Successful Treatment of Toxoplasmosis-Associated Choroidal Neovascular Lesions With Bevacizumab and Antiparasitic Therapy

In Brief Purpose: To report the effects of oral trimethoprim/sulfamethoxazole and intravitreal bevacizumab injection in the treatment of ocular toxoplasmosis–associated choroidal neovascular lesions (CNV). Methods: This was a noncomparative, nonrandomized, consecutive case series. All eyes with ocular toxoplasmosis–associated CNV received one intravitreal bevacizumab injection under the coverage of oral trimethoprim/sulfamethoxazole. The changes in best-corrected visual acuity were recorded. Serial fundus photography, fluorescein angiography, optical coherence tomography, and indocyanine green angiography were performed to measure the treatment efficacy. Results: Three eyes of two patients with a history of ocular toxoplasmosis had active CNV demonstrated by fluorescein angiography and optical coherence tomography. Each was treated with oral trimethoprim/sulfamethoxazole and one intravitreal bevacizumab injection. Best-corrected visual acuity, fundus photographs, fluorescein angiography, optical coherence tomography, and indocyanine green angiography all showed favorable results. No ocular or systemic complications were noted. In all three eyes, the CNV subsided and vision improved. Conclusion: Oral trimethoprim/sulfamethoxazole is an effective and less expensive antibiotic against Toxoplasma gondii. Intravitreal bevacizumab injection appears to be a well-tolerated treatment for toxoplasmosis-associated CNV and has the potential as an adjuvant therapy to improve final vision. More cases and further studies are required. Intravitreal bevacizumab injection appears to be a well-tolerated therapy for patients with ocular toxoplasmosis–associated choroidal neovascular lesions. The study demonstrates that this therapy has a potential as a beneficial adjuvant procedure to improve vision and facilitate the treatment of ocular toxoplasmosis–associated choroidal neovascularization.