Multifocal Necrotizing Chorioretinitis Following Phacoemulsification Surgery.
BACKGROUND
Toxoplasma chorioretinitis is a leading cause of infectious posterior uveitis worldwide.


METHODS
We report an atypical presentation of Toxoplasma chorioretinitis presenting after uneventful cataract surgery in an 81-year-old male, with known hypernephroma and rheumatoid arthritis, treated with prednisolone and methotrexate.


RESULTS
He was treated for acute retinal necrosis and cytomegalovirus retinitis before Toxoplasma chorioretinitis was confirmed by vitreous biopsy 11 months after presentation. He developed a secondary rhegmatogenous retinal detachment, treated successfully with pars plana vitrectomy, silicone oil and endolaser. Visual acuity at discharge was 6/12 following silicone oil removal.


CONCLUSIONS
Necrotising chorioretinitis in immunosuppressed or elderly patients may present with an atypical phenotype. Clinical diagnosis in this context remains challenging. We discuss the clinical reasoning behind investigation and management of this patient group in whom viral and Toxoplasma retinitis may be clinically indistinguishable. The significance of vitreous PCR results in clinical decision making in the context of infectious posterior uveitis is discussed.
Department of Ophthalmology, Oxford Eye Hospital, Headley Way, Headington , Oxford , OX3 9DU United Kingdom .
Imran H
IH
Yusuf
Shahrnaz
S
Izadi
Timothy H M
TH
Fung
Ahmed
A
Sallam
C K
CK
Patel
D000369:Aged, 80 and over; D002825:Chorioretinitis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D002829:Choroid / Q000473:pathology; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018918:Phacoemulsification / Q000009:adverse effects*; D012086:Reoperation; D012160:Retina / Q000473:pathology; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods
Immunosupression; Toxoplasma chorioretinitis; investigation; phacoemulsification; posterior uveitis; postoperative iritis; toxoplasmosis