Evaluation of Cystoid Change Phenotypes in Ocular Toxoplasmosis Using Optical Coherence Tomography

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Abstract

Purpose

To present unique cystoid changes occurring in patients with ocular toxoplasmosis observed in spectral domain optical coherence tomography (OCT).

Methods

Forty-six patients (80 eyes) with a diagnosis of ocular toxoplasmosis, who underwent volume OCT examination between January 2005 and October 2012, were retrospectively collected. Review of clinical examination findings, fundus photographs, fluorescein angiograms (FA) and OCT image sets obtained at initial visits and follow-up. Qualitative and quantitative analyses of cystoid space phenotypes visualized using OCT.

Results

Of the 80 eyes included, 17 eyes (15 patients) demonstrated cystoid changes in the macula on OCT. Six eyes (7.5%) had cystoid macular edema (CME), 2 eyes (2.5%) had huge outer retinal cystoid space (HORC), 12 eyes (15%) had cystoid degeneration and additional 3 eyes (3.75%) had outer retinal tubulation due to age related macular degeneration. In one eye with HORC, the lesion was seen in the photoreceptor outer segment, accompanied by photoreceptor elongation and splitting. Three eyes presented with paravascular cystoid degeneration in the inner retina without other macular OCT abnormality.

Conclusions

In this study, different phenotypes of cystoid spaces seen in eyes with ocular toxoplasmosis using spectral domain OCT (SD-OCT) were demonstrated. CME presented as an uncommon feature, consistently with previous findings. Identification of rare morphological cystoid features (HORC with/without photoreceptor enlongation or splitting) on clinical examination had provided evidence to previous experimental models, which may also expand the clinical spectrum of the disease. Cystoid degeneration in the inner retina next to the retinal vessels in otherwise “normal” looking macula was observed, which may suggest more often clinical evaluation for those patients. Further studies are needed to verify the relevance of cystoid features seen on SD-OCT in assisting with the diagnosis and management of ocular toxoplasmosis.

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Most cited references 18

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Ocular toxoplasmosis: clinical features and prognosis of 154 patients.

J. Bosch, Aniki Rothova, Tos Berendschot … (2002)

To ascertain the clinical features, visual outcome, and recurrence rates of ocular toxoplasmosis (OT) in a large series of patients. To determine the efficacy of various treatment strategies and identify the patients at risk of visual loss. Retrospective noncomparative observational case series. One hundred fifty-four consecutive patients with active lesions of OT (first attack and/or recurrence) were identified in a cohort of 1300 consecutive patients with uveitis. Mean follow-up was 5.8 years. A review of the medical records of 154 patients with active OT. Patients were subdivided according to clinical and laboratory criteria. Numerous variables were compared per patient and group, including age and gender distribution, onset and course of infection, clinical ocular features, laboratory data, therapeutic strategies and their outcomes, number of recurrences, complications, final visual acuity, and features associated with poor visual outcome. Primary retinal lesions were observed in 28% and a combination of active lesions and old retinochoroidal scars in 72% of the patients at first presentation to the ophthalmologist. Mean age at first presentation with an active OT lesion was 29.5 years. Patients with primary OT were older than those with a combination of active lesions and old scars (P < 0.001). Serologic characteristics of the acute phase of systemic infection were found in 11% of the patients. Ocular involvement in these patients was associated with advanced age at onset (P < 0.001) and was characterized by severe intraocular inflammation. Most (82%) of the patients with serologic characteristics of the acute phase of systemic infection had primary lesions (compared with 23% of OT in the chronic phase of systemic infection; P < 0.001). Extensive retinal lesions were more frequently observed during the acute phase of systemic infection (P = 0.02) and in patients with primary OT (P < 0.04). Recurrences, which developed in 79% of all patients followed for more than 5 years, were located predominantly in previously affected eyes (with old scars) in contrast to the sporadic cases of recurrence in the healthy contralateral eye (P < 0.0001). Standard short-term therapeutic modalities had no effect on visual outcome or future recurrence rates. Legal blindness in one or both eyes was confirmed for 24% of the patients. Blindness of both eyes was more frequent in patients with congenital OT (P < 0.001). Risk factors for visual loss included congenital infection, OT manifesting during the acute phase of systemic infection, central location and/or extensive retinal lesions, and the administration of corticosteroids without a shield of antiparasitic drugs. Legal blindness in at least one eye developed in 24% of the patients with OT. Recurrences, which developed in 79% of the patients with long-term follow-up, were located predominantly in eyes with toxoplasmic scars. Various short-term therapeutic modalities had no effect on visual outcomes or future recurrence rates, with the exception of a poor visual outcome for patients who received corticosteroids without a shield of antiparasitic drugs.

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Evaluation of age-related macular degeneration with optical coherence tomography.

Pearse Keane, Praveen Patel, Sandra Liakopoulos … (2012)

Age-related macular degeneration (AMD) is the leading cause of severe visual loss in people aged 50 years or older in the developed world. In recent years, major advances have been made in the treatment of AMD, with the introduction of anti-angiogenic agents, offering the first hope of significant visual recovery for patients with neovascular AMD. In line with these advances, a new imaging modality-optical coherence tomography (OCT)-has emerged as an essential adjunct for the diagnosis and monitoring of patients with AMD. The ability to accurately interpret OCT images is thus a prerequisite for both retina specialists and comprehensive ophthalmologists. Despite this, the relatively recent introduction of OCT and the absence of formal training, coupled with rapid evolution of the technology, may make such interpretation difficult. These problems are compounded by the phenotypically heterogeneous nature of AMD and its complex morphology as visualized using OCT. We address these issues by summarizing the current understanding of OCT image interpretation in patients with AMD and describe how OCT can best be applied in clinical practice. Copyright © 2012 Elsevier Inc. All rights reserved.

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Spatial distribution of posterior pole choroidal thickness by spectral domain optical coherence tomography.

Yanling Ouyang, Florian M. Heussen, Nils Mokwa … (2011)

To study the spatial distribution of posterior pole choroidal thickness (CT) in healthy eyes using spectral domain optical coherence tomography (SD-OCT).

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Author and article information

Contributors

Andreas Wedrich: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2014

Publication date (Electronic): 5 February 2014

Volume: 9

Issue: 2

Electronic Location Identifier: e86626

Affiliations

[1 ]Charité, University Medicine Berlin, Department of Ophthalmology, Berlin, Germany

[2 ]NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom

[3 ]Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, United States of America

Medical University Graz, Austria

Author notes

* E-mail: florian.heussen@ 123456gmail.com

Competing Interests: Dr. Keane has received a proportion of his funding from the Department of Health's NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology. Drs. Keane and Heussen have received travel grants from the Allergan European Retina Panel. Dr. Joussen received financial compensation for lectures from Novartis, Allergan Inc. and Bayer AG. Dr. Pleyer has been the Principal Investigator/Consultant for Abbott, Alcon, Allergan, Amgen, Bausch and Lomb, Bayer/Schering, Centocor, Esba Tech, Novartis but has no commercial interests or financial relationships to any agent, device, or technique. Dr. Sadda is a co-inventor of Doheny intellectual property related to optical coherence tomography that has been licensed by Topcon Medical Systems. Dr Sadda is a member of the scientific advisory board for Heidelberg Engineering. Dr Sadda also receives research support from Carl Zeiss Meditec, Optos, and Optovue, Inc. Please note, although Dr. Sadda is a co-inventor of Doheny intellectual property related to optical coherence tomography (OCT) that has been licensed by Topcon Medical Systems, the authors have used a Spectralis OCT system (Spectralis, Heidelberg Engineering, Germany) in this study. Thus, there is no patent relating to material pertinent to this article. There are no further patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Conceived and designed the experiments: YO FMH UP. Performed the experiments: YO QS NS PAK SRS AMJ. Analyzed the data: YO QS FMH. Contributed reagents/materials/analysis tools: SRS. Wrote the paper: YO FMH PAK.

Article

Publisher ID: PONE-D-13-39665

DOI: 10.1371/journal.pone.0086626

PMC ID: 3914795

PubMed ID: 24505261

SO-VID: 000df127-0f60-4992-bde0-dd886900323e

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 27 September 2013

Date accepted : 11 December 2013

Page count

Pages: 8

Funding

Dr. Keane has received a proportion of his funding from the Department of Health's NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology. The views expressed in the publication are those of the author and not necessarily those of the Department of Health. Drs. Keane and Heussen have received travel grants from the Allergan European Retina Panel. Dr. Joussen received financial compensation for lectures from Novartis, Allergan Inc. and Bayer AG. Dr. Pleyer received funding from the federal ministry of education and research of Germany (BMBF) through the Toxonet 02 research collaboration and has been the Principal Investigator/Consultant for Abbott, Alcon, Allergan, Amgen, Bausch and Lomb, Bayer/Schering, Centocor, Esba Tech, Novartis but no commercial interests or financial relationships to any agent, device, or technique. Dr. Sadda is a co-inventor of Doheny intellectual property related to optical coherence tomography that has been licensed by Topcon Medical Systems, and is a member of the scientific advisory board for Heidelberg Engineering. Dr Sadda also receives research support from Carl Zeiss Meditec, Optos, and Optovue, Inc. The authors have no commercial interests for the manuscript. This work was partially supported by the funding from the federal ministry of education and research of Germany (BMBF) through the Toxonet 02 research collaboration and the Department of Health's NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Evaluation of Cystoid Change Phenotypes in Ocular Toxoplasmosis Using Optical Coherence Tomography

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Abstract

Purpose

Methods

Results

Conclusions

Related collections

PLOS Climate

Most cited references 18

Ocular toxoplasmosis: clinical features and prognosis of 154 patients.

Evaluation of age-related macular degeneration with optical coherence tomography.

Spatial distribution of posterior pole choroidal thickness by spectral domain optical coherence tomography.

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