Purpose To present unique cystoid changes occurring in patients with ocular toxoplasmosis observed in spectral domain optical coherence tomography (OCT). Methods Forty-six patients (80 eyes) with a diagnosis of ocular toxoplasmosis, who underwent volume OCT examination between January 2005 and October 2012, were retrospectively collected. Review of clinical examination findings, fundus photographs, fluorescein angiograms (FA) and OCT image sets obtained at initial visits and follow-up. Qualitative and quantitative analyses of cystoid space phenotypes visualized using OCT. Results Of the 80 eyes included, 17 eyes (15 patients) demonstrated cystoid changes in the macula on OCT. Six eyes (7.5%) had cystoid macular edema (CME), 2 eyes (2.5%) had huge outer retinal cystoid space (HORC), 12 eyes (15%) had cystoid degeneration and additional 3 eyes (3.75%) had outer retinal tubulation due to age related macular degeneration. In one eye with HORC, the lesion was seen in the photoreceptor outer segment, accompanied by photoreceptor elongation and splitting. Three eyes presented with paravascular cystoid degeneration in the inner retina without other macular OCT abnormality. Conclusions In this study, different phenotypes of cystoid spaces seen in eyes with ocular toxoplasmosis using spectral domain OCT (SD-OCT) were demonstrated. CME presented as an uncommon feature, consistently with previous findings. Identification of rare morphological cystoid features (HORC with/without photoreceptor enlongation or splitting) on clinical examination had provided evidence to previous experimental models, which may also expand the clinical spectrum of the disease. Cystoid degeneration in the inner retina next to the retinal vessels in otherwise “normal” looking macula was observed, which may suggest more often clinical evaluation for those patients. Further studies are needed to verify the relevance of cystoid features seen on SD-OCT in assisting with the diagnosis and management of ocular toxoplasmosis.
References
[1]
Bosch-Driessen LEH, Berendschot TTJM, Ongkosuwito JV, Rothova A (2002) Ocular toxoplasmosis: clinical features and prognosis of 154 patients. Ophthalmology 109: 869–878. doi: 10.1016/s0161-6420(02)00990-9
[2]
Grossniklaus HE, Specht CS, Allaire G, Leavitt JA (1990) Toxoplasma gondii retinochoroiditis and optic neuritis in acquired immune deficiency syndrome. Report of a case. Ophthalmology 97: 1342–1346. doi: 10.1016/s0161-6420(90)32412-0
[3]
Roberts F, McLeod R (1999) Pathogenesis of toxoplasmic retinochoroiditis. Parasitology today (Personal ed) 15: 51–57. doi: 10.1016/s0169-4758(98)01377-5
[4]
Roberts T, Frenkel JK (1990) Estimating income losses and other preventable costs caused by congenital toxoplasmosis in people in the United States. Journal of the American Veterinary Medical Association 196: 249–256.
[5]
Keane PA, Patel PJ, Liakopoulos S, Heussen FM, Sadda SR, et al. (2012) Evaluation of age-related macular degeneration with optical coherence tomography. Survey of ophthalmology 57: 389–414. doi: 10.1016/j.survophthal.2012.01.006
[6]
Dodds EM, Holland GN, Stanford MR, Yu F, Siu WO, et al. (2008) Intraocular inflammation associated with ocular toxoplasmosis: relationships at initial examination. American journal of ophthalmology 146: 856–65.e2. doi: 10.1016/j.ajo.2008.09.006
[7]
Ouyang Y, Heussen FM, Mokwa N, Walsh AC, Durbin MK, et al. (2011) Spatial distribution of posterior pole choroidal thickness by spectral domain optical coherence tomography. Investigative ophthalmology & visual science 52: 7019–7026. doi: 10.1167/iovs.11-8046
[8]
Ouyang Y, Keane PA, Sadda SR, Walsh AC (2010) Detection of cystoid macular edema with three-dimensional optical coherence tomography versus fluorescein angiography. Investigative ophthalmology & visual science 51: 5213–5218. doi: 10.1167/iovs.09-4635
[9]
Ouyang Y, Heussen FM, Keane PA, Pappuru RKR, Sadda SR, et al. (2013) Evaluation of the axial location of cystoid spaces in retinal vein occlusion using optical coherence tomography. Retina (Philadelphia, Pa). doi: 10.1097/iae.0b013e318273f0e9
[10]
Heussen FM, Ouyang Y, Sadda SR, Walsh AC (2011) Simple estimation of clinically relevant lesion volumes using spectral domain-optical coherence tomography in neovascular age-related macular degeneration. Investigative ophthalmology & visual science 52: 7792–7798. doi: 10.1167/iovs.11-8023
[11]
Garg S, Mets MB, Bearelly S, Mets R (2009) Imaging of congenital toxoplasmosis macular scars with optical coherence tomography. Retina (Philadelphia, Pa) 29: 631–637. doi: 10.1097/iae.0b013e318198d8de
[12]
Bonfioli AA, Orefice F (2005) Toxoplasmosis. Seminars in ophthalmology 20: 129–141. doi: 10.1080/08820530500231961
[13]
Ouyang Y, Heussen FM, Keane PA, Sadda SR, Walsh AC (2013) The retinal disease screening study: prospective comparison of nonmydriatic fundus photography and optical coherence tomography for detection of retinal irregularities. Investigative ophthalmology & visual science 54: 1460–1468. doi: 10.1167/iovs.12-10727
[14]
Schlaegel TF, Weber JC (1984) The macula in ocular toxoplasmosis. Archives of ophthalmology 102: 697–698. doi: 10.1001/archopht.1984.01040030553014
[15]
Kianersi F, Naderi Beni A, Naderi Beni Z (2012) Clinical manifestation and prognosis of active ocular toxoplasmosis in Iran. International ophthalmology doi: 10.1007/s10792-012-9599-0
[16]
Kova？evi？-Pavi？evi？ D, Radosavljevi？ A, Ili？ A, Kova？evi？ I, Djurkovi？-Djakovi？ O (2012) Clinical pattern of ocular toxoplasmosis treated in a referral centre in Serbia. Eye (London, England) 26: 723–728. doi: 10.1038/eye.2012.20
[17]
Zweifel SA, Engelbert M, Laud K, Margolis R, Spaide RF, et al. (2009) Outer retinal tubulation: a novel optical coherence tomography finding. Archives of ophthalmology 127: 1596–1602. doi: 10.1001/archophthalmol.2009.326
[18]
Tedesco RC, Smith RL, Corte-Real S, Calabrese KS (2004) Ocular toxoplasmosis: the role of retinal pigment epithelium migration in infection. Parasitology research 92: 467–472. doi: 10.1007/s00436-003-1031-2
[19]
Ishihara K, Hangai M, Kita M, Yoshimura N (2009) Acute Vogt-Koyanagi-Harada disease in enhanced spectral-domain optical coherence tomography. Ophthalmology 116: 1799–1807. doi: 10.1016/j.ophtha.2009.04.002
[20]
Gallagher MJ, Yilmaz T, Cervantes-Casta？eda RA, Foster CS (2007) The characteristic features of optical coherence tomography in posterior uveitis. The British journal of ophthalmology 91: 1680–1685. doi: 10.1136/bjo.2007.124099
[21]
Diniz B, Regatieri C, Andrade R, Maia A (2011) Evaluation of spectral domain and time domain optical coherence tomography findings in toxoplasmic retinochoroiditis. Clinical ophthalmology (Auckland, NZ) 5: 645–650. doi: 10.2147/opth.s20033
[22]
Saxena S, Rastogi RAK, Vishvkarma K, Hansraj S, Meyer CH (2010) Spectral-domain optical coherence tomography in healed ocular toxoplasmosis. Journal of ocular biology, diseases, and informatics 3: 109–111. doi: 10.1007/s12177-011-9062-x
[23]
Holland GN (1999) Reconsidering the pathogenesis of ocular toxoplasmosis. American journal of ophthalmology 128: 502–505. doi: 10.1016/s0002-9394(99)00263-9
[24]
Frenkel JK (1961) Pathogenesis of toxoplasmosis with a consideration of cyst rupture in Besnoitia infection. Survey of ophthalmology 6: 799–825.
[25]
Cassady JV (1960) Toxoplasmic retinochoroiditis. Transactions of the American Ophthalmological Society 58: 392–431.
[26]
Gazzinelli RT, Brézin A, Li Q, Nussenblatt RB, Chan CC (1994) Toxoplasma gondii: acquired ocular toxoplasmosis in the murine model, protective role of TNF-alpha and IFN-gamma. Experimental parasitology 78: 217–229. doi: 10.1006/expr.1994.1022
[27]
Remington JSDG (1976) Toxoplasmosis. Infections diseases of the fetus and newborn infant. Saunders Philadelphia, PA. pp. 191–332.
