Visual Outcomes in Presumed Congenital Foveal Toxoplasmosis

Abstract Purpose Congenital macular lesions attributed to toxoplasmosis may limit potential visual acuity. The appearance and location of these scars may cause physicians to overlook associated amblyopia. This study reviews the visual outcomes and benefits of amblyopia therapy in children with foveal toxoplasmosis scars. Design Retrospective observational case series Methods . Setting Single center Patient population Children with with presumed foveal toxoplasmosis scars who underwent amblyopia treatment. Main outcome measure Charts were reviewed for amblyopia treatment, fundus photographs, optical coherence tomography (OCT), and visual acuity. Results Median age at presentation was 2.8 years old and median follow-up was 6.2 years. Occlusion therapy was undertaken in nine patients. Median duration of occlusion therapy was years. Six patients improved with occlusion therapy (average 4.6 lines gained on optotype acuity). Final visual acuity ranged from 20/25 - 20/250, with 6 of 8 patients better than 20/80. OCT confirmed macular scars in five patients, with varying degrees of foveal architecture disruption. Conclusion Despite the striking appearance of the lesions in patients with presumed foveal toxoplasmosis, visual potential may be better than expected. The appearance of the lesions is not always predictive of visual outcome. A trial of occlusion therapy to treat amblyopia should be initiated in these patients to ensure that they reach their maximal visual potential.