Cesk Slov Oftalmol. 2010 Feb;66(1):30-5.

[The possibility of the treatment of bilateral macular edema without the anti VEGF treatment--a case report].

[Article in Czech]

Matusková V1, Vyslouzilová D.  1Ocní klinika FN Brno Bohunice. vmatuskova@fnbrno.cz

Aim of this case report is to present a case of a female patient with bilateral macular edema successfully treated by the systemic antibiotic.

MATERIAL AND METHODS:  The authors present a case of 58 years old female with bilateral cystoid macular edema. In this patient, the central retinal thickness of the right eye was 550 microm, and 600 microm of the left eye. The best-corrected visual acuity (BCVA) of the right eye was 4/10 (0.4) and 4/12 (0.33) of the left eye. The patient underwent complex ophthalmologic examination. During the examination of the posterior pole, there were found no signs of the diabetic changes, or signs of the uveitis. The fluorescein angiography did not prove the presence of the choroidal neovascular membrane or vasculitis. The serological tests (toxoplasmosis, toxocariasis, borreliosis, syphilis--TPHA, RRR), and immunologic tests were performed as well.

Toxoplasma positive IgG antibodies were found. According to these serological results, the systemic oral antibiotic treatment was started: clindamycin 300 mg three times daily for 14 days. After the termination of the treatment, improvement of the BCVA to 4/5 (0.8) in both eyes occurred. The OCT examination showed the foveolar depression in both eyes.

Two months after the termination of the antibiotic treatment, the relapse of the macular edema occurred (BCVA 4/6 (0.66) in both eyes). According to the consultation with the doctor from the Department of Infectious Diseases, the treatment with clindamycin was started again (300 mg three times daily) for three weeks. After termination of this treatment, the foveolar depression on the OCT examination was evident and the BCVA was 4/4 (1.0) in both eyes (central retinal thickness of the right eye was 215 microm, and of the left eye it was 225 microm). This condition is stable and lasts for more than one year.

CONCLUSION:  In the differential diagnosis of the bilateral macular edema also the inflammatory etiology should be always considered. According to our experience, the bilateral macular edema may be the only presentation of toxoplasmosis.

PMID:  20521508