Combination photodynamic therapy and bevacizumab for choroidal neovascularization associated with toxoplasmosis

Abstract

A 14-year-old girl presenting with visual loss in both eyes was diagnosed to have healed toxoplasma retinochoroiditis in the right eye with active choroidal neovascularization (CNV) secondary to toxoplasmosis in the left. She underwent combination photodynamic therapy (PDT) and intravitreal bevacizumab as primary treatment. PDT was performed as per the 'Treatment of Age-related Macular Degeneration by Photodynamic therapy' study protocol and was followed by intravitreal bevacizumab after 2 days. CNV regressed at 8 weeks of follow-up and remained stable at 8 months of follow-up. The initial visual acuity improved from 20/120 to 20/30. Combination therapy with PDT and intravitreal bevacizumab appears to be effective in the treatment of CNV secondary to toxoplasma retinochoroiditis.

Figure 1

At presentation, right eye color fundus photograph (A) reveals a punched-out pigmented lesion with well-demarcated borders at the macula suggestive of a healed toxoplasma scar. Fluorescein angiography (B) reveals staining of the retinal scar. Optical coherence tomography reveals retinal atrophy corresponding to the lesion (C)

Figure 2

At presentation, left eye color fundus photograph (A) reveals a pigmented lesion at the macula along with a choroidal neovascular membrane, adjacent subretinal hemorrhage and fluid medial to the pigmented scar. Fluorescein angiography (B, C) reveals an active, subfoveal classic choroidal neovascular membrane with profuse leakage. Blocked choroidal fluorescence due to the overlying hemorrhage is also noted. Optical coherence tomography reveals subfoveal choroidal neovascular membrane and subretinal fluid adjacent to a subretinal scar

Figure 3

At 8 months of follow-up, color fundus photograph (A) reveals a regressed choroidal neovascular membrane. Optical coherence tomography reveals (B) a high reflective subfoveal scar