Abstract
PURPOSE: To determine the natural history of treated and untreated congenital toxoplasmosis and impact of this infection on vision. METHODS: In this prospective, longitudinal study, 76 newborns were treated with pyrimethamine and sulfadiazine for approximately one year, and 18 individuals not treated during their first year of life entered the study after age 1 year (historical patients). RESULTS: Chorioretinal scars were the most common eye finding in all patients and were most common in the periphery (58% of treated and 82% of historical patients). Macular scars were present in 54% of the treated patients; 41% were bilateral. Macular scars were present in 76% of the historical patients; 23% were bilateral. Visual acuity in the presence of macular lesions ranged from 20/20 to 20/400. Of the patients followed up from the newborn period and treated, 29% had bilateral visual impairment, with visual acuity for the best eye of less than 20/40. Causes for this visual impairment in eyes with quiescent lesions included macular scars, dragging of the macula secondary to a peripheral lesion, retinal detachment, optic atrophy, cataract, amblyopia, and phthisis. There were recurrences in both treated (13%, 7/54) and previously untreated historical patients (44%, 8/18). The total, median, and range of years of follow-up during which recurrences were observed were, for treated patients, 189 years (total), five years (median), and three to ten years (range) and, for historical, untreated patients, 160 years (total), 11 years (median), and three to 24 years (range). New lesions occurred in previously normal retinas and also contiguous to older scars. Active lesions appeared to become quiescent within ten to 14 days after beginning pyrimethamine and sulfadiazine therapy. CONCLUSION: Many children with congenital toxoplasmosis have substantial retinal damage at birth and consequent loss of vision. Nonetheless, vision may be remarkably good in the presence of large macular scars. Active lesions become quiescent with treatment.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1-16 |
| Number of pages | 16 |
| Journal | American journal of ophthalmology |
| Volume | 123 |
| Issue number | 1 |
| DOIs | |
| State | Published - 1997 |
Funding
Accepted for publication March 18, 1996. From the Departments of Ophthalmology (Dr. Mets), Neurology (Dr. Swisher), and Audiology (Dr. L. Stein), Children's Memorial Hospital and Northwestern University, Chicago, Illinois; Departments of Medicine (Drs. Mack and McLeod, Ms. Holfels, and Ms. Luciano) and Radiology (Dr. Patel), Michael Reese Hospital and Medical Center, Chicago, Illinois; Department of Pediatrics (Dr. Boyer), Rush University Medical School and Rush-Presbyterian St. Luke's Medical Center, Chicago, Illinois; Departments of Pediatrics (Dr. Roizen), Psychiatry (Dr. M. Stein), Ophthalmology, Medicine, and Pathology, The College, and the Committee on Immunology (Dr. McLeod), the Pritzker School of Medicine at the University of Chicago, Chicago, Illinois; Department of Psychology (Dr. Hopkins), Illinois Institute of Technology, Chicago, Illinois; Department of Nursing (Ms. Withers), The Doctors Hospital of Chicago, Chicago, Illinois; Departments of Medicine, Microbiology, Immunology, and Genetics (Drs. Mack and McLeod), The University of Illinois at Chicago, Chicago, Illinois; Department of Medicine (Dr. Remington), Stanford University and the Palo Alto Research Institute, Stanford, California; and Departments of Statistics and Mathematics (Dr. Meier), Columbia University, New York, New York. This work was supported by National Institutes of Health grants AI 16945, AI 27530, and AI 04717; March of Dimes grant 6-528; Food and Drug Administration grant FD-R-000192; The United Airlines Foundation, Angel Flight, The Huffy and the Buchanan Family, United to Save Children, Gerico, Hyatt Hotel Corporation Foundations, the Research and Education Foundation of the Michael Reese Medical Staff, the Michael Reese Institute Council, The Toxoplasmosis Research Institute, Children's Memorial Hospital Guild Fund, and The Research to Prevent Blindness Foundation (University of Chicago and Northwestern University). Rima McLeod, M.D., is the Jules and Doris Stein Research to Prevent Blindness Professor at the University of Chicago.
ASJC Scopus subject areas
- Ophthalmology