Stephen J. Kim, MD1; Ingrid U. Scott, MD, MPH2; Gary C. Brown, MD, MBA3,4,5; Melissa M. Brown, MD, MBA3,4,6; Allen C. Ho, MD7; Michael S. Ip, MD8; Franco M. Recchia, MD9
Ophthalmology, February 2013, Vol 120, 371-378 © 2013 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Objective: To evaluate the available evidence in peer-reviewed publications about the outcomes and safety of interventions for toxoplasma retinochoroiditis (TRC).
Methods: Literature searches of the PubMed and the Cochrane Library databases were last conducted on July 20, 2011 with no date restrictions. The searches retrieved 275 unique citations, and 36 articles of possible clinical relevance were selected for full text review. Of these 36 articles, 11 were deemed sufficiently relevant or of interest, and they were rated according to strength of evidence.
Results: Eight of the 11 studies reviewed were randomized controlled studies, and none of them demonstrated that routine antibiotic or corticosteroid treatment of TRC favorably affects visual outcomes or reduces lesion size. There is level II evidence from 1 study suggesting that long-term treatment with trimethoprim and sulfamethoxazole prevented recurrent disease in patients with chronic relapsing TRC. Adverse effects of antibiotic treatment were reported in as many as 25% of patients. There was no evidence supporting the efficacy of other nonmedical treatments such as laser photocoagulation.
Conclusions: There is a lack of level I evidence to support the efficacy of routine antibiotic or corticosteroid treatment for acute TRC in immunocompetent patients. There is level II evidence suggesting that long-term prophylactic treatment may reduce recurrences in chronic relapsing TRC. Adverse effects of certain antibiotic regimens are freqent, and patients require regular monitoring and timely discontinuation of the antibiotic in some cases.
1Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
2Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
3Center for Value Based Medicine, Flourtown, Pennsylvania
4Eye Research Institute, Philadelphia, Pennsylvania
5The Retina Service, Wills Eye Institute, Jefferson Medical College, Philadelphia, Pennsylvania
6Research Department, Wills Eye Institute, Jefferson Medical College, Philadelphia, Pennsylvania
7Mid Atlantic Retina, Wills Eye Institute, Philadelphia, Pennsylvania
8University of Wisconsin Medical School, Madison, Wisconsin
9Tennessee Retina PC, Nashville, Tennessee