MACULAR HOLE ASSOCIATED WITH TOXOPLASMOSIS: A SURGICAL CASE SERIES.

PURPOSE: There are currently limited data addressing the surgical outcomes of pars plana vitrectomy (PPV) in toxoplasmosis-related macular hole (tMH). We aim to report and discuss safety and efficacy of PPV for tMH. METHODS: Surgical case series (n = 11), with minimum postoperative follow-up time of 6 months. Consecutive patients who underwent PPV for tMH from 2013 to 2016 were included. Indications for surgery were: visual acuity ≥ 0.6 logarithm of the minimum angle of resolution (Snellen 20/80 or less), no intraocular inflammation for more than 6 months, extrafoveal toxoplasmosis scar, elevated tMH borders on optical coherence tomography, and patient agreement with surgery. Surgery was performed-PPV with epiretinal (if present) and internal limiting membrane peeling. Safety and efficacy of PPV for tMH were addressed by evaluating: 1) surgery-related complications and 2) visual acuity improvement. RESULTS: A total of 11 patients (6 male), with a mean age of 33.2 ± 11.0 years were studied. Mean preoperative best-corrected visual acuity significantly improved from 1.10 ± 0.24 (Snellen 20/252) to 0.43 ± 0.18 logarithm of the minimum angle of resolution (Snellen 20/54) at last follow-up visit (P < 0.01). The rate of visual acuity improvement (i.e., a gain of at least three lines) and tMH closure was 100% for both. The only reported surgery-related complication was cataract in one case. CONCLUSION: Our results suggest that PPV is a safe and effective option in tMH cases. A controlled, longitudinal study would contribute to confirm these findings.

Vitreoretinal traction and lamellar macular holes associated with cicatricial toxoplasmic retinochoroiditis: case series report.

PURPOSE: Inflammation due to retinal neuroepithelial necrotic granulomas of toxoplasmosis can extend to neighbor areas and may develop focal adhesions of the posterior hyaloid, to the surface vessels, and the margins or adjoining areas of retinochoroiditis plaques. These adhesions may develop vitreoretinal traction and retinal tears. Vitreoretinal traction may be macular (VMT) or extramacular depending on the location of the toxoplasmic plaques. Vitreomacular traction may follow anomalous posterior vitreous detachment. We report 7 cases of vitreoretinal traction (macular or peripheral) and the development of 4 lamellar macular holes in cicatricial toxoplasmic retinochoroiditis. METHODS: This is a retrospective and observational study by revision of clinical records in a retinologist office, using diagnostic techniques, especially optical coherence tomography (OCT), current management, and an extended follow-up. The OCT observations on toxoplasmic extramacular plaques are more difficult. RESULTS: Seven cases in 5 patients, 2 of them bilateral, 3 male (66.6%) and 2 female, median age 46 years, were included. Anteroposterior VMT was found in 6 cases and another case was superotemporal midperipheral; 4 developed lamellar macular holes and 3 chronic macular epiretinal membranes. Best-corrected visual acuity was equal to or better than 20/30 in 3 cases, between 20/50 and 20/80 in 2 cases, and 20/160 to 20/200 in 2 cases. One small lamellar macular hole closed spontaneously during follow-up. CONCLUSIONS: Inflammatory retinal granulomas of toxoplasmosis in cicatricial stages may present macular or peripheral focal vitreoretinal adhesions that can eventually lead to VMT and subsequent lamellar macular holes or peripheral retinal tears.

Macular hole formation after toxoplasmic retinochoroiditis.

A 56-year-old female patient presented with toxoplasmic retinochoroiditis (TR) in the right eye. Optical coherence tomography revealed a full-thickness macular hole (MH) in the affected eye. Fluorescence angiography and indocyanine green-angiography disclosed focal choroidal ischaemia in the area of inflammation. Heidelberg retinal flowmetry confirmed the significant hypoperfusion in this area. Proper medication was administered. Ophthalmological examination 4 weeks later revealed an improvement of the clinical findings without visual restoration. This case supports the clinical hypothesis that retinochoroidal ischaemia due to TR may induce the development of MH, indicating that patients with TR may have a certain risk for MH formation.

[Severe infectious keratitis in renal transplant patient: a case report]. / Kératite infectieuse sévère chez un greffé du rein: à propos d'une observation.

Keratitis occurring in renal transplant patients are often severe, with difficult management. We describe the case of a renal transplant patient, 44 year-old man, with history of recurrent herpetic keratitis, which developed an impending corneal perforation. Conjunctival smear showed the presence of amoebic cysts. Anti-amoebic treatment was undertaken in addition with oral aciclovir, and a therapeutic penetrating keratoplasty was performed. An ulceration of the graft occurred within five months. Ocular samples showed the presence of Candida albicans. Despite aggressive antifungal therapy, he required a second therapeutic penetrating keratoplasty for graft perforation. One month later, we noted a recurrence of the ulcer with corneal thinning which evolved to perforation.

[Macular hole--a rare complication of toxocariasis]. / Gaura maculara--consecinta rara a infectiei toxocarozice.

Macular hole is a condition that characterizes older patients, being rare in adolescent patients and exceptionally at children. The etiopathogenic mechanism of most macular holes in children and adolescent is idiopathic. The suggested etiopathogenic mechanism is vitreoretinal traction due to a toxocara granuloma for a 9 years old girl.

The perforation problem in hydatid disease.

Hydatidosis (echinococcosis) is endemic in the Mediterranean region, including Turkey. We evaluated the problem of perforation in hydatidosis. The clinical data on 21 patients with intra-abdominal hydatid cyst perforation who were treated in the last 10 years were evaluated retrospectively. Twelve patients (57%) were men and nine (43%) were women. Their average age was 40 (range = 20-65). Blunt trauma was the etiologic mechanism in four cases (19%). Except for a case with a cyst in the left inguinal region, most (95%) of the patients had primary hepatic hydatidosis (95%). The procedures used on the 30 cysts found in 21 patients were as follows: partial cystectomy and drainage in 21 (70%), total cystectomy in 5 (17%), partial cystectomy plus omentopexy in 2 (7%), and drainage plus vacuum obliteration in 2 (7%). The average postoperative hospital stay was 12 days (range = 6-30). Two patients (10%) had complications: an incisional hernia developed in one patient, and a gastrocutaneous fistula developed in the other. Albendazole (10 mg/kg/day) was prescribed for two months. The mean follow-up time was 80 months (range = 6-131). Three patients (14%) underwent additional surgery for recurrence at various times. The morbidity and mortality associated with perforated hydatid cysts were higher when compared with that of nonperforated cysts. Hydatidosis is endemic in Turkey and traffic accidents are common. When these factors coexist, hydatid perforation should be considered in trauma patients with stable hemodynamics, but suspicious abdominal findings. The choice of the operative approach should be based on the experience of the surgeon and regional characteristics.