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Volume 26, Number 12—December 2020

Clinical and Multimodal Imaging Findings and Risk Factors for Ocular Involvement in a Presumed Waterborne Toxoplasmosis Outbreak, Brazil1

Camilo Brandão-de-Resende, Helena Hollanda Santos, Angel Alessio Rojas Lagos, Camila Munayert Lara, Jacqueline Souza Dutra Arruda, Ana Paula Maia Peixoto Marino, Lis Ribeiro do Valle Antonelli, Ricardo Tostes Gazzinelli, Ricardo Wagner de Almeida Vitor, and Daniel Vitor Vasconcelos-SantosComments to Author 
Author affiliations: Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (C. Brandão-de-Resende, H.H. Santos, A.A.R. Lagos, C.M. Lara, J.S.D. Arruda, R.W.A, Vitor, D.V. Vasconcelos-Santos); Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte (A.P.M.P. Marino, L.R.V. Antonelli, R.T. Gazzinelli).

Main Article

Table 2

Characterization of patterns of retinochoroiditis seen in multimodal imaging among patients with toxoplasmosis treated with antiparasitic drugs and oral corticosteroids, Brazil*

Type of lesion, fundus imaging modality
Patterns of retinochoroiditis
Active phase, before treatment
Cicatricial phase, after treatment
Focal necrotizing retinochoroiditis
Fundus photo or examination Dense focal retinal whitening with indistinct borders, associated with overlying vitreous haze Initially hypopigmented retinochoroidal scar, but frequently evolving with variable degree of pigmentation and subretinal fibrosis or preretinal gliosis
SD-OCT Focal full-thickness hyper-reflectivity and disorganization of retinal layers indicating necrotizing retinitis; surrounding retinal thickening, signaling edema; numerous overlying hyper-reflective dots at the vitreous indicating vitreal inflammatory cell exudate; and underlying fusiform choroidal thickening, with loss of stromal/luminal pattern indicating reactive choroiditis Disorganization of retinal architecture; hyper-reflectivity at the level of the scar, but without perilesional retinal thickening; resolution of choroidal thickening; marked decrease in the number of overlying vitreal hyper-reflective dots; and frequent tent-like focal detachment of the less thickened overlying posterior hyaloid
FAF reflectances Subtle hypo- or hyper-autofluorescence changes at the level of the active lesion; near infrared reflectance can indicate active focus but not as remarkably as red-free reflectance Increased autofluorescence signal in the first weeks, then hypo-autofluorescence at the level of the scar after several months; scars less clearly delineated by near-infrared than red-free reflectance, but both reveal retinal wrinkling in the presence of epiretinal membrane
Early hypofluorescence, with progressive hyperfluorescence and late leakage at the retinochoroiditis lesion; reactive changes, including hyperfluorescence, of optic disc indicating edema; staining of venular walls, signaling periphlebitis
Variable window defects and blockage at the level of the scar; staining in the presence of subretinal fibrosis and epiretinal gliosis
Punctate retinochoroiditis
Fundus photo or examination Multiple subtle, indistinct, or confluent gray-whitish punctate retinal infiltrates with minimal vitreous haze Very subtle changes in retinal reflex, sometimes with minor hypopigmentation, but frequently with no apparent abnormality
SD-OCT Multifocal hyper-reflectivity at the inner retinal layers, demonstrating retinitis, occasionally extending to deeper layers, with surrounding retinal thickening (edema); numerous overlying hyper-reflective dots indicating vitreal inflammatory cell exudate, along with thickening and shallow detachment of the posterior hyaloid; mild choroidal thickening without apparent major change in reflectivity Frequent normalization of the retinal architecture, sometimes with mild disruption of outer retinal layers or retinal pigment epithelium; normalization of choroidal thickening; marked decrease in the number of overlying vitreal hyper-reflective dots and frequent tent-like focal detachment of the less-thickened overlying posterior hyaloid
FAF reflectances Subtle hypo- or hyper-autofluorescence changes at the level of the punctate active lesions; near-infrared reflectance can show changes at the area of active foci but not as remarkably as red-free reflectance Autofluorescence and reflectance changes are minimal or absent
FFA Progressive but mild hyperfluorescence or late leakage at the site of punctate lesions; reactive changes, including hyperfluorescence of optic disc, demonstrating edema; staining of venular walls indicating periphlebitis
Normal or showing minimal punctate window defects

*FAF, fundus autofluorescence; FFA, fundus fluorescein angiography; SD-OCT, spectral-domain optical coherence tomography.

Main Article

1Presented in part at the 2015 American Uveitis Society Fall meeting, November 15, 2014, Las Vegas, Nevada, USA

Page created: October 05, 2020
Page updated: November 19, 2020
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