J Korean Ophthalmol Soc.  2012 Jul;53(7):1046-1052. 10.3341/jkos.2012.53.7.1046.

Intravitreal Clindamycin Injection for Toxoplasmic Retinochoroiditis

• Park S
• Lew HM
• Song JH

• KMID: 2215870
• DOI: http://doi.org/10.3341/jkos.2012.53.7.1046

Abstract

PURPOSE
To present cases of toxoplasmic retinochoroiditis (TRC) treated successfully with intravitreal clindamycin injection.
CASE SUMMARY
(Case 1) A 41-year-old man presented with blurred left eye vision for several months. The patient had a large chorioretinal scar with infiltrations at the boundaries, and fluorescein angiography (FA) showed active retinochoroiditis. Antitoxoplasmosis (antiTX) immunoglobulin G (IgG) was positive, and the patient was started on antiTX medication. Despite several weeks of treatment with maximum doses of antiTx, the TRC progressed and visual acuity worsened. Pars plana vitrectomy (PPV) with intravitreal clindamycin injection (1.0 mg/0.1 ml) was performed, and an additional injection was given 4 weeks later. Six weeks after the second injection, TRC wascompletely resolved with 20/20 vision. (Case 2) A 67-year-old man presented with decreased left eye vision for 1 year. Fundus examinations showed vitreous opacity and epiretinal membranes. The FA revealed retinochoroiditis and the antiTX IgG titer was elevated. The presumed diagnosis was TRC, and oral medications of trimethoprim-sulfamethoxazole, clindamycin, and prednisolone was administered. Inflammation began to improve however, as the patient was not tolerating systemic antiTx medications, an intravitreal injection of clindamycin (1.0 mg/0.1 ml) was administered with PPV. The patientdiscontinued oral medication after surgery, and the inflammation resolved 5 weeks later.
CONCLUSIONS
Intravitreal clindamycin injections may be an additional treatment option for TRC in patients who are unable to tolerate systemic therapy or whose disease progresses despite systemic therapy.

Keyword

Clindamycin; Intravitreal injection; Toxoplasmic retinochoroiditis

MeSH Terms

Adult
Aged
Cicatrix
Clindamycin
Epiretinal Membrane
Eye
Fluorescein Angiography
Humans
Immunoglobulin G
Inflammation
Intravitreal Injections
Prednisolone
Trimethoprim, Sulfamethoxazole Drug Combination
Vision, Ocular
Visual Acuity
Vitrectomy
Clindamycin
Immunoglobulin G
Prednisolone

Figure

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  Figure 1 Case 1. Fundus photograph and fluorescein angiographs of the left eye at initial visit. Fundus photograph shows a huge pigmented scar at the superior retina with multiple infiltrations at its margins. The focal retinochoroiditis at the inferior margin of the main lesion (arrow) threatened the fovea (A). Fluorescein angiography reveals staining of the scar and late leakage at the margins (B, C).

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  Figure 2 Six weeks after initiation of antitoxoplasmosis medication. Fundus photograph shows that the vitreous opacity was exacerbated and the area of retinochoroiditis had enlarged. A new focal inflammatory lesion(arrow) is noted at the inferior macula (A). In fluorescein angiography, more intense leakage of the lesion is noted with blockage due to increased vitreous opacity. An additional new focal retinitis site (arrowhead) is detected at the temporal macula (B).

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  Figure 3 Fundus photograph and fluorescein angiographs at 6 weeks after the second intravitreal clindamycin injection. In fundus photograph, vitreous haze due to vitritis is cleared and all the inflammatory lesions have changed to chorioretinal scars (A). Fluorescein angiography reveals that the previous retinochoroiditis lesions are mainly stained without late leakage (B, C).

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  Figure 4 Case 2. Initial fundus photograph of the left eye shows vitreous opacity and a premacular membrane (A). Fluorescein angiography at presentation reveals lateleakage of retinal vasculatures and diffuse retinochoroidal leakage involving the macula (B).

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  Figure 5 Fundus photograph at 10 weeks after vitrectomy and intravitreal clindamycin injection. Fundus photograph shows clearing of vitreous opacity and no premacular membrane.

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