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Aniki Rothova - One of the best experts on this subject based on the ideXlab platform.
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recurrence rates of Ocular Toxoplasmosis during pregnancy
American Journal of Ophthalmology, 2014Co-Authors: Arthur M D Braakenburg, Gary N. Holland, Catherine M Crespi, Aniki RothovaAbstract:Purpose To investigate whether recurrence rates of Ocular Toxoplasmosis are higher during pregnancy in women of childbearing age. Design Retrospective longitudinal cohort study. Methods We reviewed medical records of all women seen at a university eye clinic (Utrecht, Netherlands) during episodes of active toxoplasmic retinochoroiditis that occurred while the women were of childbearing age (16–42 years). Each woman was sent a questionnaire requesting information regarding all pregnancies and episodes of Ocular Toxoplasmosis, whether or not episodes were observed at the eye clinic. Conditional fixed-effects Poisson regression was used to model incidence rate ratios of recurrence during pregnant versus nonpregnant intervals, adjusted for potential confounders, including age at time of active toxoplasmic retinochoroiditis and interval since last episode of active disease, which are known to influence risk for recurrence. Results Questionnaires were returned by 50 (58%) of 86 women, 34 of whom had had 69 pregnancies during 584 person-years of study. There were 128 episodes of Ocular Toxoplasmosis during the study period (6 during pregnancy). First episodes of Ocular Toxoplasmosis occurred between ages 9.6 and 38.5 years. The youngest age at pregnancy was 16.1 years; the oldest age at childbirth was 40.9 years. The incidence-rate ratios for pregnant versus nonpregnant intervals were in the direction of lower recurrence rates during pregnancy, with point estimates of 0.54 and 0.75 under 2 different approaches, but the ratios were not significantly different from the null value ( P values of 0.16 and 0.55). Conclusions Recurrence rates of Ocular Toxoplasmosis are probably not higher during pregnancy, in contrast to traditional beliefs.
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a prospective randomized trial of pyrimethamine and azithromycin vs pyrimethamine and sulfadiazine for the treatment of Ocular Toxoplasmosis
American Journal of Ophthalmology, 2002Co-Authors: Lotje H Boschdriessen, Frank D Verbraak, Maria S A Suttorpschulten, Rutger L J Van Ruyven, Anne Marie Klok, Carel B Hoyng, Aniki RothovaAbstract:Abstract OBJECTIVE: To compare the effects of two treatment regimens, one of which included azithromycin, for the treatment of sight-threatening (near optic disk or fovea) Ocular Toxoplasmosis DESIGN: Prospective, randomized open-labeled multicenter study, masked in part with regard to evaluation. METHODS: PARTICIPANTS TOTAL ENROLLMENT: 46 patients with sight-threatening Ocular Toxoplasmosis; pyrimethamine and azithromycin group: 24 patients; pyrimethamine and sulfadiazine group: 22 patients. INTERVENTION: Patients were randomized into two treatment regimens. Group 1 was treated with pyrimethamine and azithromycin complemented with folinic acid and the addition of prednisone from day 3. Group 2 was treated with pyrimethamine and sulfadiazine complemented with folinic acid and the addition of prednisone from day 3. Patients used study medications daily for 4 weeks. Ocular and laboratory examinations were performed at least weekly during the observation period. The study was masked in part with regard to evaluation. MAIN OUTCOME MEASURES: An assessment was madeof the time to resolution of the intraOcular inflammatory activity, the size of the retinochoroidal lesion, and visual acuity before and after the treatment as well as all adverse effects of treatments. • RESULTS: Adverse effects were more frequent in the pyrimethamine/sulfadiazine group (P • CONCLUSIONS: The efficacy of the multidrug regimen with pyrimethamine and azithromycin was similar to the standard treatment with pyrimethamine and sulfadiazine. However, the frequency and severity of adverse effects was significantly lower with a regimen containing pyrimethamine and azithromycin. Multidrug therapy with the combination of pyrimethamine and azithromycin appears to be an acceptable alternative for treatment of sight-threatening Ocular Toxoplasmosis.
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reactivations of Ocular Toxoplasmosis after cataract extraction
Ophthalmology, 2002Co-Authors: Lotje H Boschdriessen, J. S. Stilma, Marjolijn B Plaisier, Allegonda Van Der Lelij, Aniki RothovaAbstract:Abstract Purpose To determine the risk of reactivation of Ocular Toxoplasmosis following cataract extraction. Design Retrospective case-control study. Participants Out of 154 patients with Ocular Toxoplasmosis, 14 patients (15 eyes) who had undergone a cataract extraction and 45 age- and sex- matched controls without cataract were selected. Intervention A review of the medical records of 14 patients with Ocular Toxoplasmosis and cataract and 45 control patients with Ocular Toxoplasmosis but without cataract. The clinical records of the controls and patients were assessed for an identical 4-month period following the date of the cataract extraction in the index patients. Main outcome measures Development of a new active retinal lesion within 4 months after cataract surgery in patients and age -and sex matched-controls. The presence of risk factors such as sex, congenital or postnatal acquisition of Ocular Toxoplasmosis, age at first clinical manifestation of Ocular Toxoplasmosis, total number of attacks per affected eye, type of cataract, age at the time of cataract surgery and the intervals between surgery and first clinical manifestation of Ocular Toxoplasmosis and between surgery and the last recurrence of Ocular Toxoplasmosis, as well as the use of antiparasitic medication during surgery, type and complications of surgery and optimal visual acuity before and after cataract surgery. Results Reactivations of Ocular Toxoplasmosis following cataract extraction occurred in 5/14 patients (5/15 eyes), which was higher than the incidence of recurrences in age -and sex-matched controls ( p No additional risk factors for the development of recurrences of Ocular Toxoplasmosis after cataract surgery were found. Incidence of recurrences preceding surgery did not differ between patients and controls. Conclusion We identified an increased risk of reactivation of Ocular Toxoplasmosis following cataract extraction which implies that prophylactic treatment with antiparasitic drugs during and after the cataract surgery might be worthwhile for patients at risk of visual loss.
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Retinal detachment in Ocular Toxoplasmosis.
Ophthalmology, 2000Co-Authors: Lotje H. Bosch-driessen, Shakila Karimi, J. S. Stilma, Aniki RothovaAbstract:Abstract Purpose To report on the clinical course and prognosis of retinal breaks and detachment occurring in patients with Ocular Toxoplasmosis. Design Retrospective cross-sectional observational study. Participants One hundred fifty consecutive patients with Ocular Toxoplasmosis. Intervention A review of all records of patients with Ocular Toxoplasmosis who had consulted our department from 1990 through 1997 was performed. Main outcome measures The presence of retinal detachment or breaks and possible risk factors, such as age, myopia, the interval between the last recurrence of inflammation and the onset of retinal detachment, severity of vitritis, previous treatment methods, and the location of the retinal abnormalities, were analyzed. Results We found a frequency of 6% (9/150) for retinal detachment and an additional 5% (7/150) for retinal breaks among our patients with Ocular Toxoplasmosis. Attacks of active Ocular Toxoplasmosis preceding the retinal detachment or retinal breaks were characterized by severe intraOcular inflammation. The frequency of myopia in our patients with retinal detachment or retinal breaks was significantly higher than in patients with Ocular Toxoplasmosis without retinal detachment or retinal breaks. The functional prognosis for the patients with retinal detachment was poor; legal blindness (visual acuity ≤ 20/200) resulting from retinal detachment occurred in five of the nine patients. Conclusions Careful retinal examination in Ocular Toxoplasmosis is warranted, especially in patients with myopia and severe intraOcular inflammation.
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intraOcular anti toxoplasma gondii iga antibody production in patients with Ocular Toxoplasmosis
American Journal of Ophthalmology, 1999Co-Authors: Marjolein J H Ronday, Jenny V Ongkosuwito, Aniki Rothova, Aize KijlstraAbstract:Abstract PURPOSE: To investigate the immunoglobulin classes associated with the intraOcular anti– Toxoplasma gondii antibody response during clinical Ocular Toxoplasmosis and to determine which immunoglobulin class is most helpful in the diagnosis of this disease. METHODS: Paired serum and intraOcular fluid samples from 155 patients who had uveitis were tested for intraOcular anti– T. gondii IgG, IgA, and IgM antibody production. The presence of T. gondii DNA was determined by polymerase chain reaction. Patients were divided into two groups, based on the initial clinical diagnosis; group 1 included 78 patients with presumed Ocular Toxoplasmosis, and group 2 included 77 patients with uveitis that was not clinically suspected to be Ocular Toxoplasmosis. Samples from 27 nonuveitis patients who underwent intraOcular surgery were used as control subjects. The final diagnosis was based on the clinical course and interpretation of laboratory tests. RESULTS: A final diagnosis of Ocular Toxoplasmosis was made in 88 of 155 patients (group 1, 68; group 2, 20). Among these patients, 65% had intraOcular IgG production, 52% had intraOcular IgA production, 37.5% had both IgG and IgA production, 27% had IgG production only, and 15% had IgA production only. Of the 13 patients tested, only one had intraOcular IgM production. IntraOcular IgA could not be detected in patients who had final diagnoses other than Ocular Toxoplasmosis or in control subjects. A positive polymerase chain reaction combined with a test that was positive for intraOcular IgG production had a sensitivity of 77%, which increased to 91% after the detection of intraOcular IgA production was added. CONCLUSIONS: Immunoglobulin G is the major class involved in the humoral immune response against the T. gondii parasite, followed by IgA. The determination of IgA production is useful as an additional test in the diagnosis of Ocular Toxoplasmosis.
Gary N. Holland - One of the best experts on this subject based on the ideXlab platform.
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Ocular Toxoplasmosis in the united states recent and remote infections
Clinical Infectious Diseases, 2015Co-Authors: Jeffrey L Jones, Gary N. Holland, Jose G Montoya, Valerie Bonetti, Cindy Press, Steven R Sanislo, Rahul N KhuranaAbstract:We tested all samples from patients with Ocular Toxoplasmosis sent to the Palo Alto Medical Foundation Toxoplasma Reference Laboratory from June 2004 through August 2010 for serologic evidence of recent Toxoplasma gondii infection. Of 205 patients aged 10-96 years, 11.7% had recent infection. Many people develop Ocular disease soon after T. gondii infection.
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recurrence rates of Ocular Toxoplasmosis during pregnancy
American Journal of Ophthalmology, 2014Co-Authors: Arthur M D Braakenburg, Gary N. Holland, Catherine M Crespi, Aniki RothovaAbstract:Purpose To investigate whether recurrence rates of Ocular Toxoplasmosis are higher during pregnancy in women of childbearing age. Design Retrospective longitudinal cohort study. Methods We reviewed medical records of all women seen at a university eye clinic (Utrecht, Netherlands) during episodes of active toxoplasmic retinochoroiditis that occurred while the women were of childbearing age (16–42 years). Each woman was sent a questionnaire requesting information regarding all pregnancies and episodes of Ocular Toxoplasmosis, whether or not episodes were observed at the eye clinic. Conditional fixed-effects Poisson regression was used to model incidence rate ratios of recurrence during pregnant versus nonpregnant intervals, adjusted for potential confounders, including age at time of active toxoplasmic retinochoroiditis and interval since last episode of active disease, which are known to influence risk for recurrence. Results Questionnaires were returned by 50 (58%) of 86 women, 34 of whom had had 69 pregnancies during 584 person-years of study. There were 128 episodes of Ocular Toxoplasmosis during the study period (6 during pregnancy). First episodes of Ocular Toxoplasmosis occurred between ages 9.6 and 38.5 years. The youngest age at pregnancy was 16.1 years; the oldest age at childbirth was 40.9 years. The incidence-rate ratios for pregnant versus nonpregnant intervals were in the direction of lower recurrence rates during pregnancy, with point estimates of 0.54 and 0.75 under 2 different approaches, but the ratios were not significantly different from the null value ( P values of 0.16 and 0.55). Conclusions Recurrence rates of Ocular Toxoplasmosis are probably not higher during pregnancy, in contrast to traditional beliefs.
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annual burden of Ocular Toxoplasmosis in the united states
American Journal of Tropical Medicine and Hygiene, 2010Co-Authors: Jeffrey L Jones, Gary N. HollandAbstract:Toxoplasmosis is the most common retinal infection in the United States, and it can lead to severe visual impairment. It is generally believed that individuals remain infected with Toxoplasma gondii for life with intracellular cysts forming in the muscles, brain, and other organs. T. gondii IgG antibodies are also thought to remain for life. In 2003, Holland 1 estimated the burden of Ocular toxoplasmic eye lesions in the United States based on data from the third National Health and Nutrition Examination Survey (NHANES III), conducted in 1988–1994, and the 2000 census. 1 , 2 We now present an update of the Ocular Toxoplasmosis burden based on more recent NHANES and U.S. population data. For the burden calculations, we used (1) T. gondii antibody seroprevalence data from the NHANES 1999–2004 3
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Ocular Toxoplasmosis the influence of patient age
Memorias Do Instituto Oswaldo Cruz, 2009Co-Authors: Gary N. HollandAbstract:The influence of patient age on various features of Ocular Toxoplasmosis has been a subject of study for many years. The age at which Toxoplasma gondii infection occurs in different populations is related to socioeconomic factors and studies suggest that Ocular Toxoplasmosis is a more severe disease at the extremes of age. The prevalence of Ocular involvement is markedly different between individuals with congenital and those with post-natally acquired infections. Even among those with post-natally acquired infections, age influences the risk and timing of Ocular involvement. The severity of toxoplasmic retinochoroiditis (in terms of lesion size, location and associated inflammation) is also affected by patient age at the time of initial infection or recurrence. The risk of recurrent toxoplasmic retinochoroiditis is influenced by age at the time of initial infection and age at most recent episode of active disease. Understanding of relationships between Ocular Toxoplasmosis and patient age is incomplete; evidence has often been indirect and in some cases conflicting. The influence of patient age on Ocular Toxoplasmosis should be studied in a systematic manner to provide a better understanding of disease mechanisms and to provide clinical information that can used to establish better strategies for disease treatment and prevention.
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intraOcular inflammation associated with Ocular Toxoplasmosis relationships at initial examination
American Journal of Ophthalmology, 2008Co-Authors: Emilio M Dodds, Gary N. Holland, Cristina Muccioli, Anna Hovakimyan, M R Stanford, Willie O Siu, Kayur H Shah, Ninette Ten Damvan Loon, Talin BarisaniasenbauerAbstract:Purpose To describe characteristics of intraOcular inflammation in eyes with active Ocular Toxoplasmosis and to identify relationships between signs of inflammation, complications (including elevated intraOcular pressure [IOP]), other disease features, and host characteristics. Design Multicenter, retrospective, cross-sectional study. Methods We reviewed the medical records of 210 patients with toxoplasmic retinochoroiditis at seven international sites (North America, South America, and Europe) for information from the first examination at each site during which patients had active retinal lesions. Signs of inflammation included anterior chamber (AC) cells and flare and vitreous humor cells and haze. Retinal lesion characteristics included size (≤1 disc area [DA] or >1 DA) and presence or absence of macular involvement. Results AC cells and flare were related to vitreous inflammatory reactions ( P ≤ .041). One or more signs of increased inflammation were related to the following factors: older patient age, larger retinal lesions, and extramacular location. In 30% of involved eyes, there was evidence of elevated IOP (despite use of glaucoma medications by some patients); other complications were uncommon. IOP of more than 21 mm Hg was associated with both increased AC cells and elevated flare (both P ≤ .001) and with macular involvement ( P = .009). Inflammation seemed to be more severe among patients in Brazil than among those at other sites. Conclusions There is substantial variation between patients in the severity of intraOcular inflammation associated with Ocular Toxoplasmosis, attributable to multiple host- and disease-related factors. Results suggest that disease characteristics also vary in different areas of the world. Elevated IOP at initial examination reflects the severity of inflammation.
Justine R Smith - One of the best experts on this subject based on the ideXlab platform.
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pathogenesis of Ocular Toxoplasmosis
Progress in Retinal and Eye Research, 2021Co-Authors: Liam M. Ashander, Elise Rochet, Justine R Smith, Sigrid Arruda, Cynthia A Cordeiro, Shervi Lie, Rubens Belfort, João M. FurtadoAbstract:Ocular Toxoplasmosis is a retinitis -almost always accompanied by vitritis and choroiditis- caused by intraOcular infection with Toxoplasma gondii. Depending on retinal location, this condition may cause substantial vision impairment. T. gondii is an obligate intracellular protozoan parasite, with both sexual and asexual life cycles, and infection is typically contracted orally by consuming encysted bradyzoites in undercooked meat, or oocysts on unwashed garden produce or in contaminated water. Presently available anti-parasitic drugs cannot eliminate T. gondii from the body. In vitro studies using T. gondii tachyzoites, and human retinal cells and tissue have provided important insights into the pathogenesis of Ocular Toxoplasmosis. T. gondii may cross the vascular endothelium to access human retina by at least three routes: in leukocyte taxis; as a transmigrating tachyzoite; and after infecting endothelial cells. The parasite is capable of navigating the human neuroretina, gaining access to a range of cell populations. Retinal Muller glial cells are preferred initial host cells. T. gondii infection of the retinal pigment epithelial cells alters the secretion of growth factors and induces proliferation of adjacent uninfected epithelial cells. This increases susceptibility of the cells to parasite infection, and may be the basis of the characteristic hyperpigmented toxoplasmic retinal lesion. Infected epithelial cells also generate a vigorous immunologic response, and influence the activity of leukocytes that infiltrate the retina. A range of T. gondii genotypes are associated with human Ocular Toxoplasmosis, and individual immunogenetics -including polymorphisms in genes encoding innate immune receptors, human leukocyte antigens and cytokines- impacts the clinical manifestations. Research into basic pathogenic mechanisms of Ocular Toxoplasmosis highlights the importance of prevention and suggests new biological drug targets for established disease.
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clinical manifestations and visual outcomes associated with Ocular Toxoplasmosis in a brazilian population
Scientific Reports, 2021Co-Authors: Sigrid Arruda, Justine R Smith, Rubens Belfort, Barbara Vieira, Denny Marcos Garcia, Michelle Araujo, Milena Simoes, Renata Moreto, Murilo Wendeborn Rodrigues, João M. FurtadoAbstract:Ocular Toxoplasmosis is the leading cause of posterior uveitis worldwide. We conducted an observational study of 262 consecutive individuals (n = 344 eyes) with Ocular Toxoplasmosis who were followed over a 34-month period. Most subjects were T. gondii IgG + /IgM- (n = 242; 92.4%; 317 eyes), and 140 eyes (40.7%) had active lesions. For eyes in which retinal lesions were active at recruitment and best-corrected visual acuity (BCVA) could be measured (n = 133), 21.0% (n = 28) remained blind (BCVA below 20/400) after inflammation resolved. In these eyes, atypical Ocular Toxoplasmosis (OR 4.99; 95% CI 1.14-22.85; p = 0.0330), macular lesion (OR 9.95; 95% CI 2.45-47.15; p = 0.0019) and any complication (OR 10.26; 95% CI 3.82-30.67; p < 0.0001) were associated with BCVA below 20/200. For eyes with only inactive lesions at recruitment and BCVA measured (n = 178), 28.1% (n = 50) were blind. In these eyes, having at least one lesion larger than one disc-diameter (OR 6.30; 95% CI 2.28-22.46; p = 0.0013) and macular lesion (OR 5.69; 95% CI 2.53-13.54; p < 0.0001) were associated with BCVA below 20/200. Older age (OR 1.02; 95% CI 1.00-1.05; p = 0.0493) and active disease at presentation (OR 4.74; 95% CI 1.95-12.91; p = 0.0011) were associated with recurrences. Additional clinical attention should be directed towards patients with risk factors for poor visual outcome.
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Model Systems for Studying Mechanisms of Ocular Toxoplasmosis
Toxoplasma gondii, 2020Co-Authors: Justine R Smith, Liam M. Ashander, Yuefang Ma, Elise Rochet, João M. FurtadoAbstract:The most common human disease caused by infection with Toxoplasma gondii is Ocular Toxoplasmosis, which typically is manifest as recurrent attacks of necrotizing retinal inflammation with subsequent scarring. The multilayered retina contains specialized cell populations, including endothelial cells, epithelial cells, neurons and supporting cells, all of which may be involved in this condition. In vitro investigations of basic mechanisms operating in human Ocular Toxoplasmosis use cellular and molecular methods that are common to the study of many pathological processes, and the novel aspect of this research is the use of human retinal cell subsets. Most in vivo research on Ocular Toxoplasmosis is conducted in the laboratory mouse. Experimental models involve local or systemic inoculation of parasites to induce acute disease, or sequential systemic and local parasite inoculations to trigger recurrent disease. We present methods for in vitro and in vivo studies of Ocular Toxoplasmosis, including dissection of the human eye, and culture and infection of differentiated cell populations from the retina, as well as induction of mouse Ocular Toxoplasmosis by intraOcular, or sequential systemic and intraOcular, inoculations, and imaging of toxoplasmic retinal lesions.
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neutrophil activities in human Ocular Toxoplasmosis an in vitro study with human cells
Investigative Ophthalmology & Visual Science, 2019Co-Authors: Liam M. Ashander, Elise Rochet, João M. Furtado, Shervi Lie, Jennifer M Washington, Binoy Appukuttan, Justine R SmithAbstract:Purpose Retinal damage in Ocular Toxoplasmosis reflects Toxoplasma gondii-induced cell lysis and reactive inflammation. Human retinal histopathology demonstrates the presence of neutrophils, but activities of this leukocyte subset are unstudied. We conducted in vitro experiments to evaluate roles for neutrophils as retinal taxis for T. gondii and as contributors to the inflammation. Methods Human neutrophils were isolated from peripheral blood. Migration to disease-relevant chemokines was evaluated in transwells, seeded with human retinal endothelial cells for some assays, using neutrophils infected with GT-1 strain T. gondii tachyzoites. Neutrophils were cocultured with T. gondii-infected ARPE-19 and primary human retinal pigment epithelial cells, and production of reactive oxygen species (ROS) was estimated by dihydroethidium reaction. Proteins produced by T. gondii-infected ARPE-19 cells were profiled by immunoarray, and candidate neutrophil-activating proteins were targeted with specific blocking antibody in coculture assays. Results Infection with T. gondii arrested neutrophil migration across retinal endothelium regardless of the presence of CXCL8. Migration to CXCL1, CXCL2, and CXCL8 also was significantly inhibited in infected neutrophils. Neutrophils generated more ROS when cocultured with infected versus uninfected ARPE-19 cells and three of four primary retinal pigment epithelial cell isolates. Infected ARPE-19 cells augmented the synthesis of 12 neutrophil-activating proteins also expressed by primary retinal pigment epithelial cells. Antibody blockade of granulocyte-macrophage colony-stimulating factor, interleukin-6 (IL-6) and IL-18 significantly reduced ROS production by neutrophils cocultured with T. gondii-infected ARPE-19 cells. Conclusions Our findings support involvement of neutrophils in retinal inflammation, but not parasite transport, in the setting of Ocular Toxoplasmosis.
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retinal detachment associated with Ocular Toxoplasmosis
Retina-the Journal of Retinal and Vitreous Diseases, 2015Co-Authors: Ambar Faridi, Justine R Smith, Steven Yeh, Eric B Suhler, Christina J FlaxelAbstract:Purpose:To assess the frequency of retinal detachment (RD) and associated clinical features in Ocular Toxoplasmosis.Methods:A review of the medical records of patients diagnosed with Ocular Toxoplasmosis and follow-up of 6 months or more was conducted. All patients were seen at the Casey Eye Institu
Gholam A Peyman - One of the best experts on this subject based on the ideXlab platform.
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randomized trial of intravitreal clindamycin and dexamethasone versus pyrimethamine sulfadiazine and prednisolone in treatment of Ocular Toxoplasmosis
Ophthalmology, 2011Co-Authors: Masoud Soheilian, Mohammad Mehdi Sadoughi, Mohammad H Dehghan, Alireza Ramezani, Ahmad Azimzadeh, Reza Shahghadami, Mehdi Yaseri, Gholam A PeymanAbstract:Purpose To compare the efficacy of intravitreal injection of clindamycin and dexamethasone with classic treatment for Ocular Toxoplasmosis. Design Prospective, randomized single-masked clinical trial. Participants 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. Intervention The IVCD group received 1 to 3 injection(s) of 1 mg intravitreal clindamycin and 400 μg 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. Main Outcome Measures Changes in retinochoroidal lesion size, measured by a computer program written in the MATLAB environment, 6 weeks after initiation of treatment. Visual acuity (VA) changes, vitreous inflammatory response, adverse drug reactions, and rate of recurrence were secondary outcome measures. Results The mean number of injections in the IVCD group was 1.6. The lesion size reduction was statistically significant after treatment in both IVCD and CT groups ( P P = 0.009, respectively). However, the difference in mean percentage of reduction at 6 weeks was not significant: 57.0±27.8% in the IVCD group versus 58.4±29.3% in the CT group ( P = 0.569). In relation to the 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 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 insignificant 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. Conclusions Intravitreal injection of clindamycin and dexamethasone may be an acceptable alternative to the classic treatment in Ocular Toxoplasmosis. It may offer the patient more convenience, a safer systemic side effect profile, greater availability, and fewer follow-up visits and hematologic evaluations. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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prospective randomized trial of trimethoprim sulfamethoxazole versus pyrimethamine and sulfadiazine in the treatment of Ocular Toxoplasmosis
Ophthalmology, 2005Co-Authors: Masoud Soheilian, Mohammad Mehdi Sadoughi, Mehdi Ghajarnia, Mohammad H Dehghan, Shahin Yazdani, Hassan Behboudi, Arash Anisian, Gholam A PeymanAbstract:Objective To compare the efficacy of the classic treatment of Ocular Toxoplasmosis (pyrimethamine, sulfadiazine, and prednisolone) with a regimen consisting of trimethoprim/sulfamethoxazole (co-trimoxazole) plus prednisolone. Design Prospective randomized single-blind clinical trial. Participants Fifty-nine patients with active Ocular Toxoplasmosis were randomly assigned to 2 treatment groups: 29 were treated with pyrimethamine/sulfadiazine, and 30 patients received trimethoprim/sulfamethoxazole. Intervention Treatment consisted of 6 weeks' treatment with antibiotics plus steroids. AntiToxoplasmosis antibodies (immunoglobulin M [IgM] and IgG) were measured using an enzyme-linked immunosorbent assay. Main Outcome Measures Changes in retinochoroidal lesion size after 6 weeks' treatment, visual acuity (VA) before and after intervention, adverse drug reactions during follow-up, and rate of recurrence. Results Active Toxoplasmosis retinochoroiditis resolved in all patients over 6 weeks' treatment, with no significant difference in mean reduction of retinochoroidal lesion size between the 2 treatment groups (61% reduction in the classic treatment group and 59% in the trimethoprim/sulfamethoxazole group, P = 0.75). Similarly, no significant difference was found in VA after treatment between the 2 groups (mean VAs after treatment were 0.12 logarithm of the minimum angle of resolution [logMAR] [20/25] in the classic treatment group and 0.09 logMAR [20/25] in the trimethoprim/sulfamethoxazole group, P = 0.56). Adverse effects were similar in both groups, with one patient in each suffering from any significant drug side effects. The overall recurrence rate after 24 months' follow-up was 10.16%, with no significant difference between the treatment groups ( P = 0.64). Conclusions Drug efficacies in terms of reduction in retinal lesion size and improvement in VA were similar in a regimen of trimethoprim/sulfamethoxazole and the classic treatment of Ocular Toxoplasmosis with pyrimethamine and sulfadiazine. Therapy with trimethoprim/sulfamethoxazole seems to be an acceptable alternative for the treatment of Ocular Toxoplasmosis.
Mohammad Mehdi Sadoughi - One of the best experts on this subject based on the ideXlab platform.
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randomized trial of intravitreal clindamycin and dexamethasone versus pyrimethamine sulfadiazine and prednisolone in treatment of Ocular Toxoplasmosis
Ophthalmology, 2011Co-Authors: Masoud Soheilian, Mohammad Mehdi Sadoughi, Mohammad H Dehghan, Alireza Ramezani, Ahmad Azimzadeh, Reza Shahghadami, Mehdi Yaseri, Gholam A PeymanAbstract:Purpose To compare the efficacy of intravitreal injection of clindamycin and dexamethasone with classic treatment for Ocular Toxoplasmosis. Design Prospective, randomized single-masked clinical trial. Participants 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. Intervention The IVCD group received 1 to 3 injection(s) of 1 mg intravitreal clindamycin and 400 μg 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. Main Outcome Measures Changes in retinochoroidal lesion size, measured by a computer program written in the MATLAB environment, 6 weeks after initiation of treatment. Visual acuity (VA) changes, vitreous inflammatory response, adverse drug reactions, and rate of recurrence were secondary outcome measures. Results The mean number of injections in the IVCD group was 1.6. The lesion size reduction was statistically significant after treatment in both IVCD and CT groups ( P P = 0.009, respectively). However, the difference in mean percentage of reduction at 6 weeks was not significant: 57.0±27.8% in the IVCD group versus 58.4±29.3% in the CT group ( P = 0.569). In relation to the 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 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 insignificant 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. Conclusions Intravitreal injection of clindamycin and dexamethasone may be an acceptable alternative to the classic treatment in Ocular Toxoplasmosis. It may offer the patient more convenience, a safer systemic side effect profile, greater availability, and fewer follow-up visits and hematologic evaluations. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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short term results of two treatment regimens in Ocular Toxoplasmosis trimethoprim sulfamethoxazole versus pyrimethamine and sulfadiazine
Journal of ophthalmic and vision research, 2006Co-Authors: Mohammad Mehdi Sadoughi, Mohammad H Dehghan, Hassan Behboudi, Arash Anisian, Soheylian Masoud, Yazdani ShahinAbstract:Purpose : To compare the efficacy of classic treatment for Ocular Toxoplasmosis (pyrimethamine, sulfadiazine and predinsolone) with a regimen consisting of trimethoprim/sulfamethoxazole (TMP/SMX) [co-trimoxazole] plus predinsolone. Methods : In a prospective randomized single-blind clinical trial, 59 patients with active Ocular Toxoplasmosis were randomly assigned to two treatment groups: 29 were treated with pyrimethamine/sulfadiazine and 30 patients received TMP/SMX. Treatment consisted of six weeks treatment with antibiotics plus steroids. Anti-Toxoplasmosis antibodies (IgM and IgG) were measured using ELISA. Outcome measures included changes in retinochoroidal lesion size after six weeks of treatment, visual acuity before and after intervention, adverse drug reactions during follow up and rate of recurrence. Results : Active Toxoplasmosis retinochoroiditis resolved in all patients over six weeks of treatment with no significant difference in mean reduction in retinochoroidal lesion size between the two treatment groups (61% reduction in the classic treatment group and 59% in the TMP/SMX group, P=0.75). Similarly no significant difference was found in visual acuity after treatment between the two groups [mean visual acuity after treatment was 0.12 LogMAR (20/25) in classic treatment group and 0.09LogMAR (20/25) in TMP/SMX group, P = 0.56]. Adverse events were similar in both groups with one patient in each suffering from any significant drug side effects. The overall recurrence rate after 14 months of follow up was 6.7% with no significant difference between the treatment groups (P = 0.48). Conclusion : Drug efficacy in terms of reduction in retinal lesion size and improvement in visual acuity was similar between a regimen of TMP/SMX and the classic treatment of Ocular Toxoplasmosis with pyrimethamine and sulfadiazine. Therapy with TMP/SMX appears to be an acceptable alternative for the treatment of Ocular Toxoplasmosis.
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prospective randomized trial of trimethoprim sulfamethoxazole versus pyrimethamine and sulfadiazine in the treatment of Ocular Toxoplasmosis
Ophthalmology, 2005Co-Authors: Masoud Soheilian, Mohammad Mehdi Sadoughi, Mehdi Ghajarnia, Mohammad H Dehghan, Shahin Yazdani, Hassan Behboudi, Arash Anisian, Gholam A PeymanAbstract:Objective To compare the efficacy of the classic treatment of Ocular Toxoplasmosis (pyrimethamine, sulfadiazine, and prednisolone) with a regimen consisting of trimethoprim/sulfamethoxazole (co-trimoxazole) plus prednisolone. Design Prospective randomized single-blind clinical trial. Participants Fifty-nine patients with active Ocular Toxoplasmosis were randomly assigned to 2 treatment groups: 29 were treated with pyrimethamine/sulfadiazine, and 30 patients received trimethoprim/sulfamethoxazole. Intervention Treatment consisted of 6 weeks' treatment with antibiotics plus steroids. AntiToxoplasmosis antibodies (immunoglobulin M [IgM] and IgG) were measured using an enzyme-linked immunosorbent assay. Main Outcome Measures Changes in retinochoroidal lesion size after 6 weeks' treatment, visual acuity (VA) before and after intervention, adverse drug reactions during follow-up, and rate of recurrence. Results Active Toxoplasmosis retinochoroiditis resolved in all patients over 6 weeks' treatment, with no significant difference in mean reduction of retinochoroidal lesion size between the 2 treatment groups (61% reduction in the classic treatment group and 59% in the trimethoprim/sulfamethoxazole group, P = 0.75). Similarly, no significant difference was found in VA after treatment between the 2 groups (mean VAs after treatment were 0.12 logarithm of the minimum angle of resolution [logMAR] [20/25] in the classic treatment group and 0.09 logMAR [20/25] in the trimethoprim/sulfamethoxazole group, P = 0.56). Adverse effects were similar in both groups, with one patient in each suffering from any significant drug side effects. The overall recurrence rate after 24 months' follow-up was 10.16%, with no significant difference between the treatment groups ( P = 0.64). Conclusions Drug efficacies in terms of reduction in retinal lesion size and improvement in VA were similar in a regimen of trimethoprim/sulfamethoxazole and the classic treatment of Ocular Toxoplasmosis with pyrimethamine and sulfadiazine. Therapy with trimethoprim/sulfamethoxazole seems to be an acceptable alternative for the treatment of Ocular Toxoplasmosis.
