy and its ethiology must be considered when fundoscopy shows the presence of a focal retinal lesion associated to a chorioretinal scar in a young immunocompetent adult. Retinography allows documenting findings from the fundoscopy. Serological examination to identify anti toxoplasma antibodies classes IgM and IgG only confirms exposure to the parasite but do not constitute confirmatory diagnostic evidence. We present 3 cases of recurrent ocular toxoplasmosis in adult patients that were diagnosis by fundoscopic examination and retinography

Serum levels of neurotrophic factors in active toxoplasmic retinochoroiditis

Abstract Toxoplasmic retinochoroiditis (TR) is the most common identifiable cause of posterior uveitis in Brazil. Response to treatment and clinical presentation may vary significantly. We assessed serum levels of brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), nerve growth factor (NGF), neurotrophin (NT)-3, and NT-4/5 in patients with active TR, before and after TR treatment. Methods: Twenty patients with active lesion and 15 healthy controls were enrolled in the study. Serum concentration of neurotrophic factors was determined by enzyme-linked immunosorbent assay. Results: BDNF levels were significantly higher in patients before treatment when compared with controls (p = 0.0015). There was no significant difference in pro-BDNF, NGF, GDNF, NT-3, and NT-4/5 levels between TR patients and controls. Treatment did not affect the levels of these factors. Conclusion: BDNF may be released in the context of the active TR inflammatory response.

Soroepidemiologia da toxoplasmose em gestantes do município de medianeira, Paraná, Brasil / Toxoplasmosis seroepidemiology in pregnant women in the municipality of medianeira, Paraná

A zoonose causada pelo Toxoplasma gondii é conhecida como toxoplasmose. Possui distribuição geográfica mundial, com alta prevalência sorológica, podendo atingir mais de 60% da população. Os casos de doença clínica não são muito frequentes, porém ainda assim, é uma infecção muito temida durante a gravidez, devido ao risco de acometimento do feto. Ao nascimento, crianças infectadas podem apresentar sintomas como hidrocefalia, coriorretinite, calcificação cerebral e retardo mental. O objetivo deste trabalho foi determinar a prevalência de anticorpos anti-Toxoplasma gondii em gestantes atendidas nas Unidades Básicas de Saúde do município de Medianeira (PR) e verificar possíveis associações da positividade para a toxoplasmose com variáveis sócio-econômicas, comportamentais e ambientais. Foi realizada a pesquisa de anticorpos anti-Toxoplasma gondii pelo método de Imunoensaio Enzimático de Micropartículas (MEIA) em amostras de soro de 215 gestantes, no período de janeiro a novembro de 2013. Para cada gestante foi preenchido um questionário epidemiológico que incluía variáveis socioeconômicas, comportamentais e ambientais. A prevalência de toxoplasmose foi de 77,67% (IgG), a prevalência de IgM positivo foi de 1,40% e o índice de suscetibilidade a toxoplasmose foi de 22,32%, tendo como variáveis associadas à infecção a transfusão de sangue (p=0,023), faixa etária (p=0,033) e grau de instrução de ensino médio (p=0,055). Os resultados sorológicos (IgG e IgM) e as variáveis associadas à infecção toxoplásmica nas gestantes do município de Medianeira (PR), refletem a importância de se analisar e conhecer a epidemiologia local a fim de se propor programas educativos com medidas de prevenção primária contra a infecção por este parasito de importância em saúde pública, já que 22,32% dos resultados das gestantes analisadas se mostraram negativos à infecção pelo T. gondii.

The zoonosis caused by Toxoplasma gondii is known as toxoplasmosis. It has a worldwide geographic distribution, with high serological prevalence, reaching over 60% of the population. The clinical disease cases are less frequent, however, it is a very dreaded infection during pregnancy due to the risk of impairment of the fetus. At birth, infected children can present symptoms like hydrocephalus, chorioretinitis, cerebral calcification and mental retardation. The aim of this study was to determine the prevalence of anti-Toxoplasma gondii antibodies in pregnant women attended at Basic Health Units in the municipality of Medianeira (PR) and to assess possible associations of positivity for toxoplasmosis with socio-economic, behavioral and environmental variables. The presence of anti-Toxoplasma gondii antibodies was detected by the Microparticle Enzyme Immunoassay (MEIA) method in serum samples from 215 pregnant women, in the period from January to November 2013. Each patient completed an epidemiological questionnaire including socio-economic, behavioral and environmental variables. The prevalence of toxoplasmosis was 77.67 % (IgG), the prevalence of positive IgM was 1.40% and the index of susceptibility to toxoplasmosis was 22,32%, with the variables associated with infection by blood transfusion (p = 0.023), age (p = 0.033) and high school education level (p = 0.055). Serological results (IgG and IgM) and the variables associated with T. gondii infection in pregnant women in the municipality of Medianeira (PR) reflect the importance to analyze and understand the local epidemiology in order to offer educational programs for primary prevention measures against infection by this highly significant parasite for public health, since 22,32% of the analyzed outcomes in pregnant women proved to be negative for T. gondii infection.

Propriedades psicométricas do Children's Visual Function Questionnaire adaptado para avaliação de qualidade de vida relacionada à visão de crianças com toxoplasmose congênita / Psychometric properties of the Children's Visual Function Questionnaire adapted to assess vision-related quality of life in children with congenital toxoplasmosis

Introdução: A elevada prevalência da toxoplasmose congênita (TC) no Brasil, verificada também no estado de Minas Gerais, associada ao maior comprometimento ocular observado nas crianças brasileiras comparadas às europeias; e a evolução de muitos desses indivíduos para a baixa visão (BV), nos remetem à necessidade de compreender o impacto da perda visual na qualidade de vida em uma coorte de crianças infectadas identificadas no período neonatal e tratadas com antiparasitários durante o primeiro ano de vida. Objetivo: Adaptar o questionário Children's Visual Function Questionnaire (CVFQ) à realidade sociocultural de crianças brasileiras com toxoplasmose congênita e investigar as propriedades psicométricas para mensuração da qualidade de vida (QV) relacionada à visão nesses pacientes; descrever as lesões retinocoroideanas observadas em uma coorte de crianças pré-escolares com TC em Minas Gerais; avaliar quantitativamente o déficit visual e investigar sua correlação com a pontuação na percepção da QV relacionada à perda visual (CVFQ7-BR-toxo). Método: Estudo epidemiológico transversal aninhado, em uma coorte de 142 crianças acompanhadas prospectivamente nos Serviços de Infectologia Pediátrica e Oftalmologia do Hospital das Clínicas da UFMG. Questionários foram aplicados aos pais e cuidadores para avaliar a percepção sobre a QV de suas crianças com TC e para verificar a situação socioeconômica das famílias. Oftalmologistas do setor de uveite avaliaram a retina das crianças e descreveram as lesões de retinocoroidite quanto à localização, número de lesões, tamanho e lateralidade. No setor de baixa visão, oftalmologistas avaliaram a acuidade visual. Foram usadas técnicas de estatística multivariada para avaliar as propriedades psicométricas da escala de QV e testes de Kruskal Wallis e Mann Whitney para a comparação dos escores medianos da escala de QV em crianças com visão normal, perda visual leve e baixa visão. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da UFMG. Resultado: Adaptações no CVFQ versão brasileira deram origem ao CVFQ7-BR-toxo, questionário para avaliar a percepção de pais/cuidadores sobre qualidade de vida relacionada a baixa visão de crianças com toxoplasmose congênita pré-escolares. Na análise fatorial exploratória o resultado do teste Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) foi de 0,74, indicando boa adequabilidade do modelo fatorial. Seis componentes (fatores) extraídos correspondem a 46,3% da variância total explicada, e são compostos por itens com coeficiente de saturação (carga fatorial) maior ou igual a 0,45. Pela descrição, estrutura de variabilidade, e interpretação do agrupamento dos itens do questionário CVFQ adaptado (CVFQ7-BR-toxo) identificaram-se seis subescalas: saúde geral; capacidade visual; desempenho visual/visão funcional; comportamento social e pessoal, impacto na família e tratamento. A homogeneidade das medidas para o construto QV no CVFQ adaptado foi avaliada pela consistência interna das subescalas. As subescalas Desempenho visual - visão funcional e o Impacto na família se mostraram adequadas, com coeficiente alfa de Cronbach de 0,75 e 0,77 respectivamente. As subescalas comportamento pessoal e social e, tratamento apresentaram valores de alfa de Cronbach menores que 0,7 (0,68 e 0,61 respectivamente). A correlação entre as subescalas e a escala global foram todas significativas (p-valor <0,001) variando de 0,42 a 0,75. As correlações item-escala globais foram significativas (p-valor <0,01) e maiores do que 0,20, sendo estes valores considerados aceitáveis. Verificou-se a validade discriminante do instrumento pelas diferenças significativas (p<0,005) na comparação das escalas do CVFQ7-BR-toxo para escores relatados pelo pai/cuidador de crianças com e sem baixa visão. A validação convergente foi verificada pela correlação (r=0,58; p<0,001) entre o escores globais do CVFQ7-BR-toxo e do PedsQL, com resultado moderado. Para análise dos exames clínicos oftalmológicos, das 142 crianças, duas foram excluídas por não terem realizado todos os exames. Das 140 crianças, 87,1% (121/139) apresentaram pelo menos uma lesão de retinocoroidite e, dentre elas, 20,7% (25/121) foram diagnosticadas com baixa visão (BV). A retinocoroidite esteve presente em ambos os olhos de 81,0% (98/121) das crianças com lesões, sendo que 25,5% (25/98) destas tinham BV. Lesão macular (foveal e/ou extrafoveal) em ambos os olhos ocorreu em 43,9% (43/98) das crianças e 51,2% (22/43) destas apresentaram BV. Pelo menos 50% das crianças com BV apresentaram lesões com tamanho médio superior a 3,0 diâmetros de disco óptico (DD). Ausência de lesão ocorreu em apenas 12,9% (18/140) das crianças. Na percepção dos pais cuidadores (CVFQ7-BR-toxo) das crianças diagnosticadas com BV, os escores medianos foram menores nas dimensões capacidade visual (p=0,002), desempenho funcional/visão funcional (p=0,002), impacto na família (p=0,001) e na QV global (p=0,009) quando comparados às crianças com perda visual leve e com visão normal. Conclusão: As propriedades psicométricas do CVFQ7-BR-toxo se mostraram adequadas quanto à validade do construto QV. O instrumento foi capaz de registrar o impacto no comprometimento da visão funcional e na família de crianças com toxoplasmose congênita. Na avaliação oftalmológica dessa população foram observadas lesões retinocoroideanas de maior gravidade, por serem em sua maioria maculares, múltiplas, bilaterais, resultando em comprometimento da função visual e menor acuidade visual. Na percepção dos pais e cuidadores sobre a QV relacionada a baixa visão, estas crianças apresentaram pior capacidade visual, pior desempenho funcional / visão funcional, com maior impacto nas suas famílias e piora da qualidade de vida global. Esses resultados podem subsidiar políticas para melhor controle e prevenção da toxoplasmose congênita.

Introduction: The high prevalence of congenital toxoplasmosis (CT) in Brazil, in addition to the high burden of ocular involvement in infected individuals, evolving to low vision (LV) in many of them, highlights the importance of assessing their quality of life (QOL). Objective:To adapt the Children's Visual Function Questionnaire (CVFQ) to the sociocultural reality of Brazilian children with CT, and to investigate the psychometric properties to measure vision-related quality of life (QOL) for these patients; to characterize retinochoroidal changes in a cohort of preschool children with CT in Minas Gerais; to quantitatively evaluate the visual deficit and to investigate its correlation with QOL perception scores (CVFQ7-BR-toxo instrument).Methods: Cross-sectional epidemiological study with nested cohort of 142 children prospectively followed at the Pediatric Infectious Disease and Ophthalmology Services of Hospital das Clínicas da Universidade Federal de Minas GeraisQuestionnaires were applied to parents and carers to evaluate QOL perception of their children with CT and to characterize the socioeconomic status of their families. Number, location, size and laterality of retinochoroidal lesions were recorded. Best-corrected visual acuity was also assessed. Multivariate statistical techniques were used to evaluate psychometric qualities of QOL scale. Kruskal Wallis and Mann Whitney test were employed for comparison of median scores of the QOL scale in children with normal visual, mild vision loss and low vision. Results: Adaptations in the CVFQ-Brazilian version originated the CVFQ7-BR-toxo, a questionnaire to evaluate perception of parents/carers about vision-related QOL of preschool children with CT. In the exploratory factor analysis, result of KaiserMeyer-Olkin Measure of Sampling Adequacy test (KMO) was 0.74, indicating good suitability of the factor model.Six extracted components (factors) explained 46.3% of total variance, consisting of items with saturation coefficient (factor load) ≥ 0.45. Six subscales were identified after description, variability structure and interpretation of grouping of items of CVFQ7-BR-toxo: Overall Health; Visual Acuity; Visual Performance/Functional Vision; Individual and Social Behavior, Impact on Family, and Treatment. Homogeneity of measures for the QOL construct in the adapted CVFQ was evaluated by internal consistency of the subscales: Subscales Visual Performance/Functional Vision and Impact on Family showed to be adequate, with Cronbach's alpha of 0.75 and 0.77 respectively.Subscales Individual and Social Behavior and Treatment showed Cronbach's alpha coefficient smaller than 0.7 (0.68 and 0.61 respectively). The correlations between subscales and the global scale were all statistically significant (p-value <0.001) ranging from 0.42 to 0.75. The global item-scale correlations were also significant (p-value <0.01) and greater than 0.20, with these values being considered acceptable. Discriminant validity of the instrument by significant differences (p <0.005) was verified in the comparison of CVFQ7-BR-toxo scales to the scores reported by the parent/carers of children with and without low vision.The convergent validity was verified by the moderate correlation (r = 0.58; p <0.001) between the overall scores CVFQ7- BR-toxo and PedsQL. For the analysis of the clinical examinations of the 142 children, two were excluded because they did not have all the exams. Of the 140 children, 87.1% (121/139) had at least one retinochoroidal lesion. Among them, 20.7% (25/121) were diagnosed with LV. Retinochoroiditis was found in both eyes in 81.0% (98/121), and 25.5% (25/98) of these had LV. Macular (foveal and/or extrafoveal) lesions in both eyes occurred in 43.9% (43/98); 51.2% (22/43) of these children had low LV. At least 50% of children with LV presented retinochoroidal lesions with an average size > 3 optic disc diameter. Absence of retinochoroidal lesions was recorded in only 12.9% (18/140) of children. In the perception of carers parents (CVFQ7-BR-toxo) of children diagnosed with LV, median scores were lower for visual ability dimensions (p = 0.002), functional performance- visual function (p = 0.002), impact on family (p = 0.001) and overall QOL (p = 0.009) when compared to those of children with mild visual loss and with normal vision. Conclusion: CVFQ7-BR-toxo psychometric properties were appropriate concerning the validity of the QOL construct. The questionnaire was able to register the impact of visual disability on families of children with CT. Retinochoroiditis, was more severe, with frequent multiple, bilateral and macular lesions, resulting in impaired visual function. According to QOL perception of parents and carers, children with LV presented worse scores for visual capacity, functional performance/functional vison, with greater impact on their families and decreased overall quality of life. These results can support policies for better control and prevention of CT.

Multilevel Precision-Based Rational Design of Chemical Inhibitors Targeting the Hydrophobic Cleft of Toxoplasma gondii Apical Membrane Antigen 1 (AMA1)

Toxoplasma gondii is an intracellular Apicomplexan parasite and a causative agent of toxoplasmosis in human. It causes encephalitis, uveitis, chorioretinitis, and congenital infection. T. gondii invades the host cell by forming a moving junction (MJ) complex. This complex formation is initiated by intermolecular interactions between the two secretory parasitic proteins—namely, apical membrane antigen 1 (AMA1) and rhoptry neck protein 2 (RON2) and is critically essential for the host invasion process. By this study, we propose two potential leads, NSC95522 and NSC179676 that can efficiently target the AMA1 hydrophobic cleft, which is a hotspot for targeting MJ complex formation. The proposed leads are the result of an exhaustive conformational search-based virtual screen with multilevel precision scoring of the docking affinities. These two compounds surpassed all the precision levels of docking and also the stringent post docking and cumulative molecular dynamics evaluations. Moreover, the backbone flexibility of hotspot residues in the hydrophobic cleft, which has been previously reported to be essential for accommodative binding of RON2 to AMA1, was also highly perturbed by these compounds. Furthermore, binding free energy calculations of these two compounds also revealed a significant affinity to AMA1. Machine learning approaches also predicted these two compounds to possess more relevant activities. Hence, these two leads, NSC95522 and NSC179676, may prove to be potential inhibitors targeting AMA1-RON2 complex formation towards combating toxoplasmosis.

Ocular Syphilis Presenting as both Optic Neuritis and Chorioretinitis in both Eyes

PURPOSE: To report a patient with ocular syphilis, who showed variable ocular manifestations, including optic neuritis and chorioretinitis in both eyes over a short time period. CASE SUMMARY: A 44-year-male visited our clinic for central scotoma in the left eye. The visual acuity was 20/25 in the right eye and 20/40 in the left eye. The fundus of the left eye showed a slightly hyperemic optic disc and multiple yellowish deposits. One week later, visual acuity and fundus lesion improved to 20/20 without a definitive treatment. However, 1 month later, he reported a new deterioration of vision in his right eye to 20/40. The right eye had a relative afferent pupillary defect and the fundus examination showed a blurred optic disc margin. Serological work-up was recommended but the patient refused. He returned 3 weeks later with an improvement in the right eye vision (20/25) and a worsening in the left eye (20/200). The examination revealed an improvement of the previously blurred disc margin in the right eye and newly developed chorioretinitis with vasculitis in the left eye. A serological test was performed. The venereal diseases research laboratory titer was 1:32. The fluorescent treponemal antigen absorbance test as positive for IgG and IgM. He was diagnosed with ocular syphilis and referred to the infectious disease department. He was treated with antibiotics. Six months later, the visual acuity was 20/20 in both eyes and the previous fundus lesions had disappeared. CONCLUSIONS: Ocular syphilis should be considered in patients with atypical and variable clinical course.

Granulomatous Lung Disease: A Novel Complication following Metallosis from Hip Arthroplasty / 대한고관절학회지

A case of a female patient with local and systemic complications of metallosis, following catastrophic wear of a revised hip arthroplasty, is presented. The patient had a history of a fractured ceramic-on-ceramic implant, exchanged with a metal-on-polyethylene prosthesis. Systemic complications included sarcoidosis-like reactions, presenting as granulomatous lung disease, along with chorioretinitis, erythema nodosum, and cardiomyopathy. High local and circulating cobalt and chromium levels established the diagnosis. The patient underwent extensive debridement and implant revision. One year postoperatively, she had no respiratory symptoms or functional impairment. Local and systemic complications of metallosis after hip arthroplasty should be promptly recognized and treated operatively.

Detection of Toxoplasma gondii DNA in peripheral blood and aqueous humor of patients with Toxoplasmic active focal necrotizing retinochoroiditis using real-time PCR / Detecção de DNA do Toxoplasma gondii no sangue periférico e humor aquoso por PCR em tempo real

ABSTRACT Purpose: To evaluate the ability of real-time quantitative PCR (qPCR) for detectingToxoplasma gondii DNA in the peripheral blood and aqueous humor of patients with toxoplasmic active focal necrotizing retinochoroiditis. Methods: Fifty-five patients with infectious uveitis seen from 2009 to 2013 at the Department of Ophthalmology and Visual Sciences of the Federal University of São Paulo were enrolled in this study. Forty-three patients had toxoplasmic active focal necrotizing retinochoroiditis, and the remaining 12 had non-toxoplasmic infectious uveitis and served as controls. qPCR analysis forT. gondii DNA was performed on the patients' peripheral blood and aqueous humor samples. Results: The qPCR was positive for T. gondii DNA in 37.21% (16/43) of the aqueous humor samples and 2.33% (1/43) of the peripheral blood samples; further, 16.27% (7/43) of the patients had positive results in both their blood and aqueous humor samples. Conclusion: qPCR was able to detect T. gondii DNA in patients with toxoplasmic active focal necrotizing retinochoroiditis in the blood as well as the aqueous humor and can help with the diagnosis of the disease.

RESUMO Objetivo: Analisar o uso do PCR em tempo real (qPCR) na detecção do DNA do T. gondii no sangue periférico e no humor aquoso de pacientes com lesões de retinocoroidite focal, ativa por toxoplasmose. Métodos: Cinquenta e cinco pacientes com uveite infecciosa foram incluídos neste estudo. Os pacientes foram atendidos entre 2009 a 2013, no Departamento de Oftalmologia e Ciências Visuais da Universidade Federal de São Paulo. Quarenta e três pacientes tiveram o diagnóstico de lesões de retinocoroidite focal, ativa por toxoplasmose e, os outros 12 tiveram o diagnóstico de uveíte infecciosa não toxoplásmica e, por isso foram usados como grupo controle. A técnica de qPCR foi utilizada na detecção de DNA do T. gondii em amostras de sangue periférico e humor aquoso. Resultados: O qPCR foi positivo para o DNA do T. gondii em 37,21% (16/43) das amostras de humor aquoso, 2,33% (1/43) nas amostras de sangue periférico e, 16,27% (7/43) em ambas amostras simultaneamente. Conclusão: O qPCR foi capaz de detectar o DNA do T. gondii em pacientes com lesões de retinocoroidite focal, ativa por Toxoplasmose, no sangue bem como, no humor aquoso, podendo ajudar no diagnostico.

Visual function and macular architecture in patients with inactive zone 2 and 3 toxoplasmic retinochoroiditis / Função visual e arquitetura macular em pacientes com retinocoroidite toxoplásmica inativa nas zonas 2 e 3

ABSTRACTPurpose:To evaluate the visual function and architecture of the central and peripapillary retina in patients with inactive toxoplasmic retinochoroiditis outside the macular and peripapillary regions (zones 2 and 3).Methods:Cross-sectional study of 20 eyes (18 patients) with zone 2 and 3 toxoplasmic scars and visual acuity ≥20/25. Patients underwent Humphrey 10-2 perimetry, contrast sensitivity (Mars test), and color vision testing (L'Anthony desaturated D-15). The retinal nerve fiber layer (RNFL) and macular thicknesses were determined by optical coherence tomography.Results:The patients' mean age was 27.4 ± 10.3 years, and the mean duration of remission was 6.15 ± 5.19 months. Abnormal contrast sensitivity and color vision were observed in three (15.0%) and four eyes (20.0%), respectively. Mean deviation (MD) and pattern standard deviation (PSD) fell outside the 95% normal confidence limits of the perimeter's database in 14 (70.0%) and seven eyes (35.0%), respectively. Foveal and mean RNFL thicknesses were within the normal limits in all eyes. Eyes with zone 2 retinochoroiditis had lower foveal sensitivity than eyes with zone 3 lesions (p=0.041). Eyes with a longer duration of remission had a higher MD (r=0.575; p=0.013) and a lower PSD (r=-0.593; p=0.010).Conclusions:Despite normal central and peripapillary retinal architecture, eyes with inactive zone 2 and 3 toxoplasmic retinochoroiditis can present with abnormal color, contrast, and macular perimetric sensitivity. Zone 2 retinochoroiditis was associated with lower foveal sensitivity, and a longer duration of retinochoroiditis remission was associated with better perimetric parameters (MD and PSD).

RESUMOObjetivo:Avaliar a função visual e arquitetura da retina central e peripapilar em pacientes com retinocoroidite toxoplásmica inativa fora da região macular e peripapilar (zonas 2 e 3).Métodos:Estudo transversal de 20 olhos (18 pacientes) com cicatrizes toxoplásmicas nas zonas 2 e 3 com acuidade visual ≥20/25. Os pacientes foram submetidos à perimetria Humphrey 10-2, teste de sensibilidade ao contraste (Teste Mars) e teste de visão de cores (L'Anthony D-15 dessaturado). As espessuras da camada de fibras nervosas da retina (CFNR) e da mácula foram determinadas pela tomografia de coerência óptica.Resultados:A média de idade dos pacientes foi 27,4 ± 10,3 anos, e a duração média da remissão da retinocoroidite foi de 6,15 ± 5,19 meses. Alterações na sensibilidade ao contraste e cores foram observada em, respectivamente, 3 olhos (15,0%) e 4 olhos (20,0%). Os índices perimétricos mean deviation (MD) e pattern standard deviation (PSD) estiveram fora do intervalo de confiança de 95% do perímetro em 14 olhos (70,0%) e 7 olhos (35,0%), respectivamente. A espessura foveal e da CFNR média estiveram dentro do limite da normalidade em todos os olhos. Olhos com retinocoroidite na zona 2 tiveram menor sensibilidade foveal que olhos com lesões na zona 3 (p=0,041). Olhos com remissão de longa duração tiveram um MD mais alto (r=0,575; p=0,013) e um PSD mais baixo (r=-0,593; p=0,010).Conclusão:Apesar da arquitetura normal da retina central e peripapilar, olhos com retinocoroidite inativa nas zonas 2 e 3 podem apresentar anormalidades da visão de cores, sensibilidade ao contras e perimetria macular. A retinocoroidite na zona 2 está associada a uma menor sensibilidade foveal. Longos intervalos de remissão da retinocoroidite estiveram associados a melhores parâmetros perimétricos (MD e PSD).