Abstract

P 176

Macular hole formation in a patient with toxoplasmotic retinochoroiditis – unusual complication or coincidence?

Zisis Gatzioufas, Ursula Löw, Matthias Hild, Andre Schafia, Arnulf Schnaidt, Sebastian Walter, Berthold Seitz
Klinik für Augenheilkunde, Universitätskliniken des Saarlandes, Homburg/Saar

Objective
We describe a patient who presented with active ocular toxoplasmosis and macular hole in the affected eye and investigate the potential aetiopathological association between toxoplasmotic retinochoroiditis (TR) and macular hole formation.
Methods
A 56-year-old female patient referred to our department with photophobia and floaters in the right eye. She had experienced one episode of TR in the same eye one year ago, treated successfully with appropriate medication in another hospital. Best-corrected visual acuity was 0.1 in the right eye (OD) and 1.0 in the left eye (OS). Slit lamp examination revealed signs of inflammation in anterior segment; anterior chamber cells 2+ (scale: 0 up to 4+), anterior chamber flare 2+ (scale: 0 up to 4+) and vitreous humor cells 3+ (scale: 0 up to 4+). Intraocular pressure was 14 mmHg in both eyes. Fundus examination revealed a retinochoroidal lesion parapapillary with a size of < 1 disc area as well as a macular hole grade IV (Gass classification). Ocular coherence tomography confirmed the presence of a full-thickness macular hole. Fluorescence angiography as well as indocyanine green (ICG) angiography was also performed. ICG angiography disclosed focal ischemia of the choroid in the area of inflammation.
Results
Oral medication (Daraprim 50 mg, Sulfadiazin 2 g, Folat 7.5 mg and Urbason 80 mg) was administered. Topical therapy was also applied (dexamethasone eye drops 3x per day). Ophthalmological examination 4 weeks later revealed an improvement of the clinical findings without visual restoration.
Conclusions
It is well established that retinal ischemia may lead to retinal hole formation. Fluorescence angiography in our patient revealed focal ischemia of the choroid expanding beyond the visible retinochoroidal lesions. Therefore, we assume that macular hole development in our patient was induced by the underlying macular ischemia associated with TR. This is the first report indicating that macular hole formation represents a rare complication of TR.

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