Local treatment of toxoplasmic retinochoroiditis with intravitreal clindamycin and dexamethasone

ABSTRACTPurpose:To report the clinical outcomes of local treatment of toxoplasmic retinochoroiditis (TRC) with intravitreal injections of clindamycin and dexamethasone.Methods:Study population: 16 eyes (16 patients) with active TRC sparing the macula and juxtapapillary area treated with intravitreal injections of clindamycin (1 mg) and dexamethasone (1 mg) without concomitant systemic antitoxoplasmic or anti-inflammatory therapy. Measured parameters: Best-corrected visual acuity (BCVA) was measured by an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. BCVA and clinical characteristics of retinochoroiditis were assessed at baseline and at 1, 3, 6, and 12 months. Primary outcome measures: Resolution of retinochoroiditis and changes in BCVA.Results:Control of TRC was achieved in all cases with a mean interval of 2.48 ± 1.03 weeks (2-6 weeks). A single injection of intravitreal clindamycin and dexamethasone was performed in 12 patients, and four patients required two intravitreal injections, during the follow-up period. Fourteen eyes (87.5%) improved ≥ 2 ETDRS lines of BCVA, of two or more Early Treatment Diabetic Retinopathy Study lines, BCVA remained stable in two eyes (12.5%), and no patient had decreased BCVA at the end of the follow-up period. No ocular or systemic adverse events were observed.Conclusion:Local treatment with intravitreal injections of clindamycin and dexamethasone without concomitant systemic therapy was associated with resolution of TRC in patients without macular or juxtapapillary involvement. Intravitreal clindamycin and dexamethasone may represent a viable treatment option in patients with allergies or inadequate responses to oral medications.

摘要
目的：报告玻璃体内注射克林霉素与地塞米松治疗弓形虫性视网膜脉络膜炎（toxoplasmic retinochoroiditis, TRC）的临床疗效。
方法：
研究对象：16例（16眼）活动期弓形虫性视网膜脉络膜炎患者，病变未累及黄斑及视乳头旁区域，予以玻璃体内注射克林霉素（1 mg）与地塞米松（1 mg）治疗，未联合全身抗弓形虫或抗炎治疗。
检测指标：采用早期糖尿病视网膜病变研究（Early Treatment Diabetic Retinopathy Study, ETDRS）视力表测量最佳矫正视力（best-corrected visual acuity, BCVA）。分别于基线及随访1、3、6、12个月时评估BCVA与视网膜脉络膜炎的临床特征。
主要结局指标：视网膜脉络膜炎的消退情况及BCVA变化。
结果：所有病例均实现TRC病情控制，平均间隔时间为2.48±1.03周（范围2~6周）。随访期间，12例患者仅接受单次玻璃体内克林霉素与地塞米松注射，4例患者需接受两次玻璃体内注射。14眼（87.5%）的BCVA提升≥2行ETDRS视力表行数；2眼（12.5%）BCVA维持稳定，随访期末无患者出现BCVA下降。未观察到眼部或全身不良事件。
结论：对于未累及黄斑及视乳头旁区域的TRC患者，予以玻璃体内注射克林霉素与地塞米松且不联合全身治疗的局部疗法，可实现TRC消退。对于口服药物过敏或口服治疗应答不佳的患者，玻璃体内注射克林霉素与地塞米松或为一种可行的治疗选择。