Vitreoretinal traction and lamellar macular holes associated with cicatricial toxoplasmic retinochoroiditis: case series report.
OBJECTIVE
Inflammation due to retinal neuroepithelial necrotic granulomas of toxoplasmosis can extend to neighbor areas and may develop focal adhesions of the posterior hyaloid, to the surface vessels, and the margins or adjoining areas of retinochoroiditis plaques. These adhesions may develop vitreoretinal traction and retinal tears. Vitreoretinal traction may be macular (VMT) or extramacular depending on the location of the toxoplasmic plaques. Vitreomacular traction may follow anomalous posterior vitreous detachment. We report 7 cases of vitreoretinal traction (macular or peripheral) and the development of 4 lamellar macular holes in cicatricial toxoplasmic retinochoroiditis.


METHODS
This is a retrospective and observational study by revision of clinical records in a retinologist office, using diagnostic techniques, especially optical coherence tomography (OCT), current management, and an extended follow-up. The OCT observations on toxoplasmic extramacular plaques are more difficult.


RESULTS
Seven cases in 5 patients, 2 of them bilateral, 3 male (66.6%) and 2 female, median age 46 years, were included. Anteroposterior VMT was found in 6 cases and another case was superotemporal midperipheral; 4 developed lamellar macular holes and 3 chronic macular epiretinal membranes. Best-corrected visual acuity was equal to or better than 20/30 in 3 cases, between 20/50 and 20/80 in 2 cases, and 20/160 to 20/200 in 2 cases. One small lamellar macular hole closed spontaneously during follow-up.


CONCLUSIONS
Inflammatory retinal granulomas of toxoplasmosis in cicatricial stages may present macular or peripheral focal vitreoretinal adhesions that can eventually lead to VMT and subsequent lamellar macular holes or peripheral retinal tears.
Fundación Oftalmológica Nacional-Universidad del Rosario, Bogotá - Colombia.
Alvaro
A
Rodríguez
Fundación Oftalmológica Nacional-Universidad del Rosario, Bogotá - Colombia.
Marcela
M
Valencia
Fundación Oftalmológica Nacional-Universidad del Rosario, Bogotá - Colombia.
Flor E
FE
Gomez
D000293:Adolescent; D000368:Aged; D005128:Eye Diseases / Q000175:diagnosis / Q000469:parasitology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000175:diagnosis / Q000469:parasitology*; D012167:Retinal Perforations / Q000175:diagnosis / Q000469:parasitology*; D012189:Retrospective Studies; D000267:Tissue Adhesions; D041623:Tomography, Optical Coherence / Q000379:methods; D014126:Toxoplasmosis, Ocular / Q000175:diagnosis / Q000469:parasitology*; D014792:Visual Acuity; D014822:Vitreous Body / Q000469:parasitology* / Q000473:pathology; D055815:Young Adult