Background Ocular toxoplasmosis is common across all regions of the world. Understanding of the epidemiology and approach to diagnosis and treatment have evolved recently. In November 2020, an international group of uveitis-specialised ophthalmologists formed the International Ocular Toxoplasmosis Study Group to define current practice.
Methods 192 Study Group members from 48 countries completed a 36-item survey on clinical features, use of investigations, indications for treatment, systemic and intravitreal treatment with antiparasitic drugs and corticosteroids, and approach to follow-up and preventive therapy.
Results For 77.1% of members, unilateral retinochoroiditis adjacent to a pigmented scar accounted for over 60% of presentations, but diverse atypical presentations were also reported. Common complications included persistent vitreous opacities, epiretinal membrane, cataract, and ocular hypertension or glaucoma. Most members used clinical examination with (56.8%) or without (35.9%) serology to diagnose typical disease but relied on intraocular fluid testing—usually PCR—in atypical cases (68.8%). 66.1% of members treated all non-pregnant patients, while 33.9% treated selected patients. Oral trimethoprim–sulfamethoxazole was first-line therapy for 66.7% of members, and 60.9% had experience using intravitreal clindamycin. Corticosteroid drugs were administered systemically by 97.4%; 24.7% also injected corticosteroid intravitreally, almost always in combination with an antimicrobial drug (72.3%). The majority of members followed up all (60.4%) or selected (35.9%) patients after resolution of acute disease, and prophylaxis against recurrence with trimethoprim–sulfamethoxazole was prescribed to selected patients by 69.8%.
Conclusion Our report presents a current management approach for ocular toxoplasmosis, as practised by a large international group of uveitis-specialised ophthalmologists.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Collaborators Members of the International Ocular Toxoplasmosis Study Group: Massimo Accorinti (Italy), Aniruddha Agarwal (India), Mamta Agarwal (India), Seong Joon Ahn (South Korea), Nurettin Akyol (Turkey), Carlos Alvarez (Mexico), Radgonde Amer (Israel), Sofia Androudi (Greece), Cheryl Arcinue (Philippines), Lourdes Arellanes-Garcia (Mexico), J. Fernando Arevalo (USA), Cesar Arrieta-Bechara (Spain), Joseba Artaraz (Spain), Ashraf Ata (Palestine), Viera Kalinina Ayuso (The Netherlands), Kalpana Babu (India), Reema Bansal (India), Matthias Becker (Switzerland), Lyll Karen Bigornia-Arriola (Philippines), Jyotirmay Biswas (India), Ana Blanco-Esteban (Spain), Bahram Bodaghi (France), Marcelo Bursztyn (Argentina), Maria Jose Capella (Spain), Ester Carreño (Spain), Wei-Chun Chan (Taiwan), Yo-Chen Chang (Taiwan), Yu-Jang Chao (Taiwan), Rashel Cheja-Kalb (Mexico), Luca Cimino (Italy), Kåre Clemmensen (Denmark), Lidia Cocho (Spain), Luz Elena Concha-Del-Rio (Mexico), Diana Conrad (Australia), Dipankar Das (India), Janet Davis (USA), Joke De Boer (Netherlands), Ekaterina Denisova (Russia), Larissa Derzko-Dzulynsky (Canada), Luca De Simone (Italy), Christoph Deuter (Germany), Jesús Díaz-Cascajosa (Spain), Oleksandra Dorokhova (Ukraine), Gonzalo Duarte (Chile), Nazanin Ebrahimiadib (Iran), Sivan Elyashiv (Israel), Parisa Emami-Naeini (USA), Marie Helene Errera (USA), Mar Esteban-Ortega (Spain), Alex Fonollosa (Spain), Eric Fortin (Canada), Samantha Fraser-Bell (Australia), Marion Funk (Austria), Manuel Garza-Leon (Mexico), Justus Garweg (Switzerland), Zsuzsanna Géhl (Hungary), Raz Gepstein (Israel), Terese Gerges (Egypt), Alex Gimenez (Spain), Hiroshi Goto (Japan), Chloe Gottlieb (Canada), Konstantin Gugleta (Switzerland), Vishali Gupta (India), Avinash Gurbaxani (United Arab Emirates), Zohar Habot-Wilner (Israel), Anthony Hall (Australia), Noriyasu Hashida (Japan), Christopher Henry (USA), Maryam Hosseini (Iran), Chen Hsi-Fu (Taiwan), Boonsiri Hunchangsith (Thailand), De-Kuang Hwang (Taiwan), Yih Shiou Hwang (Taiwan), Alessandro Invernizzi (Italy), Salam Saeb Iriqat (Palestine), Hamisah Ishak (Malaysia), Shah Md. Bulbul Islam (Bangladesh), Chiharu Iwahashi (Japan), Margarita Jódar-Márquez (Spain), Bouleau Julien (France), Toshikatsu Kaburaki (Japan), Sibel Kadayifçilar (Turkey), Koju Kamoi (Japan), Kashyap Kansupada (USA), Tzu-En Kao (Taiwan), Alexander Kaplan (Canada), Hiroshi Keino (Japan), John H. Kempen (Ethopia And USA), Moncef Khairallah (Tunisia), Min Kim (South Korea), Seong-Woo Kim (South Korea), Alexandra Kozyreff (Belgium), Robert Kuijpers (Netherlands And Belgium), Sentaro Kusuhara (Japan), Timothy Y. Y. Lai (Hong Kong), Jenny Laithwaite (South Africa), Blerta Lang (Germany), Maria Isabel Gabriela Ortega Larrocea (Mexico), Caspers Laure (Belgium), Christopher Seungkyu Lee (South Korea), Ji Hwan Lee (South Korea), Lyndell Lim (Australia), Victor Llorenç (Spain), Ann-Marie Lobo-Chan (USA), Preeyachan Lourthai (Thailand), Padmamalini Mahendradas (India), Dorine Makhoul (Belgium), Irene Redondo Marcos (Spain), Cynthia Espinosa Martinez (Mexico), Lucía Martínez-Costa (Spain), Peter McCluskey (Australia), Ilhem Mili-Boussen (Tunisia), Elisabetta Miserocchi (Italy), Manabu Mochizuki (Japan), Shelina Oli Mohamed (Malaysia), Philip I. Murray (UK), Kei Nakai (Japan), Satoko Nakano (Japan), Nakhoul Nakhoul (Israel), Kenichi Namba (Japan), Heloisa Nascimento (Brazil), Piergiorgio Neri (United Arab Emirates), Nor Fariza Ngah (Malaysia), John Nguyen (USA), Quan Dong Nguyen (USA), Rachael Niederer (New Zealand), Aya Oguma (Japan), Shigeaki Ohno (Japan), Kouichi Ohta (Japan), Annabelle A. Okada (Japan), Narciss Okhravi (UK), Pinar Özdal (Turkey), Yılmaz Özyazgan (Turkey), Alan Palestine (USA), Maria Pia Paroli (Italy), Jorge Arturo Aguilera Partida (Mexico), Carlos Pavesio (UK), Eduard Pedemonte-Sarrias (Spain), Francesco Pichi (United Arab Emirates), Lefebvre Pierre (Belgium), Uwe Pleyer (Germany), Joanna Przeździecka-Dołyk (Poland), Aleksandra Radosavljevic (Serbia), Zahedur Rahman (Bangladesh), Stephanie Voorduin Ramos (Mexico), Narsing Rao (USA), Ola Rauer (Sweden), Lia Judice Relvas (Belgium), Josephine Richards (Australia), Alejandro Rodriguez-Garcia (Mexico), Maite Sainz-de-la-Maza (Spain), Beatriz Sánchez (Spain), Hla Sandar (Myanmar), Shaul Sar (Israel), Luiz Paulo Bastos Schmidt (Brazil), Yuen Yew Sen (Singapore), Juan Luis Sánchez Sevila (Spain), Shwu-Jiuan Sheu (Taiwan), Shiri Shulman (Israel), Monica Cunha Signorelli (Brazil), Sukhum Silpa-Archa (Thailand), Justine Smith (Australia), Wendy Smith (USA), Ovi Sofia (Indonesia), Thanapong Somkijrungroj (Thailand), Sreekanth Sreekantam (UK), Sridharan Sudharshan (India), Hiroshi Takase (Japan), Masaru Takeuchi (Japan), Christoph Tappeiner (Switzerland), Mei-Ling Tay-Kearney (Australia), Barbara Teuchner (Austria), Jennifer E. Thorne (USA), Sara Touhami (France), Victoria Toumanidou (Greece), Peter Trittibach (Switzerland), Ilknur Tugal-Tutkun (Turkey), Mayjane Tumulak (Phillipines), Anna Nur Utami (Indonesia), Julie Vadboncoeur (Canada), Luc Van Os (Belgium), Daniel Vitor Vasconcelos-Santos (Brazil), Erika Vazquez (Spain), François Willermain (Belgium), May Zun Aung Win (Myanmar), Lihteh Wu (Costa Rica), Nilüfer Yalçındağ (Turkey), Ryoji Yanai (Japan), Peizeng Yang (China), Nobuyo Yawata (Japan), Oleksandra Zborovska (Ukraine), Manfred Zierhut (Germany).
Contributors KY, JMF, BB and JS designed the survey; KY administered the survey; KY, JMF, JM and JS collated the survey responses; KY, JM and JS drafted the manuscript; KY, JMF, BB, JM and JS reviewed and edited the draft.
Funding This work was supported in part by a grant from the Foundation for Support of Teaching, Research and Assistance of the Clinical Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (1901/2017, Dr Furtado).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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