Toxoplasmic Retinochoroiditis: Clinical Characteristics and Visual Outcome in a Prospective Study

Purpose
To ascertain the clinical features and visual outcome of toxoplasma retinochoroiditis in a large series of cases.
Subjects and Methods
Two hundred and thirty subjects diagnosed with active toxoplasma retinochoroiditis were prospectively followed for periods ranging from 269 to 1976 days. All patients presented with active retinochoroiditis and positive IgG T. gondii serology at the beginning of the study and received a standardized drug treatment for toxoplasmosis, both in the first episode and in the subsequent recurrences.
Results
The group involved 118 (51.3%) men and 112 (48.7%) women, with ages ranging from 14 to 77 years, mean of 32.4 years (SD = 11.38). Primary retinochoroidal lesions were observed in 52 (22.6%) cases and active retinochoroiditis combined with old scars in 178 (77.4%) subjects at the beginning of the study. A hundred sixty-two recurrent episodes in 104 (45.2%) patients were observed during follow-up. New subclinical retinochoroidal lesions were detected in 23 of 162 (14.2%) recurrences episodes during the follow-up. Posterior segment complications were observed in 73 (31.7%) subjects. Retinochoroidal lesions adjacent to the optic nerve and in the macular area were observed in 27 of 40 (67.5%) cases of severe visual impairment (VA = 20/200 or worse).
Conclusion
Toxoplasma retinochoroiditis in this population had a high recurrence rate after an active episode. Severe visual impairment was associated with location of the retinochoroidal scar, recurrences and posterior segment complications. It is crucial to consider the location of the lesion in studies analyzing visual prognosis as a measure for treatment effectiveness and prevention strategies.

研究目的
探明大样本病例系列中弓形虫性视网膜脉络膜炎（toxoplasma retinochoroiditis）的临床特征与视觉预后。
研究对象与方法
本研究前瞻性随访了230例确诊为活动性弓形虫性视网膜脉络膜炎的患者，随访时长为269至1976天不等。所有入组患者在研究初始均表现为活动性视网膜脉络膜炎，且血清刚地弓形虫（Toxoplasma gondii）IgG检测呈阳性；无论首次发病还是后续复发，患者均接受了标准化的弓形虫病药物治疗方案。
研究结果
本研究纳入的患者中，男性118例（51.3%），女性112例（48.7%），年龄范围为14至77岁，平均年龄32.4岁（标准差SD=11.38）。研究初始时，52例（22.6%）患者表现为原发性视网膜脉络膜病变，178例（77.4%）患者表现为活动性视网膜脉络膜炎合并陈旧性瘢痕。随访期间，共在104例（45.2%）患者中观察到162次复发事件。在162次复发事件中，有23次（14.2%）检出了新发亚临床视网膜脉络膜病变。73例（31.7%）患者出现了后节并发症。在40例重度视力损害（视力VA=20/200或更差）的患者中，有27例（67.5%）的视网膜脉络膜病变位于视神经旁或黄斑区。
研究结论
本研究人群中的弓形虫性视网膜脉络膜炎在活动性发作后复发率较高。重度视力损害与视网膜脉络膜瘢痕的位置、复发事件及后节并发症显著相关。在分析视力预后以评估治疗有效性与制定预防策略的研究中，病变位置是至关重要的考量因素。