title: Corticosteroids as adjuvant therapy for ocular toxoplasmosis.
abstract: BACKGROUND
  Ocular infestation with Toxoplasma gondii, a parasite, may result in inflammation in the retina, choroid, and uvea and consequently lead to complications such as glaucoma, cataract, and posterior synechiae.
  
  
  OBJECTIVE
  The objective of this systematic review was to assess the effects of adjunctive use of corticosteroids for ocular toxoplasmosis.
  
  
  METHODS
  We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to October 2012), EMBASE (January 1980 to October 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to October 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We searched the reference lists of included studies for any additional studies not identified by the electronic searches. We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 11 October 2012.
  
  
  METHODS
  We planned to include randomized and quasi-randomized controlled trials. Eligible trials would have enrolled participants of any age who were immunocompetent and were diagnosed with active ocular toxoplasmosis. Included trials would have compared anti-parasitic therapy plus corticosteroids versus anti-parasitic therapy alone, or different doses or times of initiation of corticosteroids.
  
  
  METHODS
  Two authors independently screened titles and abstracts retrieved from the electronic searches. We retrieved full-text articles of studies categorized as 'unsure' or 'include' after review of the abstracts. Two authors independently reviewed each full-text article. Discrepancies were resolved through discussion.
  
  
  RESULTS
  The electronic searches retrieved 368 titles and abstracts. We reviewed 20 full-text articles. We identified no trials eligible for inclusion in this systematic review.
  
  
  CONCLUSIONS
  Although research has identified wide variation in practices regarding use of corticosteroids, our systematic review did not identify evidence from randomized controlled trials for the role of corticosteroids in the management of ocular toxoplasmosis. Several questions remain unanswered by well-conducted randomized trials in this context, including whether use of corticosteroids is more effective than use of anti-parasitic therapy alone, when corticosteroids should be initiated in the treatment regimen (early versus late course of treatment), and which dosage and duration of steroid use is best. These questions are easily amenable to research using a randomized controlled design and they are ethical due to the absence of evidence to support or discourage use of corticosteroids for this condition. The question of foremost importance, however, is whether they should be used as adjunct therapy (that is, additional) to anti-parasitic agents.
authors: Department of Ophthalmology, ChristianMedical College, Vellore, India.
authors: Smitha
authors: S
authors: Jasper
authors: Satyanarayana S
authors: SS
authors: Vedula
authors: Sheeja S
authors: SS
authors: John
authors: Saban
authors: S
authors: Horo
authors: Yasir J
authors: YJ
authors: Sepah
authors: Quan Dong
authors: QD
authors: Nguyen
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D014126:Toxoplasmosis, Ocular / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones
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