Acute choroidal ischemia associated with toxoplasmic retinochoroiditis.
OBJECTIVE
To describe eight patients with active toxoplasmic retinochoroiditis (RC) who had features suggestive of acute choroidal ischemia.


METHODS
A retrospective review of the clinical records of 23 consecutive patients with acute toxoplasmic RC was performed. All patients underwent detailed ophthalmic examination at presentation and throughout follow-up, including dilated biomicroscopic fundus examination, fundus photography, fluorescein angiography, and indocyanine green (ICG) angiography.


RESULTS
Of 23 patients, 8 (34.8%) had a large area of retinal whitening surrounding a small focus of RC. Fluorescein as well as ICG angiography showed a well demarcated geographic area of early choroidal hypofluorescence that extended beyond the clinical borders of the white retinal lesion, particularly by ICG angiography. Associated findings for these 8 patients included old retinochoroidal scars (7 [87.5%]), serous retinal detachment (3 [37.5%]), retinal hemorrhages (1 [12.5%]), and multiple satellite dark dots by ICG angiography (6 [75%]). Seven of eight patients were treated using a combination of antitoxoplasmic drugs and corticosteroids. All findings seen at the acute stage resolved in 2 weeks to 6 weeks. A small atrophic retinochoroidal scar replaced the active toxoplasmic lesion and was surrounded with mild or moderate retinal pigment epithelium changes that were associated with decreased final visual acuity in 2 patients (25%).


CONCLUSIONS
Patients with toxoplasmic RC may develop features suggestive of choroidal ischemia that can result in a transient or permanent decrease in vision. Choroidal ischemia can only be suspected clinically, and fluorescein angiography and ICG angiography are required to establish the definitive diagnosis.
Khairallah
Moncef
M
Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia. moncef.khairallah@rns.tn
Yahia
Salim Ben
SB
Zaouali
Sonia
S
Jenzeri
Salah
S
Attia
Sonia
S
Messaoud
Riadh
R
D000208:Acute Disease; D000328:Adult; D017963:Azithromycin / Q000627:therapeutic use; D002825:Chorioretinitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D002829:Choroid / Q000098:blood supply*; D004396:Coloring Agents; D004359:Drug Therapy, Combination; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology*; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D011739:Pyrimethamine / Q000627:therapeutic use; D012189:Retrospective Studies; D014126:Toxoplasmosis, Ocular / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
D004396:Coloring Agents; D017963:Azithromycin; D007208:Indocyanine Green; D002955:Leucovorin; D011241:Prednisone; D011739:Pyrimethamine