Toxoplasmosis-Associated Neovascular Lesions Treated Successfully With Ranibizumab and Antiparasitic Therapy

Abstract

With Ranibizumab and Antiparasitic TherapyChoroidal neovascular membranes (CNVMs) rarely complicate toxoplasmic chorioretinitis [1][2][3][4][5] and are managed by observation; antiparasitic, anti-inflammatory medication; laser photocoagulation; surgical excision; or photodynamic therapy, with variable outcomes.As occurs with CNVMs secondary to age-related macular degeneration, Toxoplasma gondii increases expression of hypoxia-inducible factor-1␣ in tissue cultures along with vascular endothelial growth factor (VEGF). 6Report of Cases.Two patients with prior ocular toxoplasmosis had active CNVMs with subretinal blood and fluid on clinical examination and ocular coherence tomography (OCT) and hyperfluorescence with leakage documented on fluorescein angiogram (FA).Each was treated with offlabel intravitreal injections of ranibizumab (Genentech, Inc, South San Francisco, California) and antiparasitic treatment, with responses documented with measurements of visual acuity, full fundus photographs, FA, and OCT.We reviewed courses and photographs of 187 persons with toxoplasmosis, 175 definitely congenitally acquired, followed up in the National Collaborative Chicagobased Congenital Toxoplasmosis Study to identify those who had recognized ocular neovascular disease.Three persons had a CNVM and 1 had a retinal angioma with exudation.Institutional review board approval was obtained for this study.Written informed consent was obtained from parents or legal guardians of participating children and directly from patients (if legal adult age).This study is in compliance with Health Insurance Portability and Accountability Act of 1996 regulations.