First Author: N.Amine TUNISIA
Co Author(s): H. Amir T. Rafak B. Saloua F. Jamel
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Toxoplasmic retinochoroiditis (TRC) is the most common cause of infectious posterior uveitis. A vitreous inflammation is usually present and occasionally vasculitis is observed. Unusual clinical features on TRC such as vitreous haemorrhage (VH) may be observed. We report the case of an inactive TRC revealed by a VH due to peripheral retinal neo vascularization (RN) distant from the scar lesion.
20-year-old woman was referred with a two day history of a painless sudden visual loss in her right eye. Her past medical history was unremarkable.
Best corrected visual acuity was counting fingers at 50 centimeters in the right eye and 20/20 in the left eye. Anterior segment was normal and intraocular pressure was within the normal limits in both eyes. There was a mild to moderate VH in the right eye. Fundus examination showed an atrophic lesion measuring ¾ disc diameter in size, located at the supero-temporal vascular arcade. In the left eye fundus, there also was an atrophic retinochoroiditis lesion in the nasal mid periphery.
Fluorescein angiography showed central hypofluorescence and peripheral hyperfluorescence of the inactive TRC lesion. It also demonstrated a masking effect due to VH. There was a RN area in the supero-temporal periphery with associated retinal capillary non perfusion. Toxoplasma serological profile revealed a positive immunoglobulin G (IgG) antibody which was consistent with a prior exposure to the parasite. The patient received scatter laser photo cogulation to the peripheral area of retinal capillary non perfusion. Two months after laser treatment, VH had completely resolved with subsequent improvement of visual acuity to 20/20.
Inactive ocular toxoplasmosis should be considered in the differential diagnosis of unilateral VH in young patients. Careful clinical examination and regular follow-up complemented in selected cases with fluorescein angiography may help detecting serious complications such as peripheral RN. Laser photocoagulation is useful in the management of RN.