• Frederick Robinson posted an update 3 days, 14 hours ago

    Patients were clinically diagnosed by the presence of an active white and bright focal retinal lesion with blurred margins with or without dark retinochoroidal scars. Confirmation was obtained by serum IgG and IgM antibody against T. gondii in all patients. The inclusion criteria were age between 16 and 75 years and lesions that matched the modified criteria formulated by Holland and associates; [1] a lesion within 3000 μm from the foveal center (zone 1) or [2] a lesion >2 disc diameters in size with 3–4 (+) vitreous shk within the region beyond the borders of zone 1 (zones 2 and 3).6The exclusion criteria were the presence of other ocular diseases including other causes of uveitis, glaucoma, any retinal lesion, and systemic conditions such as uncontrolled diabetes, pregnancy, and any history of hypersensitivity to azithromycin and Sulfonamides, immunosuppression especially HIV or consumption of immunosuppressive drugs, history of any previous adverse drug reaction, corticosteroid treatment within 1 month prior to visit, and best corrected visual acuity (BCVA) less than 20/400 (1.3 logMAR) on the Snellen chart in either eye.A total of 36 patients were clinically diagnosed with toxoplasmic retinochoroiditis, 5 patients used steroid drugs due to systemic diseases so they received the classic treatment, and 4 patients were lost to follow-up. Finally, using block randomization, 27 patients completed the study. Fourteen patients were treated with oral azithromycin, and 13 patients were treated with oral trimethoprim/sulfamethoxazole. The first group received 500 mg as a loading dose for one day followed by azithromycin 250 mg daily. In the second group, treatment included trimethoprim (160 mg)/sulfamethoxazole (800 mg) twice daily. Both groups were assigned to treatment for 6–12 weeks. Both groups received oral prednisone 1 mg/kg daily from the third day, and the dose was tapered over 2 weeks based on vitritis control.A masked ophthalmologist examined patients on day 1 and then after 1, 2, 3, 5, 6, 8, and 12 weeks. The patients were observed for at least 9 months after treatment completion. On each visit, BCVA was measured with a Snellen chart (converted to the logMAR) for all patients, and anterior vitreous inflammation was estimated according to the system devised by Kimura et al16 which is the base of SUN group for uveitis classification. Fundus examination was done using a slit-lamp with a 90-diopter lens and indirect ophthalmoscopy. Goldmann applanation tonometry was also performed. Fundus photographs, fundus autofluorescence (FAF), and infrared reflectance (IR) imaging were taken on day one and then after 4 and 12 weeks of therapy (Retinal Angiography system, HRA2; Heidelberg Engineering, Dossenheim, Germany). Computer-assisted measurement of the initial and final lesion size was done in square millimeter on fundus photography, IR, and FAF using the Digimizer (version 4.2.2) image analysis software (MedCalc Software, Ostend, Belgium). This digital analyzer also measured the ratio of the lesion area to disc area in each patient\’s FAF. A change in the lesion size was calculated from these measurements. If the active lesion was adjacent to the old scar, the lesion size was generally considered as one lesion, while in 6 patients in which the active lesion was far from the old scar, the active lesion and old scar were calculated separately.