Intravitreal cotrimoxazole as adjuvant therapy for active ocular toxoplasmosis: a case series and literature review

TL;DR

This study shows that adding intravitreal cotrimoxazole to standard treatment for severe eye toxoplasmosis improves vision and reduces inflammation safely.

Contribution

The study introduces a novel adjuvant intravitreal cotrimoxazole therapy for active ocular toxoplasmosis with promising clinical outcomes.

Findings

All patients showed rapid reduction in inflammation and lesion size within one month.

Visual acuity improved to 8/10 to 10/10 in all patients with no complications.

No recurrence or systemic/ocular complications occurred during three months of follow-up.

Abstract

Ocular toxoplasmosis represents the most common cause of posterior uveitis worldwide and remains a major cause of visual morbidity, particularly among young and immunocompetent individuals. The purpose of this study is to assess the efficacy and safety of combined intravitreal trimethoprim/sulfamethoxazole and dexamethasone with concurrent systemic cotrimoxazole and oral corticosteroids in patients with active Toxoplasma chorioretinitis.

This retrospective interventional case series included a total of seven eyes from seven consecutive patients with active necrotizing toxoplasma retinochoroiditis and dense vitritis involving zone 1. All examinations were performed by a uveitis specialist. Each patient received a single intravitreal injection of trimethoprim/sulfamethoxazole and dexamethasone, in addition to systemic cotrimoxazole and prednisolone. Clinical evaluation included best-corrected visual acuity (BCVA), intraocular pressure (IOP), grading of ocular inflammation, and fundus examination. Patients were followed weekly for one month and subsequently on a monthly basis for three months.

All patients demonstrated a rapid reduction in inflammation and lesion size, accompanied by improvement in BCVA, achieving a final visual acuity of 8/10 to 10/10 at one month. No ocular or systemic complications, IOP elevation, or recurrence were observed during the three-month follow-up period.

Adjuvant intravitreal cotrimoxazole therapy appears to be a safe and effective option for vision-threatening ocular toxoplasmosis, providing rapid disease control and excellent visual outcomes.

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