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 Table of Contents    
CLINICAL IMAGE
Year : 2012  |  Volume : 5  |  Issue : 1  |  Page : 64-65  

Spontaneous separation of inflammatory epiretinal membrane in a patient with toxoplasmic retinochoroiditis


1 Department of Vitreoretinal Services Sankara Nethralaya, Chennai, Tamil Nadu, India
2 Department of Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India

Date of Web Publication7-Apr-2012

Correspondence Address:
Aditi Gupta
Department of Vitreoretinal Services, Sankara Nethralaya, 18, College Road, Chennai 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-620X.94786

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How to cite this article:
Gupta A, Gopal L, Biswas J. Spontaneous separation of inflammatory epiretinal membrane in a patient with toxoplasmic retinochoroiditis. Oman J Ophthalmol 2012;5:64-5

How to cite this URL:
Gupta A, Gopal L, Biswas J. Spontaneous separation of inflammatory epiretinal membrane in a patient with toxoplasmic retinochoroiditis. Oman J Ophthalmol [serial online] 2012 [cited 2019 Sep 17];5:64-5. Available from: http://www.ojoonline.org/text.asp?2012/5/1/64/94786

Although spontaneous resolution of inflammatory epiretinal membrane (ERM) has been reported in young, [1] there is no such report for ERM associated with ocular toxoplasmosis. We report a rare case of spontaneous resolution of an ERM associated with toxoplasmic retinochoroiditis in a young patient with good visual improvement.


   Case Report Top


A 24-year-old female presented with diminution of vision in left eye since 3 days. On examination, best-corrected visual acuity (BCVA) was 6/6 in right eye and 6/12 in left eye. Right eye examination was normal. Left eye examination revealed mild anterior chamber reaction, 2+ vitritis, optic disc edema, and juxtapapillary patches of retinochoroiditis [Figure 1]. On blood investigations, serum toxoplasma IgG titer came positive and IgM was negative. A diagnosis of toxoplasma retinochoroiditis was made and the patient was started on Tab clindamycin 300 mg four times a day and Tab azithromycin 250 mg two times a day. Tab prednisolone 1 mg/kg body weight was started (in tapering doses) on the third day of therapy after obtaining physician's clearance. After 3 weeks, examination revealed quiet anterior chamber, decreased vitritis, and resolving lesions of retinochoroiditis with development of thick ERM [Figure 2]. Because the resultant traction was causing distortion of foveal contour with decreased vision, the patient was explained about possible need of vitrectomy and ERM peeling surgery in future. On 3 weekly follow-up visits, retinochoroiditis lesions were seen to be resolving with spontaneous contraction of posterior vitreous face and lifting of ERM [Figure 3]. As the lesions healed, the ERM was noted to resolve completely [Figure 4]. [Figure 5]a depicts the optical coherence tomography (OCT) scan at presentation showing incomplete posterior vitreous detachment (PVD), attached to the thick ERM. [Figure 5]b depicts OCT scan after healing of lesions, showing presence of complete PVD, separation of ERM, and restoration of normal foveal contour. Left eye BCVA improved to 6/6. The oral treatment was stopped and the patient was advised to remain under regular follow-ups.
Figure 1: Red-free fundus photograph of left eye showing retinochoroiditis lesions superior to optic disc and vitreous haze temporal to disc without any epiretinalmembrane

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Figure 2: Red-free fundus photograph showing development of thick epiretinal membrane over the posterior pole extending inferiorly and temporally

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Figure 3: Red-free fundus photograph showing spontaneous contraction of posterior vitreous face and lifting of epiretinal membrane with healing of retinochoroiditis lesions

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Figure 4: Red-free fundus photograph showing near-complete healing of retinochoroiditis lesions and total regression of epiretinal membrane

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Figure 5: OCT scans of left eye showing (a) incomplete posterior vitreous detachmentwith thick epiretinal membrane and associated retinal thickening anddistortion and (b) absence of epiretinal membrane with residual wrinklingofinternal limiting membrane and significant resolution of retinal thickening

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   Discussion Top


The spontaneous resolution of ERM has been reported earlier, in presence [1] and absence of preexisting PVD. [2],[3] Although spontaneous separation is more commonly described for idiopathic ERM, [2],[3] Schadlu and associates reported the same for inflammatory ERM associated with intermediate uveitis. [1] Inflammatory ERM secondary to toxoplasmic retinochoroiditis, although uncommon, often does not resolve and needs surgical removal. [4],[5] Adan and associates reported visual improvement after vitrectomy and membrane peeling in two patients with ERM associated with ocular toxoplasmosis. [4] When we noted the thick ERM developing in our patient, we also explained the option of future surgery to her. However, on regular follow-up visits, as the retinochoroiditis lesions showed regression, ERM gradually contracted and separated spontaneously along with PVD.

Desatnik and associates proposed that the more immature and dynamic cellular composition of ERM in young patients may be responsible for the higher rate of spontaneous membrane detachment than is seen in elderly. [3] They advocated conservative approach for patients with idiopathic ERM and only mild visual disturbances. [3] It may also be advisable to wait for spontaneous resolution of an inflammatory ERM before planning any surgical intervention, especially till complete healing of all inflammatory lesions is over.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

 
   References Top

1.Schadlu R, Apte RS. Spontaneous resolution of an inflammation-associated epiretinal membrane with previously documented posterior vitreous detachment. Br J Ophthalmol 2007;91:1252-3.  Back to cited text no. 1
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2.Meyer CH, Rodrigues EB, Mennel S, Schmidt JC, Kroll P. Spontaneous separation of epiretinal membrane in young subjects: Personal observations and review of the literature. Graefes Arch Clin Exp Ophthalmol 2004;242:977-85.  Back to cited text no. 2
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3.Desatnik H, Treister G, Moisseiev J. Spontaneous separation of an idiopathic macular pucker in a young girl. Am J Ophthalmol 1999;127:729-31.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Adan A, Giralt J, Alvarez G, Alforja S, Burés-Jesltrup A, Casaroli-Marano RP, et al. Pars plana vitrectomy for vitreoretinal complications of ocular toxoplasmosis. Eur J Ophthalmol 2009;19:1039-43.  Back to cited text no. 4
    
5.Papadopoulou DN, Petropoulos IK, Mangioris G, Pharmakakis NM, Pournaras CJ. Pars plana vitrectomy in the treatment of severe complicated toxoplasmic retinochoroiditis. Eur J Ophthalmol 2011;21:83-8.  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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