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Measurement of the active toxoplasma retinochoroiditis lesion size during the disease course with swept-source optical coherence tomography angiography: A retrospective image analysis

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Abstract

Purpose

To measure the lesion size reduction in eyes with active toxoplasma retinochoroiditis during the disease course with swept-source optical coherence tomography angiography (SS-OCTA).

Methods

We retrospectively analysed the chorioretinal lesion size in a group of 14 eyes with a single active toxoplasma retinochoroiditis lesion. SS-OCTA was performed at the baseline and follow-up in all eyes. The 6 × 6 mm choriocapillaris slab images were evaluated with image analysis (MATLAB). The number of black and white pixels in a 1500-µm-diameter circle centred on each active lesion was counted at the time of baseline examination and at the first follow-up visit when the chorioretinal scar formation was noticed.

Results

Fourteen eyes with a single active toxoplasmosis retinochoroiditis lesion were included. Ten patients were female and three were male. The mean age was 29.1 ± 14.9 years. Active lesions were at the macula in five eyes, at the periphery in six eyes and juxtapapillary in three eyes. At the initial examination, the lesion area was observed as an area with a decreased flow signal on SS-OCTA. There was the perilesional capillary disruption in superficial and deep capillary plexi together with a diffuse capillary network attenuation and non-detectable flow signal zones in the choriocapillaris slabs. In addition to sulfamethoxazole-trimethoprim and azithromycin combination, oral corticosteroids were only co-administered in five (35%) eyes with macular involvement. The chorioretinal scar formation was observed in 4 to 16 weeks. At the time of inactivity, the original lesion was diminished in size when compared to its baseline in all study eyes (p = 0.001) with a mean black pixel reduction percentage of 21.8%. The reduction was 15.4% in eyes with macular lesion, 31.6% with peripheral lesions and 18.1% with juxtapapillary lesions (p = 0.001, p = 0.032, p = 0.028, p = 0.043, respectively). Visual acuity was correlated with black pixel reduction percentage in eyes with macular lesion (r = 0.56, p < 0.001).

Conclusion

Healing of the active toxoplasma retinochoroiditis lesion size could be monitored with an OCTA-based image analysis technique. Interestingly, the reduction in the lesion size was lesser in the macular lesions than the peripheral and juxtapapillary lesions following the treatment and this might contribute to the poorer visual outcomes observed in eyes with macular lesions.

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Data availability

All data obtained during the study process were used in the study.

References

  1. Yalcindag FN, Ozdal PC, Ozyazgan Y et al (2018) Demographic and clinical characteristics of Uveitis in Turkey: the first national registry report. Ocul Immunol Inflamm 26:17–26. https://doi.org/10.1080/09273948.2016.1196714

    Article  PubMed  Google Scholar 

  2. Lujan BJ (2014) Spectral domain optical coherence tomography imaging of punctate outer retinal toxoplasmosis. Saudi J Ophthalmol 28:152–156. https://doi.org/10.1016/j.sjopt.2014.03.010

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mathis T, Delaunay B, Favard C, Denis P, Kodjikian L (2020) Hyperautofluorescent spots in acute ocular toxoplasmosis: a new indicator of outer retinal inflammation. Retina 40:2396–2402. https://doi.org/10.1097/IAE.0000000000002759

    Article  CAS  PubMed  Google Scholar 

  4. Yoshizumi MO (1976) Experimental toxoplasma retinitis: a light and electron microscopical study. Arch Pathol Lab Med 100:487–490

    CAS  PubMed  Google Scholar 

  5. Vainisi SJ, Campbell LH (1969) Ocular toxoplasmosis in cats. J Am Vet Med Assoc 154:141–152

    CAS  PubMed  Google Scholar 

  6. Dingerkus VLS, Munk MR, Brinkmann MP et al (2019) Optical coherence tomography angiography (OCTA) as a new diagnostic tool in uveitis. J Ophthalmic Inflamm Infect 9:10. https://doi.org/10.1186/s12348-019-0176-9

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yeo JH, Chung H, Kim JT (2019) Swept-source optical coherence tomography angiography according to the type of choroidal neovascularization. J Clin Med 8:1272. https://doi.org/10.3390/jcm8091272

    Article  CAS  PubMed Central  Google Scholar 

  8. Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature Working G (2005) Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol 140:509–516. https://doi.org/10.1016/j.ajo.2005.03.057

    Article  Google Scholar 

  9. Holland GOCG, Belfort R, Remington JS (1996) Toxoplasmosis. In: Pepose JS, Holland GN, Wilhelmus KR (eds) Ocular infection and immunity. Mosby-Year Book Inc, Missouri, St Louis, pp 1183–1223

    Google Scholar 

  10. Otsu N (1979) A threshold selection method from gray-level histograms. IEEE Trans Syst Man Cybern 9:62–66. https://doi.org/10.1109/tsmc.1979.4310076

    Article  Google Scholar 

  11. Cohen LM, Goldstein DA, Fawzi AA (2016) Structure-function relationships in uveitic cystoid macular edema: using en face optical coherence tomography to predict vision. Ocul Immunol Inflamm 24:274–281. https://doi.org/10.3109/09273948.2015.1056535

    Article  PubMed  Google Scholar 

  12. Karti O, Saatci AO (2019) Optical coherence tomography angiography in eyes with non-infectious posterior uveitis; some practical aspects. Med Hypothesis Discov Innov Ophthalmol 8:312–322

    PubMed  PubMed Central  Google Scholar 

  13. de Oliveira Dias JR, Campelo C, Novais EA et al (2020) New findings useful for clinical practice using swept-source optical coherence tomography angiography in the follow-up of active ocular toxoplasmosis. Int J Retina Vitreous 6:30. https://doi.org/10.1186/s40942-020-00231-2

    Article  PubMed  PubMed Central  Google Scholar 

  14. Park JH, Lee SY, Lee EK (2019) Morphological characteristics of ocular toxoplasmosis and its regression pattern on swept-source optical coherence tomography angiography: a case report. BMC Ophthalmol 19:199. https://doi.org/10.1186/s12886-019-1209-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Leong BCS, Gal-Or O, Freund KB (2019) Optical coherence tomography angiography of retinal-choroidal anastomosis in toxoplasmosis chorioretinitis. JAMA Ophthalmol 137:e184091. https://doi.org/10.1001/jamaophthalmol.2018.4091

    Article  PubMed  Google Scholar 

  16. Spaide RF (2015) Volume rendering of optical coherence tomography angiography reveals extensive retinal vascular contributions to neovascularization in ocular toxoplasmosis. Retina 35:2421–2422. https://doi.org/10.1097/IAE.0000000000000721

    Article  PubMed  Google Scholar 

  17. Azar G, Favard C, Salah S, Brezin A, Vasseur V, Mauget-Faysse M (2020) Optical coherence tomography angiography analysis of retinal and choroidal vascular networks during acute, relapsing, and quiescent stages of macular toxoplasma retinochoroiditis. Biomed Res Int 2020:4903735. https://doi.org/10.1155/2020/4903735

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Vezzola D, Allegrini D, Borgia A et al (2018) Swept-source optical coherence tomography and optical coherence tomography angiography in acquired toxoplasmic chorioretinitis: a case report. J Med Case Rep 12:358. https://doi.org/10.1186/s13256-018-1902-x

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kaufman HE (1960) The effect of corticosteroids on experimental ocular toxoplasmosis. Am J Ophthalmol 50:919–926. https://doi.org/10.1016/0002-9394(60)90344-5

    Article  CAS  PubMed  Google Scholar 

  20. Hofflin JM, Conley FK, Remington JS (1987) Murine model of intracerebral toxoplasmosis. J Infect Dis 155:550–557. https://doi.org/10.1093/infdis/155.3.550

    Article  CAS  PubMed  Google Scholar 

  21. Oray M, Ozdal PC, Cebeci Z, Kir N, Tugal-Tutkun I (2016) Fulminant Ocular toxoplasmosis: the hazards of corticosteroid monotherapy. Ocul Immunol Inflamm 24:637–646. https://doi.org/10.3109/09273948.2015.1057599

    Article  CAS  PubMed  Google Scholar 

  22. Holland GN, Lewis KG (2002) An update on current practices in the management of ocular toxoplasmosis. Am J Ophthalmol 134:102–114. https://doi.org/10.1016/s0002-9394(02)01526-x

    Article  PubMed  Google Scholar 

  23. Chodos JB, Habegger-Chodos HE (1961) The treatment of ocular toxoplasmosis with spiramycin. Arch Ophthalmol 65:401–409. https://doi.org/10.1001/archopht.1961.01840020403014

    Article  CAS  PubMed  Google Scholar 

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Funding

The authors declared that this study received no financial support.

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Authors and Affiliations

  1. Department of Ophthalmology, Dokuz Eylul University, Narlı Mah. İsmet İnönü Cad., Ege Apt. No:50, Daire 7, Narlıdere, İzmir, Turkey

    Ferdane Atas, Mahmut Kaya, Betul Akbulut Yagci & Ali Osman Saatci

  2. The Institute of Natural and Applied Sciences, Dokuz Eylul University, İzmir, Turkey

    Tugce Toprak

  3. Department of Electrical and Electronics Engineering, Dokuz Eylul University, İzmir, Turkey

    Alper Selver

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  1. Ferdane Atas
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  2. Mahmut Kaya
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  3. Tugce Toprak
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  4. Betul Akbulut Yagci
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  5. Alper Selver
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  6. Ali Osman Saatci
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Contributions

All co-authors have contributed to the study, and all have read and approved the final version of the manuscript. AOS and MK contributed to concept; AOS and MK contributed to design; FA, MK, BA and AOS contributed to data collection or processing; MK, BA, TT, AS and FA contributed to analysis or interpretation; FA, AOS, BA and MK contributed to literature search; FA, MK and AOS contributed to writing.

Corresponding author

Correspondence to Ferdane Atas.

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Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Animal research

There was no research on animals in this manuscript.

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Informed consent for participation was obtained from all study patients.

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Informed consent for publication was obtained from all study patients.

Ethics approval

This study was conducted in accordance with the tenets of the Helsinki Declaration after obtaining the approval of local ethics committee (Dokuz Eylül University: 2021/04-01).

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Atas, F., Kaya, M., Toprak, . et al. Measurement of the active toxoplasma retinochoroiditis lesion size during the disease course with swept-source optical coherence tomography angiography: A retrospective image analysis. Int Ophthalmol 41, 4127–4135 (2021). https://doi.org/10.1007/s10792-021-01985-w

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  • DOI: https://doi.org/10.1007/s10792-021-01985-w

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