Intravitreal cotrimoxazole as adjuvant therapy for active ocular toxoplasmosis: a case series and literature review

Ocular toxoplasmosis represents the most common cause of posterior uveitis worldwide and remains a major cause of visual morbidity, particularly among young and immunocompetent individuals. The purpose of this study is to assess the efficacy and safety of combined intravitreal trimethoprim/sulfamethoxazole and dexamethasone with concurrent systemic cotrimoxazole and oral corticosteroids in patients with active Toxoplasma chorioretinitis. This retrospective interventional case series included a total of seven eyes from seven consecutive patients with active necrotizing toxoplasma retinochoroiditis and dense vitritis involving zone 1. All examinations were performed by a uveitis specialist. Each patient received a single intravitreal injection of trimethoprim/sulfamethoxazole and dexamethasone, in addition to systemic cotrimoxazole and prednisolone. Clinical evaluation included best-corrected visual acuity (BCVA), intraocular pressure (IOP), grading of ocular inflammation, and fundus examination. Patients were followed weekly for one month and subsequently on a monthly basis for three months. All patients demonstrated a rapid reduction in inflammation and lesion size, accompanied by improvement in BCVA, achieving a final visual acuity of 8/10 to 10/10 at one month. No ocular or systemic complications, IOP elevation, or recurrence were observed during the three-month follow-up period. Adjuvant intravitreal cotrimoxazole therapy appears to be a safe and effective option for vision-threatening ocular toxoplasmosis, providing rapid disease control and excellent visual outcomes.