Recurrent choroidal neovascularization complicating ocular toxoplasmosis in a child

Author: Kmar Maaloul (Tunisia)

Co-authors: Salma Gargouri, Mona Rekik, Takwa Sammouda, Imen Kaibi, Saloua Ben Amor, Amira Trigui

Purpose

To describe a case of recurrent choroidal neovascularization complicating ocular toxoplasmosis in a child

Setting/Venue

Department of Ophthalmology, Habib Bourguiba University Hospital, Sfax, Tunisia.

Methods

Case report.

Results

A 12-year-old child with a history of functional amblyopia in the left eye was seen for progressive visual acuity decrease in the right eye. The best corrected visual acuity was 3/10 in the right eye and counting fingers at two meters in the left eye. Results of slit-lamp examination were unremarkable. Fundus examination showed temporomacular atrophopigmentary foci with superficial macular hemorrhage in the right eye and papillary dysversion in the left eye. Fluorescein angiography was in favor of cicatricial foci and Swept Source-OCT and OCT-angiography showed the presence of an active choroidal neovessel. After an exhaustive etiological assessment, the diagnosis of a cicatricial toxoplasmic retinochoroiditis complicated by choroidal neovascularization was made. The child was treated with an intravitreal injection of bevacizumab with improvement in visual acuity and reduction of the neovessel and the exudative signs. The evolution was marked by a recurrence 10 months later. The child received another intravitreal injection of bevacizumab. The final visual acuity in the right eye was 7/10.

Conlusions

One of the possible complications of a toxoplasmic retinochoroiditis scar is the occurrence of choroidal neovascularization. The alteration of the Bruch membrane by a former focus can promote the development of a choroidal neovessel generally adjacent to it. Multimodal imaging can make the diagnosis and eliminate an active focus. Intravitreal injections of anti-VEGF have shown their effectiveness in the regression of these neovessels, but recurrence remains possible.

Financial Disclosure

No

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