Toxoplasma chorioretinitis associated with retinal neovascularization in a 13-year old child

Author: Karina Spiess (United Kingdom)

Co-authors: Angela Ding-Wu, Mostafa Elgohary, Zoya Hameed

Purpose

To present a case of retinal neovascularization secondary to retinal ischaemia associated with toxoplasmoa chorioretinitis in a 13-year old child and subsequent regression after systemic treatment and sector retinal laser photocoagulation.

Setting/Venue

The Royal Eye Unit, Kingston Hospital, Kingston-upon-Thames, London (UK)

Methods

Case report with multimodal imaging including fluorescein angiography, sequential OCT scans and fundus photographs (Topcon, Heidelberg Spectralis OCT, and Optos wide field).

Results

A healthy 13-year-old female patient of Nigerian origin presented with 4-week history of blurry vision and floaters in the left eye. There was no relevant previous ocular history. On examination at presentation, her visual acuity was 6/6 in both eyes and intraocular pressure normal. She was diagnosed with left active peripheral toxoplasma chorioretinitis overlying a non-perfused vessel and moderate vitritis. Adjacent to this she developed a small retinal neovascular complex (NV) with preretinal haemorrhages. Fluorescein angiography confirmed neovascularization and sectorial non-perfusion anterior to the chorioretinitis lesion. Toxoplasma serology showed positive IgG and negative IgM titres. Examination of the fellow eye revealed an inferior pigmented retinochoroidal scar suggestive of previous toxoplasmosis retinitis. Oral Azithromycin was initiated however the NV complex tripled in size over a fortnight with little improvement in the vitritis and size of the chorioretinal lesion. Treatment was switched to oral Sulfadiazine and Prednisolone (0.5mg/kg) and the patient underwent sectorial laser PRP which led to regression of new vessels. At 7 weeks the vitritis had resolved and the toxoplasmosis lesion appeared inactive evolving into an atrophic healed scar.

Conlusions

Albeit rare, toxoplasmosis chorioretinitis can be associated with retinal vascular occlusions and secondary neovascularization in children. Close monitoring is advisable as neovascularization this may progress rapidly leading to haemorrhagic and sight threatening complications. Treating advanced ischaemia with sectorial PRP in tandem with systemic antimicrobials seems to be successful in these conditions. It is important to make both patient and parent aware of the potential side effects of retinal laser treatment including visual field defects.

Financial Disclosure

No financial disclosures