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¹Vakıf Gureba EA Hastanesi, Göz, İstanbul, Uzm. Dr.
²Vakıf Gureba EA Hastanesi, Göz, İstanbul, Asist Dr.
³Vakıf Gureba EA Hastanesi, Göz, İstanbul, Doç. Dr. Purpose: To investigate the effectiveness of trimethoprim and sulfamethoxazole (co-trimoxazole) and clindamycin combination in patients with the diagnosis of toxoplasmic retinochoroiditis.
Materials and Methods: Fifteen eyes of 15 patients with toxoplasmic retinochoroiditis that were treated with trimethoprim-sulfamethoxazole (160/800 mg bid) and clindamycin (300 mg qid) combination were included into the study. The diagnosis was based on clinical findings and supported with anti-toxoplasma IgG and IgM tests. Visual acuity, anterior segment, vitreous body and fundus were evaluated before and after the treatment. Pigmentation of active toxoplasmic retinochoroiditis was regarded as the response to treatment.
Results: Twelve of 15 patients were women and the mean age was 32.3±11.0 years. It was the first retinochoroiditis attack in 9 eyes, the second in 4 eyes, the third in one eye and the fourth in one eye.The mean pretreatment Snellen visual acuity was 0.55±0.38 (SD). The anterior segment examination disclosed normal findings in 10 eyes but various degrees of inflammation was evident in 5 eyes and there were mutton-fat keratic precipitates in one of them. The intraocular pressures was higher than 21mmHg in two eyes. There were 3 (+) cells in 4 eyes, 2 (+) cells in 9 eyes and 1 (+) cell in 2 eyes in the vitreous body. The active lesion was located at peripapillary region in 6 eyes , macular area in 2 eyes, and various retinal areas in 7 eyes . Anti-toxoplasma IgG and anti-toxoplasma IgM was positive in 12 patients and in one patient respectively. Additional steroid therapy was initiated in 6 patients (4 oral administrations, 2 subtenon injections). Antibiotic combination therapy continued at least six weeks and ceased after the lesion became pigmented and the cells in the vitreous body decreased. After the treatment the mean Snellen visual acuity was improved to 0.73±0.31 (p=0.007). Visual acuity did not show any improvement only in an eye with macular degeneration.
Conclusion: Although there were various drugs in the treatment of toxoplasmic retinochoroiditis cotrimoxazol and clindamycin combination may give good results. Keywords : Clindamycin, cotrimoxazol, toxoplasmic retinochoroiditis