Background
Retinochoroiditis is the most common ocular manifestation of congenital toxoplasmosis, but other associated ophthalmological
pathologies can also occur. The aim of this study was to determine the nature of the latter in treated cases of the disease
and to assess their impact on visual function.
Methods
Four hundred and thirty consecutive children with serologically confirmed congenital toxoplasmosis were included in this study.
Data were prospectively collected using standardized ophthalmological assessment forms. The presence of retinochoroiditis
and of associated pathologies was ascertained, and their impact on visual function was assessed.
Results
After a median follow-up of 12 years [range 0.6–26 years], 130 children manifested retinochoroiditis. We detected 22 foci
of retinochoroiditis at birth and 264 additional ones during the follow-up period. Of these, 48 (17%) were active when first
diagnosed. Twenty-five of the 130 children (19%) had other associated ocular pathologies. Of these, 21 (16%) had a strabismus,
which was due to macular lesions in 86% of the cases; 7 (5.4%) presented with unilateral microphthalmia, and 4 (3%) with cataracts.
Most of these events were detected after the onset of retinochoroiditis. None of the children presented with ocular involvement
in the absence of chorioretinal lesions. Macular lesions occurred more frequently in children with associated pathologies
(p<0.0001), and associated pathologies were likewise more common in individuals with macular lesions (p=0.0003). Visual impairment occurred in 31/130 cases, and in all but 3 of these eyes it was due not to an associated pathology
but to macular retinochoroiditis.
Conclusions
At the end of the follow-up period, ocular involvement existed in 30% of the treated children with congenital toxoplasmosis.
Associated eye pathologies were manifested less frequently than anticipated. They may occur later in life and are an indirect
marker of the severity of congenital toxoplasmosis, but they do not have a direct impact on visual acuity. The overall functional
prognosis of congenital toxoplasmosis is better than would be expected on the basis of literature findings, with only 2 of
the 130 children suffering bilateral visual impairment.
Keywords Congenital toxoplasmosis - Retinochoroiditis - Visual impairment - Infection - Ocular manifestation
The findings of this study were presented at the “International Conference on Toxoplasmosis” in Copenhagen, Denmark (L.K.,
23-25 July 2003) and on the Annual Meeting of the DOG in 2004 in Berlin (J.G.G.).
Laurent Kodjikian and Martine Wallon had full access to all available data and take full responsibility for its integrity
and for the accuracy of the analysis. The authors permit Graefe’s Archive for Clinical and Experimental Ophthalmology to review the data on request.