Assessment of quality of life, psychosocial, and epidemiological aspects in patients diagnosed with tuberculous uveitis.

PURPOSE: To assess the quality of life in patients diagnosed as having tuberculous uveitis and its association with sociodemographic, clinical, and psychosocial aspects. METHOD: By conducting standardized interviews, clinical and demographic data were collected using a measure developed in this study. This measure was applied in addition to other measures, namely SF-12, Hospital Anxiety and Depression Scale, and NEI-VFQ-39, which were used to assess health-related quality of life, anxiety and depression symptoms, and visual functioning. RESULTS: The study included 34 patients [mean age: 46.5 ± 15.1 years, female patients: 21 (61.8%)]. The mean of the VFQ-39 score was 74.5 ± 16.6 and that of SF-12 physical and mental component scores were 45.8 ± 10.1 and 51.6 ± 7.5, respectively, for the health-related quality of life. Anxiety symptoms were the most prevalent compared with depression symptoms and were found in 35.3% of the participants. CONCLUSION: Tuberculous uveitis affects several scales of quality of life, thereby affecting a population economically active with a social, psychological, and economic burden.

Toxoplasmosis outbreak in São Paulo, Brazil: Epidemiology and visual outcome.

PURPOSE: To describe a 2019 acute toxoplasmosis outbreak in the city of São Paulo, Brazil, and to evaluate the laboratory serological profile for toxoplasmosis for three consecutive years. The ophthalmological manifestations of the patients involved in the outbreak were also studied. METHODS: A cross-sectional descriptive study of a toxoplasmosis outbreak in São Paulo, Brazil, between February and May 2019. Epidemiological data were described, as were the observed ocular manifestations. As part of this study the number of patients with positive IgM toxoplasmosis serology was obtained from a large laboratory network (DASA) for three consecutive years, including the year of the outbreak (2018, 2019, 2020). RESULTS: Eighty-three individuals were identified in the outbreak and two clusters were studied. The clinical picture of at least 77% of the patients, the epidemiological analysis, and the short incubation period (5-8 days) suggested contamination by oocysts. Serological laboratory data analysis revealed an increase of positive toxoplasmosis IgM in 2019 of 73% compared to the previous year. Ophthalmological examination revealed that at least 4.8% of the patients developed toxoplasmic retinochoroiditis, none of whom had been treated during the acute systemic disease. CONCLUSION: Our findings indicate vegetable contamination as the possible source of this outbreak, a high prevalence of toxoplasmosis in São Paulo during the outbreak period, and a drop in the number of tests during the COVID-19 pandemic. Retinochoroiditis was observed in at least 4.8% of the cases. We confirm the need to implement effective means for the prevention, diagnosis, and treatment of the disease. This may involve raising awareness among the population of the importance of vegetable hygiene, and improved quality control of food and water.

Toxoplasmosis outbreak in São Paulo, Brazil: Epidemiology and visual outcome

ABSTRACT Purpose: To describe a 2019 acute toxoplasmosis outbreak in the city of São Paulo, Brazil, and to evaluate the laboratory serological profile for toxoplasmosis for three consecutive years. The ophthalmological manifestations of the patients involved in the outbreak were also studied. Methods: A cross-sectional descriptive study of a toxoplasmosis outbreak in São Paulo, Brazil, between February and May 2019. Epidemiological data were described, as were the observed ocular manifestations. As part of this study the number of patients with positive IgM toxoplasmosis serology was obtained from a large laboratory network (DASA) for three consecutive years, including the year of the outbreak (2018, 2019, 2020). Results: Eighty-three individuals were identified in the outbreak and two clusters were studied. The clinical picture of at least 77% of the patients, the epidemiological analysis, and the short incubation period (5-8 days) suggested contamination by oocysts. Serological laboratory data analysis revealed an increase of positive toxoplasmosis IgM in 2019 of 73% compared to the previous year. Ophthalmological examination revealed that at least 4.8% of the patients developed toxoplasmic retinochoroiditis, none of whom had been treated during the acute systemic disease. Conclusion: Our findings indicate vegetable contamination as the possible source of this outbreak, a high prevalence of toxoplasmosis in São Paulo during the outbreak period, and a drop in the number of tests during the COVID-19 pandemic. Retinochoroiditis was observed in at least 4.8% of the cases. We confirm the need to implement effective means for the prevention, diagnosis, and treatment of the disease. This may involve raising awareness among the population of the importance of vegetable hygiene, and improved quality control of food and water.

New findings useful for clinical practice using swept-source optical coherence tomography angiography in the follow-up of active ocular toxoplasmosis.

BACKGROUND: Ocular toxoplasmosis is one of the most common causes of intraocular inflammation and posterior uveitis in immunocompetent patients. This paper aims to investigate swept-source optical coherence tomography angiography (SS-OCTA) findings in eyes with active toxoplasmic retinochoroiditis. METHODS: This case series was conducted from November 2017 through October 2019 in two Brazilian centers. 15 eyes of 15 patients with active toxoplasmic retinochoroiditis were included, and were imaged at baseline and after at least 4 weeks of follow-up. All patients underwent ophthalmic examinations and multimodal imaging including SS-OCT and SS-OCTA before and after treatment of ocular toxoplasmosis. The differential diagnoses included toxoplasmosis, syphilis, and human immunodeficiency virus, which were eliminated through serologic and clinical evaluations. RESULTS: All 15 patients presented with positive anti-Toxoplasma gondii immunoglobulin G titers and three also presented with positive anti-T. gondii immunoglobulin M titers. The mean age at examination was 32.4 years ± 12.7 years (range 15-59 years). Sixty percent of the patients were female. In all eyes, the inner retinal layers were abnormally hyperreflective with full-thickness disorganization of the retinal reflective layers at the site of the active toxoplasmic retinochoroiditis. At baseline, 80% of eyes had focal choroidal thickening beneath the retinitis area, and all eyes had a choroidal hyporeflective signal. Before treatment, SS-OCTA showed no OCTA decorrelation signal next to the lesion site in all eyes, and flow signal improvement was noticed after treatment. Three eyes presented with intraretinal vascular abnormalities during follow-up. SS-OCTA showed retinal neovascularization in one patient and a presumed subclinical choroidal neovascular membrane in another patient. CONCLUSIONS: SS-OCT and SS-OCTA are useful for assessing unexpected structural and vascular retinal and choroidal changes in active and post-treatment toxoplasmic retinochoroiditis and these findings are useful for clinical practice.

Local treatment of toxoplasmic retinochoroiditis with intravitreal clindamycin and dexamethasone.

PURPOSE: To report the clinical outcomes of local treatment of toxoplasmic retinochoroiditis (TRC) with intravitreal injections of clindamycin and dexamethasone. STUDY POPULATION: 16 eyes (16 patients) with active TRC sparing the macula and juxtapapillary area treated with intravitreal injections of clindamycin (1 mg) and dexamethasone (1 mg) without concomitant systemic antitoxoplasmic or anti-inflammatory therapy. Measured parameters: Best-corrected visual acuity (BCVA) was measured by an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. BCVA and clinical characteristics of retinochoroiditis were assessed at baseline and at 1, 3, 6, and 12 months. PRIMARY OUTCOME MEASURES: Resolution of retinochoroiditis and changes in BCVA. RESULTS: Control of TRC was achieved in all cases with a mean interval of 2.48 ± 1.03 weeks (2-6 weeks). A single injection of intravitreal clindamycin and dexamethasone was performed in 12 patients, and four patients required two intravitreal injections, during the follow-up period. Fourteen eyes (87.5%) improved ≥ 2 ETDRS lines of BCVA, of two or more Early Treatment Diabetic Retinopathy Study lines, BCVA remained stable in two eyes (12.5%), and no patient had decreased BCVA at the end of the follow-up period. No ocular or systemic adverse events were observed. CONCLUSION: Local treatment with intravitreal injections of clindamycin and dexamethasone without concomitant systemic therapy was associated with resolution of TRC in patients without macular or juxtapapillary involvement. Intravitreal clindamycin and dexamethasone may represent a viable treatment option in patients with allergies or inadequate responses to oral medications.

Local treatment of toxoplasmic retinochoroiditis with intravitreal clindamycin and dexamethasone / Tratamento local para a retinocoroidite toxoplásmica com clindamicina e dexametasona intravítrea

ABSTRACTPurpose:To report the clinical outcomes of local treatment of toxoplasmic retinochoroiditis (TRC) with intravitreal injections of clindamycin and dexamethasone.Methods:Study population: 16 eyes (16 patients) with active TRC sparing the macula and juxtapapillary area treated with intravitreal injections of clindamycin (1 mg) and dexamethasone (1 mg) without concomitant systemic antitoxoplasmic or anti-inflammatory therapy. Measured parameters: Best-corrected visual acuity (BCVA) was measured by an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. BCVA and clinical characteristics of retinochoroiditis were assessed at baseline and at 1, 3, 6, and 12 months. Primary outcome measures: Resolution of retinochoroiditis and changes in BCVA.Results:Control of TRC was achieved in all cases with a mean interval of 2.48 ± 1.03 weeks (2-6 weeks). A single injection of intravitreal clindamycin and dexamethasone was performed in 12 patients, and four patients required two intravitreal injections, during the follow-up period. Fourteen eyes (87.5%) improved ≥ 2 ETDRS lines of BCVA, of two or more Early Treatment Diabetic Retinopathy Study lines, BCVA remained stable in two eyes (12.5%), and no patient had decreased BCVA at the end of the follow-up period. No ocular or systemic adverse events were observed.Conclusion:Local treatment with intravitreal injections of clindamycin and dexamethasone without concomitant systemic therapy was associated with resolution of TRC in patients without macular or juxtapapillary involvement. Intravitreal clindamycin and dexamethasone may represent a viable treatment option in patients with allergies or inadequate responses to oral medications.

RESUMOObjetivo:Reportar os resultados clínicos do tratamento local da retinocoroidite toxoplásmica com injeções intravítreas de clindamicina e dexametasona.Métodos:População do estudo: 16 olhos (16 pacientes) com retinocoroidite toxoplásmica ativa sem comprometimento da mácula e da área juxtapapilar, tratados com injeções intravítreas de clindamicina (1 mg) e dexametasona (1 mg) sem terapia sistêmica anti-toxoplásmica ou anti-inflamatória concomitante. Procedimento de observação: A melhor acuidade visual corrigida (BCVA) foi medida através da tabela ETDRS. A BCVA e as características clínicas da retinocoroidite foram avaliadas na qualificação, primeiro, terceiro, sexto e 12º mês. Medidas do resultado principal: resolução da retinocoroidite e mudanças na BCVA.Resultados:O controle da retinocoroidite toxoplásmica foi atingido em todos os casos com um intervalo médio de 2,48 ± 1,03 semanas (intervalo de 2 a 6 semanas). Uma única injeção intravítrea de clindamicina e dexametasona foi aplicada em 12 pacientes, e quatro pacientes precisaram de duas injeções durante o seguimento. Quatorze olhos (87,5%) melhoraram ≥ 2 linhas ETDRS de BCVA, a BCVA ficou estável em 2 olhos (12,5%) e nenhum paciente apresentou diminuição da acuidade visual no final do seguimento. Não foram observados eventos adversos sistêmicos ou oculares.Conclusão:O tratamento local com injeções intravítreas de clindamicina e dexametasona sem terapia sistêmica concomitante esteve associado com a resolução da retinocoroidite toxoplásmica em pacientes sem comprometimento macular ou juxtapapilar. A clindamicina e dexametasona intravítrea representam um tratamento promissor em pacientes com intolerância, contraindicação ou resposta inadequada a medicação oral.