Intravitreal Clindamycin Injection for Toxoplasmic Retinochoroiditis

Abstract

Purpose: To present cases of toxoplasmic retinochoroiditis (TRC) treated successfully with intravitreal clindamycin injection.

Case summary: (Case 1) A 41-year-old man presented with blurred left eye vision for several months. The patient had a large chorioretinal scar with infiltrations at the boundaries, and fluorescein angiography (FA) showed active retinochoroiditis. Antitoxoplasmosis (antiTX) immunoglobulin G (IgG) was positive, and the patient was started on antiTX medication. Despite several weeks of treatment with maximum doses of antiTx, the TRC progressed and visual acuity worsened. Pars plana vitrectomy (PPV) with intravitreal clindamycin injection (1.0 mg/0.1 ml) was performed, and an additional injection was given 4 weeks later. Six weeks after the second injection, TRC wascompletely resolved with 20/20 vision. (Case 2) A 67-year-old man presented with decreased left eye vision for 1 year. Fundus examinations showed vitreous opacity and epiretinal membranes. The FA revealed retinochoroiditis and the antiTX IgG titer was elevated. The presumed diagnosis was TRC, and oral medications of trimethoprim-sulfamethoxazole, clindamycin, and prednisolone was administered. Inflammation began to improve however, as the patient was not tolerating systemic antiTx medications, an intravitreal injection of clindamycin (1.0 mg/0.1 ml) was administered with PPV. The patientdiscontinued oral medication after surgery, and the inflammation resolved 5 weeks later.

Conclusions: Intravitreal clindamycin injections may be an additional treatment option for TRC in patients who are unable to tolerate systemic therapy or whose disease progresses despite systemic therapy.

목적: 톡소플라스마 망맥락막염 환자에서 유리체강내 클린다마이신 주입술 시행 후 염증의 호전을 경험하였기에 이를 보고하고자 한다.

증례요약: 첫 증례는 좌안 시력저하를 주소로 내원한 41세 환자로 안저에서 경계부 염증침윤을 동반한 망맥락막 반흔이 관찰되었고 톡소플라스마 면역글로불린G (IgG)가 양성이었다. 톡소플라스마 망맥락막염 진단하에 경구 스테로이드와 항톡소플라스마 항생제 치료 를 시작하였으나 염증이 지속적으로 악화되어 유리체절제술과 안내 클린다마이신 주입술(1.0 mg/0.1 ml)을 2회 시행하였고 이후 병변 은 안정되었다. 두 번째 증례는 좌안 시력저하를 주소로 내원한 67세 환자로 안저에서 유리체혼탁과 망막전막이 관찰되었고 형광안저 혈관조영술에서 망맥락막염 소견을 보였으며 톡소플라스마 IgG 양성이었다. 항톡소플라스마 약제를 6주간 투여하였으나 부작용으로 투약지속이 어려워 안내 클린다마이신 주입술(1.0 mg/0.1 ml)과 유리체절제술을 시행하였다. 수술5주 뒤 유리체 염증이 소실되었다.

결론: 경구 항생제치료에 반응하지 않거나 부작용으로 투약이 어려운 눈톡소플라스마증에서 유리체강내 클린다마이신 주입술이 유용 한 추가 치료가 될 수 있을 것이다.