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Graefes Arch Clin Exp Ophthalmol (2010) 248:11871192 DOI 10.1007/s00417-010-1379-9
INFLAMMATORY DISORDERS
Does atovaquone prolong the disease-free interval of toxoplasmic retinochoroiditis?
Sibylle Winterhalter & Katja Severing &
Johannes Stammen & Anna Karina Maier &
Erhard Godehardt & Antonia Maria Joussen
Received: 20 September 2009 /Revised: 17 March 2010 /Accepted: 2 April 2010 /Published online: 2 May 2010 # Springer-Verlag 2010
AbstractBackground To evaluate the efficacy of suppressing a recurrence of Toxoplasma retinochoroiditis after treatment with atovaquone.
Methods Retrospective, nonrandomized, clinical trial. Forty-one immunocompetent patients were treated for Toxoplasma retinochoroiditis with atovaquone between 1999 and 2006. The diagnosis was based on clinical signs alone. Atovaquone was given 750 mg two to three times daily together with oral steroids. Lesion location, time interval until recurrence, visual function, and adverse events were recorded.
Results Forty-two eyes of 41 patients were treated with atovaquone for Toxoplasma retinochoroiditis. Side-effects were usually mild and only one patient stopped therapy with atovaquone because of nausea. Reactivation of retinochoroiditis occurred in 18 patients (44%) during a time interval of 370 months.
Conclusions The therapy of Toxoplasma retinochoroiditis with atovaquone is well tolerated. Our data suggests that therapy with atovaquone has the potential to prolong the time to recurrence of Toxoplasma retinochoroiditis. A
prospective randomized comparative long-term clinical trial would be necessary to confirm our data.
Keywords Toxoplasma retinochoroiditis . Atovaquone . Recurrence rate . Posterior infectious uveitis
Introduction
Toxoplasmic retinochoroiditis is the most common cause of posterior uveitis and accounts for 1635% of all cases in the United States and Europe. It is also the most frequent cause of infectious retinochoroiditis in immunocompetent patients.
Toxoplasmic retinochoroiditis was first described in 1923 as a congenital infection. Infections during adulthood have been described in 1952 [1]. Therapeutic approaches have not changed much during the past few decades. Treatment consists of a combination of antibiotics including pyrimethamine, clindamycine, trimethoprim, and sulphonamides. So far, only three randomized placebo-controlled clinical trials [24] are available examining the clinical benefit of different combinations of antibiotics. The combinations of pyrimethamine, sulfadiazine, and steroids as well as the combination of clindamycin, sulfadiazine, and steroids, and a combination of trimethoprim, sulfamethoxazole, and steroids were studied by Rothova et al. However, no beneficial treatment effect could be shown in regard to final visual acuity in...