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Meta-Analysis
. 2023 May 22:56:e05522022.
doi: 10.1590/0037-8682-0552-2022. eCollection 2023.

Clinical outcomes of intravitreal treatment for ocular toxoplasmosis: systematic review and meta-analysis

Lutiana Amaral de Melo  1 , Mayara Rodrigues Brandão de Paiva  1 , Gabriella Maria Fernandes-Cunha  2 , Armando Silva-Cunha  3 , Marcos Paulo Gomes Mol  1 , Sílvia Ligorio Fialho  1
Affiliations
Meta-Analysis

Clinical outcomes of intravitreal treatment for ocular toxoplasmosis: systematic review and meta-analysis

Lutiana Amaral de Melo et al. Rev Soc Bras Med Trop. .

Abstract

Background: Ocular toxoplasmosis is the leading cause of infectious posterior uveitis worldwide, accounting for 30-50% of all cases in immunocompetent patients. Conventional treatment is associated with adverse effects and does not prevent recurrence. Intravitreal drug administration can improve disease outcomes and reduce side effects. Herein, we conducted a systematic review and meta-analysis on the efficacy of intravitreal injections for treating ocular toxoplasmosis.

Methods: The systematic search was conducted using PubMed, SciELO, and Google Scholar with the descriptors "ocular toxoplasmosis" AND "intravitreal". We analyzed studies that met the inclusion criteria, i.e., experimental cases in patients treated intravitreally for ocular toxoplasmosis. Considering the systematic review, we focused on the number of intravitreal injections, the therapeutic drug class, and the presence of preexisting conditions. To assess the efficacy of intravitreal injections, a meta-analysis was performed using visual acuity, side effects, disease recurrence, and inflammatory responses as variables.

Results: Intravitreal injection-induced side effects were rarely observed (0.49% [0.00, 1.51%] ). The use of antiparasitic and anti-inflammatory drugs afforded improved visual acuity (99.81% [98.60, 100.00%]) and marked effectiveness in treating ocular toxoplasmosis.

Conclusions: Intravitreal injections may facilitate the successful treatment of ocular toxoplasmosis. However, clinicians should carefully evaluate the presence of preexisting conditions for ocular toxoplasmosis or previous diseases, as these can impact the decision to administer intravitreal injections.

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Conflict of interest statement

Conflict of Interest: The authors declare that there is no conflict of interest.

Figures

FIGURE 1:
FIGURE 1:. Flow chart of articles selection stages.
FIGURE 2:
FIGURE 2:. Descriptive statistical data regarding the prevalence (%) of improved eyesight (A), adverse reactions (B), recurrence (C), and inflammation reduction (D), according to therapeutic class. anti-VEGF: anti-vascular endothelial growth factor.
FIGURE 3:
FIGURE 3:. A: Forest plot of improvement in visual acuity prevalence (%) for all included papers by meta-analysis (above) and according to therapeutic class, anti-inflammatory associated with antiparasitic (left), and antiparasitic (right); B: Forest plot of adverse effects prevalence (%) for all included papers; C: Forest plot of reduced ocular inflammation prevalence (%) for all included papers. CI: confidence interval.
See this image and copyright information in PMC

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