Ocular Toxocariasis: Clinical Features and Long-term Visual Outcomes in Adult Patients

Abstract

Purpose: To investigate clinical characteristics and treatment outcomes of proven ocular toxocariasis (OT) in adult patients.

Design: Retrospective, consecutive, interventional case series.

Methods: setting: Institutional.

Study population: Consecutive OT patients with positive serum serology and positive western blot (WB) on ocular sample.

Observation procedures: Clinical features, optical coherence tomography (OCT), and treatment outcomes.

Main outcome measures: Best-corrected visual acuity (BCVA) and OCT central foveal thickness (CFT).

Results: Fourteen patients were included between 2011 and 2013. Mean age at diagnosis was 45.6 years. Mean duration between the first symptoms and diagnosis was 15.1 months. Uveitis was unilateral in all cases and all patients displayed vitreous inflammation. The main baseline findings were presence of ≥1 peripheral granulomas (57.1%), vasculitis (57.1%), vitreoretinal traction (57.1%), and chronic macular edema (ME) (71.4%). Delayed diagnosis (>8 months) seemed to be associated with higher rate of ME. All patients received albendazole. Systemic (n = 5) and/or local corticosteroids (CS) (n = 7) were administered in case of ME and/or posterior segment inflammation. Vitrectomy was performed when vitreous inflammation was severe and persistent despite CS or in case of threatening traction or visually significant epimacular membrane (28.6%). Overall, this regimen allowed significant decrease of CFT (P = .01). In the vitrectomy subgroup, mean BCVA increased (P = .01) and CFT decreased (P = .017).

Conclusion: While some features such as granuloma are typical signs of OT, atypical features can delay the diagnosis. In doubtful situations, WB on ocular samples seems to be more specific than serum antibodies alone. ME seems to be a common complication of longstanding OT in the adult.