Management of active ocular toxoplasmosis in pregnancy
Purpose
Ocular toxoplasmosis is the most common cause of infectious posterior uveitis. Studies have suggested that ocular toxoplasmosis may have increased incidence and severity during pregnancy. The traditional treatment regimen poses possible fetal adverse effects. This study intends to describe approaches in the management of ocular toxoplasmosis in pregnancy and describe maternal ocular outcomes.
Methods
Single-center, retrospective case series. Patients with active toxoplasmosis during pregnancy were identified and classified into 3 groups: patients with complete follow-up (group 1), patients with incomplete follow-up (group 2), and patients who were on treatment upon discovery of pregnancy (group 3).
Results
Twelve pregnancies from 11 patients were identified. Five patients were classified under group 1, 3 patients under group 2, and 2 patients under group 3. Most presented on the second trimester of pregnancy (average 21 weeks AOG). One patient had 2 episodes of active toxoplasmosis. All patients received topical treatment. Eighteen percent received intravitreal medications. Only 36% of patients were given at least 1 of 3 of azithromycin, atovaquone and spiramycin. Eighty-three percent of patients completing visits had visual improvement following treatment.
Conclusion
Patients with non-visual threatening ocular toxoplasmosis can be treated conservatively with topical steroids alone. Combined intravitreal antibiotic-steroid injections are options to prevent fetal side effects. Pyrimethamine and cotrimoxazole should be avoided during the first trimester of pregnancy; spiramycin and atovaquone are safe and effective alternatives. Pregnancy testing is suggested for women of childbearing age prior to starting medications.
Conflict of interest
No
Authors 1
Last name
ARTIAGA
Initials of first name(s)
JC
Department
Moorfields Eye Hospital NHS Foundation Trust
City
London
Country
United Kingdom
Authors 2
Last name
Ouyang
Initials of first name(s)
Y
Department
Moorfields Eye Hospital NHS Foundation Trust
City
London
Country
United Kingdom
Authors 3
Last name
Degli Esposti
Initials of first name(s)
S
Department
Moorfields Eye Hospital NHS Foundation Trust
City
London
Country
United Kingdom
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