Case of Macular Hole Secondary to Ocular Toxoplasmosis Treated Successfully by Vitrectomy with Inverted Internal Limiting Membrane Flap

Surgical management of retinal detachment and macular holes secondary to ocular toxoplasmosis: a systematic review and meta-analysis

BACKGROUND

Toxoplasma gondii causes ocular toxoplasmosis (OT), involving inflammation, scarring, and retinal complications. The OT complications were retinal detachment (RD), and retinal breakage (RB). Surgical interventions like scleral buckling (SB) and vitrectomy are common. Limited understanding exists of the safety and efficacy of surgical management of RD/RB secondary to OT. Another complication is toxoplasmosis-related macular holes (tMH), with sparse evidence on surgical outcomes. This meta-analysis aims to clarify clinical characteristics, and surgical results, and enhance understanding of RD, RB, and MH secondary to OT.

METHODS

PubMed, Cochrane, Embase and Web of Science database were queried for retrospective studies, case series and case reports that provided information on RD, RB and MH associated with OT and reported the outcomes of: (1) Retinal reattachment of RD/RB and tMH closure; (2) Best-corrected visual acuity (BCVA) improvement; and (3) Complications. Heterogeneity was examined with I2 statistics. A random-effects model was used for outcomes with high heterogeneity. Statistical analysis was performed using the software R (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria).

RESULTS

Fourteen final studies, comprising a total of 96 patients were analyzed, 81 with RD or RB and 15 with tMH. Overall, surgical management was associated with several advantages: a high rate of retinal reattachment of RD/RB of 97% (95% Confidence Interval [CI] 92-100%; I2 = 0%), retinal reattachment of just RD of 96% (95% CI 89-100%; I2 = 30%) and tMH closure 97% (95% CI 87-100; I2 = 12%). There were significant differences in BCVA after surgeries in studies of RD/RB (MD 0.60; 95% CI 0.35-0.65; I2 = 20%) and MH (MD 0.67; 95% CI 0.50-0.84; I2 = 0%). The overall complication rate associated with surgical procedures in RD/RB secondary to OT was confirmed to be 25%.

CONCLUSIONS

The systematic review and meta-analysis showed that the treatment approaches currently in use are effective, with a remarkable rate of retinal reattachment of RD/RB, tMH closure, and substantial improvements in visual acuity. More randomized, long-term studies on disease and surgical factors can provide valuable insights into their impact on anatomical and visual outcomes.

Macular Pucker: A Devastating Complication in Ocular Toxoplasmosis

Ocular toxoplasmosis has multiple devastating complications with possible recurrence. A potentially blinding complication of ocular toxoplasmosis is macular pucker. Here, we report a case of macular pucker in ocular toxoplasmosis treated with azithromycin and prednisolone. A 35-year-old woman complained of central scotoma for six days, which was associated with fever, headache, joint pain, and myalgia. Her visual acuity was counting finger OD and 6/18 OS. Her right eye optic nerve function test was impaired. Fundoscopy showed bilateral optic disc swelling that progressed to retinal fibrosis over papillomacular bundle and macular pucker over the right eye. CT scan of the brain and orbit was normal. Toxoplasma titer was positive. She was diagnosed to have a right eye macular pucker secondary to ocular toxoplasmosis. Oral azithromycin and oral prednisolone (on a tapering dose) were administered for six weeks. Fundoscopy showed resolved optic disc swelling. However, her vision in the right eye remained poor. Ocular toxoplasmosis may progress to macular pucker which can lead to poor vision and legal blindness. Reduced vision-related quality of life notably in the younger population as a complication of ocular toxoplasmosis is difficult to prevent. However, therapy with azithromycin and prednisolone may reduce the negative consequences of inflammation and shrink lesions, especially when the lesions are located at the macula or near the optic disc. Vitrectomy is an alternative treatment for complications such as macular pucker in selected cases.

Treatment of a full-thickness macular hole and retinal detachment secondary to toxoplasma chorioretinitis that developed shortly after COVID-19: A case report

Although ocular toxoplasmosis is usually a self-limiting infection, it can lead to severe reduction in visual acuity due to intense vitreous inflammation or involvement of posterior segment structures. Depending on the severity of intraocular inflammation, serious complications, including epiretinal membrane or retinal detachment may develop. In this paper, we aim to present a case that complicated by both a full-thickness macular hole and retinal detachment secondary to toxoplasmosis chorioretinitis that developed shortly after the novel coronavirus disease (COVID-19) and discuss our treatment approach. After the patient was diagnosed based on a routine ophthalmological examination, fundus imaging, and serological examination, functional and anatomical recovery was achieved through systemic antibiotherapy and vitreoretinal surgery. Full-thickness macular hole and retinal detachment are rare complications of ocular toxoplasmosis. However, there are only few publications in the literature concerning these complications and their surgical treatment. In this case report, we demonstrated the success of vitreoretinal surgery combined with antibiotic therapy on the posterior segment complications of ocular toxoplasmosis.