# 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.

## Key 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.