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A patient with chorioretinal scars and anterior uveitis
  1. L K van der Beek-de Jong1,
  2. J D F de Groot-Mijnes1,2,
  3. J H de Boer1
  1. 1FC Donders Institute of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Department of Virology, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Dr Joke de Boer, FC Donders Institute of Ophthalmology, University Medical Center, Utrecht, E.03.136, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; jboer{at}umcutrecht.nl

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Case

A 42-year-old woman presented with decreased vision in the left eye (LE). At that time, her visual acuity was LE 20/32. Slit lamp examination of the LE revealed uveitis, characterised by fine stellate keratic precipitates, few cells, a faint flare and opacities in the vitreous in the absence of posterior synechiae. Fundus examination of the LE revealed dragged retinal vessels with macular ectopia and old chorioretinal scars (figure 1). Fundus examination of the right amblyopic eye revealed multiple, inactive chorioretinal scars. The patient developed severe glaucoma in the LE, and she underwent trabeculectomy. Before surgery, she received prophylactic treatment with pyrimethamine because the chorioretinal scars were suspected to be caused by congenital toxoplasmosis. Although treatment with trimethoprim/sulfamethoxaline is generally considered to be the best way to prevent recurrences of ocular toxoplasmosis, we chose pyrimethamin as a therapeutic treatment option in the preoperative and postoperative periods because the patient's other eye was legally blind due to amblyopia. During ocular surgery, aqueous humour was collected and examined for rubella virus and Toxoplasma gondii by Goldmann–Witmer coefficient (GWC), which is indicative of intraocular antibody production, and polymerase chain reaction (PCR). Real-time PCR analysis on aqueous humour and the primers and probes used for Toxoplasma were described previously.1For rubella virus PCR, RNA was extracted from 25 μl of ocular fluid with the total nucleic acid kit (Roche, Penzberg, Germany), and copy DNA was produced by using the Taqman reverse transcription reagents (Applied Biosystems, Branchburg, New Jersey, USA) according to the instructions of the manufacturer. Subsequently, the same real-time PCR protocol as for Toxoplasma was applied, using a rubella virus-specific forward primer (5′ caccgggactgytgrttgc …

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