obsolete peripheral focal retinitis and retinochoroiditis

Obsolete Peripheral Focal Retinitis and Retinochoroiditis: A Rare Ocular Condition

Peripheral focal retinitis and retinochoroiditis is a rare ocular condition characterized by inflammation of the retina and choroid in the peripheral region of the eye. This condition is often associated with other systemic medical conditions, such as infections and inflammatory diseases.

Symptoms and Presentation

The typical presentation of this condition includes:

• Focal retinitis at the border of a pre-existing pigmented retinochoroidal scar [2]
• Decreased vision
• Floaters in the gel of the eye
• Blurred vision

Causes and Associations

This condition is often associated with other systemic medical conditions, such as:

• Infections (e.g., toxoplasmosis)
• Inflammatory diseases (e.g., uveitis)

Treatment and Management

The treatment for peripheral focal retinitis and retinochoroiditis typically involves the use of steroids to reduce inflammation. However, due to the potential side effects of long-term steroid use, alternative treatments such as steroid-sparing medications may be prescribed.

References

• [2] B Balansard (2005) - The typical presentation of ocular toxoplasmosis includes focal retinitis at the border of a pre-existing pigmented retinochoroidal scar.
• [8] A Agarwal (2022) - Viral retinitis lesions are usually peripheral in location, and the retinitis lesion is typically described as a focal area of full-thickness necrotic lesion.
• [10] MedGen UID: 509695 - Peripheral focal retinitis AND retinochoroiditis.

Signs and Symptoms of Obsolete Peripheral Focal Retinitis and Retinochoroiditis

Peripheral focal retinitis and retinochoroiditis are conditions that affect the retina and choroid in the eye. While they may be considered obsolete, it's essential to understand their signs and symptoms for historical and educational purposes.

Decreased Vision The primary symptom of peripheral focal retinitis and retinochoroiditis is decreased vision, particularly in the affected area (1). This can manifest as a blind spot or a decrease in visual acuity.

Floaters and Metamorphopsia Patients may experience floaters, which are small spots that appear to float in front of their eyes. Additionally, they may experience metamorphopsia, a condition where straight lines appear wavy (3).

Blurred Vision and Photophobia Other symptoms include blurred vision and photophobia, or sensitivity to light (3). In some cases, patients may also experience redness and pain in the affected eye.

Retinal Lesions The conditions are characterized by the presence of retinal lesions, which can appear as gray-white or yellowish-white spots on the retina. These lesions can be focal or multifocal, depending on the extent of the disease (6).

Vitreous Inflammation In some cases, vitreous inflammation may occur, obscuring the active lesion on dilated fundus examination (7). This can lead to a decrease in visual acuity and other symptoms.

Classic Presentation The classic presentation of peripheral focal retinitis and retinochoroiditis is an area of fluffy white, focal necrotizing retinitis adjacent to a pigmented chorioretinal scar (15).

It's essential to note that these conditions are considered obsolete, and modern treatments have improved significantly. However, understanding their signs and symptoms can provide valuable insights for medical professionals and researchers.

References:

• [1] Toxoplasma-induced retinal choroiditis can also manifest itself as multiple gray-white punctate lesions deep in the retina.
• [3] The symptoms include decreased vision, floaters in the gel of the eye, blurred vision, photophobia, have red, painful eyes accompanied with fever, chills, and ...
• [6] Posterior pole retinochoroiditis is the most prevalent form. This condition is characterized by yellowish-white retinal lesions and decreased visual acuity.
• [7] Active lesions present as grey-white focus of retinal necrosis with adjacent choroiditis, vasculitis, hemorrhage and vitreitis.
• [15] Classic presentation. The typical finding of ocular toxoplasmosis is an area of fluffy white, focal necrotiz­ing retinitis adjacent to a pigmented chorioretinal scar ().Vitreous inflammation may obscure the active lesion on dilated fundus examination, resulting in the headlight ...

Based on the provided context, it appears that diagnostic tests for peripheral focal retinitis and retinochoroiditis have evolved over time.

Traditional Diagnostic Methods

• Clinical examination by an experienced ophthalmologist is still a mainstay in diagnosing these conditions [3].
• Direct and indirect treponemal antibody tests are used to diagnose syphilis, which can cause retinal lesions [6].

Modern Diagnostic Techniques

• Polymerase Chain Reaction (PCR) testing of ocular samples can be useful in presumed toxoplasmosis, especially in patients older than 50 with inflammation [7].
• Fluorescein angiography may reveal bilateral mild disc hyperfluorescence and is useful in diagnosis and follow-up [9].
• Optical Coherence Tomography (OCT) has also been used to diagnose and monitor these conditions [2, 9].

Limitations of Diagnostic Tests

• The sensitivity and specificity for aqueous viral PCR testing are high, but lower for aqueous toxoplasma PCR testing [4].
• In some cases, the diagnosis may be made solely based on clinical findings, as seen in focal viral retinitis [5].

Other Considerations

• Posterior segment findings of Cat-Scratch Disease (CSD) include neuroretinitis, focal retinitis, multifocal retinitis, choroiditis or retinochoroiditis, intermediate uveitis, branch retinal vein and artery occlusions [10].
• The patient's history may lack clues to the source of infection, making diagnosis challenging in some cases [11].

In summary, while traditional diagnostic methods are still useful, modern techniques such as PCR testing, fluorescein angiography, and OCT have improved our ability to diagnose peripheral focal retinitis and retinochoroiditis. However, limitations in sensitivity and specificity remain, and a thorough clinical examination is still essential for accurate diagnosis.

References: [1] 7 [2] 9 [3] 3 [4] 4 [5] 5 [6] 6 [7] 7 [8] 10

Treatment Options for Obsolete Peripheral Focal Retinitis and Retinochoroiditis

Peripheral focal retinitis and retinochoroiditis are conditions that affect the retina, causing inflammation and damage to the tissue. While there is no cure for these conditions, various treatment options can help manage symptoms and slow disease progression.

Traditional Treatment Options

• Pyrimethamine, Sulfadiazine, and Systemic Corticosteroids: This classic treatment combination has been used for decades to treat toxoplasmosis retinochoroiditis (TRC). However, its effectiveness is still debated, and some studies suggest that it may not be the most effective option. [6][9]
• Trimethoprim/Sulfamethoxazole: This antibiotic combination has been shown to accelerate the resolution of TRC and improve visual outcomes in some patients. [8]

Intravitreal Injections

• Clindamycin and Dexamethasone: Intravitreal injections of these medications have been used to treat TRC, particularly in cases where systemic treatment is not effective or tolerated. These injections are generally well-tolerated and may offer an additional strategy for managing TRC. [7]

Other Treatment Options

• Ganciclovir and Foscarnet: These antiviral medications have been approved by the FDA for the treatment of CMV retinitis, a condition that can cause peripheral focal retinitis and retinochoroiditis. However, their effectiveness in treating TRC is still being studied. [4]
• Bevacizumab: This medication has been used to treat various eye conditions, including TRC. However, its effectiveness in treating obsolete peripheral focal retinitis and retinochoroiditis is not well established. [2]

Important Considerations

• Uncertainty about Effectiveness: There is still uncertainty about the effectiveness of some treatment options for obsolete peripheral focal retinitis and retinochoroiditis.
• Variability in Therapeutic Practice: Treatment practices can vary depending on individual patient needs, and some clinicians may reserve certain treatments for specific cases. [12]

It's essential to consult with an eye care professional to determine the best course of treatment for each individual case.

The differential diagnosis for obsolete peripheral focal retinitis and retinochoroiditis involves considering various conditions that can present with similar symptoms. Based on the search results, here are some possible differentials:

• Toxoplasmosis: This is a common cause of focal necrotizing retinitis, which can be associated with vitritis and anterior uveitis [10].
• Cytomegalovirus (CMV) retinitis: CMV retinitis can present as a multifocal necrotizing retinitis even in seemingly immunocompetent patients [13].
• Retinitis pigmentosa masquerades: These are conditions that mimic the symptoms of peripheral focal retinitis and retinochoroiditis, such as retinal degeneration or other inflammatory conditions.
• Atypical toxoplasmic retinochoroiditis: This is a condition that can be difficult to distinguish from ARN (acute retinal necrosis) [11].
• Ocular manifestations of Cat-Scratch Disease (CSD): CSD can present with neuroretinitis and focal retinochoroiditis/retinal infiltrates, which are common clinical forms of ocular CSD [9].

It's worth noting that the diagnosis of these conditions often requires a comprehensive evaluation of the patient's history, age, clinical presentation, and patterns of retinal and/or choroidal involvement.

References:

[10] - This condition is characterized by focal necrotizing retinitis associated or not with vitritis and anterior uveitis. [11] - Atypical toxoplasmic retinochoroiditis continues to be the primary differential diagnosis for ARN, as revealed in this study. [13] - Ocular toxoplasmosis can present as a multifocal necrotizing retinitis even in seemingly immunocompetent patients. [9] - B. henselae is among the most common causes of neuroretinitis.

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