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Considerations in the management of ocular toxoplasmosis in pregnancy: a review of literature

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Abstract

Ocular toxoplasmosis is the most common cause of infectious posterior uveitis. Available literature is still conflicting regarding the incidence of recurrence during pregnancy as various calculations were employed in the different published studies. Although earlier reports have suggested a difference in presentation and an increase in severity during pregnancy, newer studies appear to show otherwise. Further diagnostic testing, including serologic and intraocular fluid sampling, may be indicated to increase the diagnostic accuracy in this special population of patients. The management of ocular toxoplasmosis during pregnancy is challenging as the foetus is additionally considered in the choice of treatment. Traditionally preferred anti-toxoplasmosis regimens containing antifolate drugs, such as pyrimethamine and trimethoprim-sulfamethoxazole, cannot be used routinely in pregnant patients, especially during the first trimester. This review includes literature on alternative treatments for ocular toxoplasmosis during pregnancy, including spiramycin and intravitreal treatment options.

摘要

眼弓形虫病是感染性后葡萄膜炎最常见的病因。关于妊娠期复发的发生率, 在发表的研究中仍存在矛盾, 因为不同文献采用了不同的计算方法。虽然早期文献认为妊娠期的表现有所不同, 严重程度也会增加, 但最新研究表明情况并非如此。进一步的诊断检测, 包括血清学和眼内液采样, 可提高对这一特殊患者群体的诊断准确率。妊娠期眼弓形虫病的治疗具有挑战性, 因为在选择治疗方法时还要考虑到胎儿。传统上首选的抗弓形虫治疗方案含有抗叶酸药物, 如乙胺嘧啶和三甲氧苄氨嘧啶-磺胺甲噁唑, 但不能常规用于孕妇, 尤其是妊娠头三个月。本综述收录了有关妊娠期眼弓形虫病替代治疗的文献, 包括螺旋霉素和玻璃体内治疗方案。

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Authors and Affiliations

  1. Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines

    Jose Carlo M. Artiaga, Faye D. Levina, Bryan Vincent Q. Mesina & Cheryl A. Arcinue

  2. Section of Ophthalmology, Department of Surgery, University of Calgary, Calgary, AB, Canada

    Corrina P. Azarcon

  3. Department of Ophthalmology, Stanford University, Palo Alto, CA, USA

    Albert John Bromeo

  4. Asian Eye Institute, Makati City, Philippines

    Cheryl A. Arcinue

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JCMA had the lead role in conceptualising the review, collecting and analysing data for the review and writing the initial and final manuscript. CPA, FDL and AJB collected and analysed data and had major contributions to writing the manuscript and approving its final version. BVQM and CAA contributed critical appraisal of initial manuscript and approval of final manuscript.

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Artiaga, J.C.M., Azarcon, C.P., Levina, F.D. et al. Considerations in the management of ocular toxoplasmosis in pregnancy: a review of literature. Eye (2024). https://doi.org/10.1038/s41433-023-02916-y

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