Pars Plana Vitrectomy Combined with Endolaser in Refractory Active Ocular Toxoplasmosis: A Retrospective Case Series.

Purpose: This study aims to evaluate the effectiveness of pars plana vitrectomy (PPV) combined with endolaser treatment for patients with active ocular toxoplasmosis who have not responded to conventional therapies.

Methods: We retrospectively reviewed the records of 18 consecutive patients with active ocular toxoplasmosis who failed to respond to ≥3 months of systemic therapy, experienced worsening retinitis during treatment, or developed vitreoretinal complications (retinal detachment or vitreous hemorrhage). All patients underwent 23-gauge PPV with direct 532 nm endolaser application to and around the active retinitis area.

Results: Complete lesion resolution was achieved in 17 patients (95%; 95% CI: 74.2-99.0%). Four patients (22%; 95% CI: 9.0-45.2%) developed reactivation between 1.3 and 9 months after surgery; three responded promptly to oral therapy. Visual acuity improved in 44.5% of eyes, remained stable in 11%, and worsened in 44.5%. Postoperative complications occurred in 16 patients (89%), most frequently retinal detachment (39%) and cataract (33%). Mean follow-up was 33.3 months.

Conclusion: Pars plana vitrectomy combined with endolaser appears to be an effective option for patients with active ocular toxoplasmosis who do not respond to standard therapies.