RESUMO
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