Controversy and consensus on the management of ocular toxoplasmosis: A joint statement by the Asia-Pacific Society of Ocular Inflammation and Infection (APSOII), the Asia-Pacific Vitreo-Retina Society (APVRS), the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and The Infectious Uveitis Treatment Algorithm Network (TITAN) Group.

Abstract

This international consensus effort, convened by The Infectious Uveitis Treatment Algorithm Network (TITAN) group, brought together 103 uveitis experts to address long-standing controversies in the management of ocular toxoplasmosis (OT), a leading cause of infectious posterior uveitis worldwide. Despite the availability of advanced diagnostic tools, variability persists in clinical decision-making. Controversies were identified from previous surveys on OT management, which served as the foundation for developing the survey questions in this study. Using a two-round modified Delphi method, experts reviewed evidence and rated recommendations across three domains: diagnosis and investigations, treatment, and follow-up management. Key consensus findings include support for antiparasitic therapy in most active cases, selective use of polymerase chain reaction (PCR) testing for atypical presentations, and prophylactic therapy in high-risk scenarios. These expert-derived consensus provide a framework for best practices in OT clinical management and highlight priorities for future prospective studies.