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PurposeThis review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up and therapeutic approach of ocular toxoplasmosis focusing mainly on the postnatally acquired form of the disease.MethodsA meticulous literature search was performed in the PubMed database. A supplementary search was made in Google Scholar to complete the collected items.ResultsOcular toxoplasmosis is one of the most frequent infectious etiologies of posterior uveitis. It typically presents with retinochoroiditis. Setting an accurate diagnosis depends to a considerable degree on detecting characteristic clinical characteristics. In addition to the evaluation of clinical features, the diagnosis of toxoplasmosis relies at a large degree on serologic testing. The detection of the parasite DNA in the aqueous or vitreous humor can provide evidence for a definitive diagnosis. The current mainstay for the treatment, if necessary, is the use of oral antibiotic with systemic corticosteroids. Recent evidence suggests other therapeutic approaches, such as intravitreal antibiotics can be used.ConclusionRecent developments in the diagnostic and therapeutic approach have contributed to preventing or limiting vision loss of patients suffering from ocular toxoplasmosis. Further studies are required to provide a better understanding of epidemiology, pathogenesis, diagnosis, and treatment with a significant impact on the management of this challenging clinical entity.

Ocular toxoplasmosis (OT) is caused by the parasite Toxoplasma gondii. OT is the leading cause of posterior uveitis globally; it is a recurrent disease that may result in visual impairment and blindness. This systematic review and meta-analysis aim to summarize and evaluate the risk factors for recurrences, visual impairment, and blindness described in the literature worldwide. We performed a systematic literature search in PubMed, Embase, VHL, Cochrane Library, Scopus, and DANS EASY Archive. All studies reporting patients with clinically and serologically confirmed OT presenting any clinical or paraclinical factor influencing recurrences, visual impairment, and blindness were included. Studies presenting secondary data, case reports, and case series were excluded. An initial selection was made by title and abstract, and then the studies were reviewed by full text where the eligible studies were selected. Then, the risk of bias was assessed through validated tools. Data were extracted using a validated extraction format. Qualitative synthesis and quantitative analysis were done. This study was registered on PROSPERO (CRD42022327836). Seventy two studies met the inclusion criteria. Fifty-three were summarized in the qualitative synthesis in three sections: clinical and environmental factors, parasite and host factors, and treatment-related factors. Of the 72 articles, 39 were included in the meta-analysis, of which 14 were conducted in South America, 13 in Europe, four in Asia, three multinational, two in North America and Central America, respectively, and only one in Africa. A total of 4,200 patients with OT were analyzed, mean age ranged from 7.3 to 65.1 year of age, with similar distribution by sex. The frequency of recurrences in patients with OT was 49% (95% CI 40%-58%), being more frequent in the South American population than in Europeans. Additionally, visual impairment was presented in 35% (95% CI 25%-48%) and blindness in 20% (95% CI 13%-30%) of eyes, with a similar predominance in South Americans than in Europeans. On the other hand, having lesions near the macula or adjacent to the optic nerve had an OR of 4.83 (95% CI; 2.72-8.59) for blindness, similar to having more than one recurrence that had an OR of 3.18 (95% CI; 1.59-6.38). Finally, the prophylactic therapy with Trimethoprim/Sulfamethoxazole versus the placebo showed a protective factor of 83% during the first year and 87% in the second year after treatment. Our Systematic Review showed that clinical factors such as being older than 40 years, patients with de novo OT lesions or with less than one year after the first episode, macular area involvement, lesions greater than 1 disc diameter, congenital toxoplasmosis, and bilateral compromise had more risk of recurrences. Also, environmental and parasite factors such as precipitations, geographical region where the infection is acquired, and more virulent strains confer greater risk of recurrences. Therefore, patients with the above mentioned clinical, environmental, and parasite factors could benefit from using prophylactic therapy.

To emphasize the importance of promptly assessment of punctate outer retinal toxoplasmosis (PORT), and to present a case series in a third-level reference center in Mexico City. Retrospective, observational case series of eight eyes of eight patients who presented PORT between January 2020 to February 2023. Diagnosis was made by uveitis specialists based on clinical findings, serology, and multimodal imaging. Descriptive statistics were used to exhibit absolute and relative frequencies. Patient ages ranged from 19 years to 67 years old. Each patient presented creamy yellowish-white, punctate outer retinal lesions. All patients had SD-OCT showed outer retinal alterations and in autofluorescence presented hyperautofluorescent lesions. 85% of the patients improved their BCVA after treatment, but three (42.8%) were legally blind. PORT is an atypical presentation of ocular toxoplasmosis. Lesions usually lead to retinochoroidal scarring which can significantly diminish a patient's BCVA irreversibly. Recognition of PORT lesions is important since timely and efficacious therapy leads to better visual prognosis and diminish the risk of legal blindness.

Ocular toxoplasmosis (OT) is the most common cause of infectious uveitis worldwide, including Thailand. This study describes the clinical presentation, visual acuity (VA) outcomes, and factors associated with VA loss in patients with active OT following antiparasitic treatment. A retrospective chart review of patients with active OT treated with antiparasitic drugs between 2010 and 2020 was performed. Outcome measures included clinical characteristics, interval VA, and predictive factors associated with loss of VA ≤ 20/50 at 6 months post-treatment. Ninety-two patients (95 eyes) were enrolled. The median follow-up time was 10.9 months (IQR 4.9-31.8 months). The median age at presentation was 35.9 years, 51% were male, and 92.4% had unilateral OT. Eleven patients (12%) were immunocompromised (HIV infection, eight patients; receiving immunosuppressive agents, three patients). Patients mainly presented with primary retinitis without previous scar (62%), posterior pole lesion (56%), and lesion size of ≤ 2-disc area (75%). Immunocompromised patients showed a significantly larger size of retinitis than immunocompetent patients. Oral trimethoprim/sulfamethoxazole monotherapy was the primary short-term antiparasitic drug prescribed (85%). At the final visit, 21% of all affected eyes suffered VA ≤ 20/200. The cumulative incidence of recurrent OT at three years was 33.9% (95% CI, 19.7%-54.2%). Immunocompromised patients [adjusted odds ratio (aOR) 4.9, p = 0.041], macular lesion (aOR 5.4, p = 0.032), and initial VA ≤ 20/200 (aOR 9.1, p = 0.014) were predictive of having VA ≤ 20/50 at 6 months post-treatment. Ocular toxoplasmosis mainly presents as unilateral primary retinitis within the posterior pole. Severe VA loss was observed in one-fifth of eyes following treatment with lesion resolution. Immunocompromised patients, eyes with macular lesions, and poor initial VA were associated with poor VA outcomes.

ObjectiveThe clinical features, disease course and visual outcomes of toxoplasmosis are less commonly reported in China than in other countries. To reduce misdiagnosis and improve visual function, the clinical characteristics, management and visual outcomes of 13 cases of ocular toxoplasmosis (OT) were described.MethodsThis retrospective study included 14 eyes of 13 patients who were diagnosed with OT in Hubei, China. The clinical characteristics, course of treatment and outcomes are presented. There were 7 males and 6 females.ResultsThe main form of OT was retinochoroiditis with vitritis or anterior uveitis. Next-generation sequencing was applied to 3 eyes, and positive results were found in those eyes. Thirteen patients were positive for Toxoplasma gondii IgG antibodies, and 3 of them were also positive for IgM T. gondii antibodies. One patient with acquired immune deficiency syndrome was diagnosed with coinfection with OT and cytomegalovirus, as evidenced by an aqueous humor etiological test. Three patients were misdiagnosed with noninfectious uveitis. Recurrence occurred in 3 eyes during the follow-up periods. One patient who received vitreous implantation of Ozurdex therapy at another hospital before referral relapsed. One patient who received sulfadiazine, azithromycin and glucocorticoid therapy relapsed. One patient who received sulfadiazine therapy experienced relapse. Patients who received clindamycin and sulfadiazine or who received clindamycin only did not experience recurrence during the follow-up period. The best corrected visual acuity was improved in 6 eyes after inflammation resolved.ConclusionsPrimary active retinochoroiditis is the main form of OT in Hubei, China. Timely correct diagnosis on the basis of ocular characteristics and aetiological test results and effective treatment should be adopted to prevent poor visual outcomes and recurrence.

Toxoplasmic retinochoroiditis is a common, potentially blinding parasitic infection. We sought to define the spectrum and frequency of signs of active toxoplasmic retinochoroiditis by spectral domain optical coherence tomography (SD-OCT), and to identify clinical associations. Ninety eyes of 90 individuals presenting consecutively to a tertiary referral uveitis service with active toxoplasmic retinochoroiditis and gradable SD-OCT scans were evaluated prospectively. SD-OCT features were collated, and associations with lesion location, primary versus recurrent episode, serological status, human immunodeficiency virus infection and best-corrected Snellen visual acuity were explored. Active toxoplasmic retinochoroiditis presented with thickened (65%) and hyperreflective (61%) retina, choroidal thickening (55%) and hyporeflectivity (61%), hyperreflective vitreous dots (80%) and deposits (36%), and posterior hyaloid thickening (35%) on SD-OCT. Most signs occurred with similar frequency across clinical groups. Retinal hyporeflectivity (17%) was significantly associated with a visual acuity of 20/200 or worse at resolution. Our observations demonstrate that active toxoplasmic retinochoroiditis has diverse SD-OCT signs and that none are universally present. Retinal hyporeflectivity—suggesting liquefactive necrosis—predicts poor visual outcome.

In 2015, an outbreak of presumed waterborne toxoplasmosis occurred in Gouveia, Brazil. We conducted a 3-year prospective study on a cohort of 52 patients from this outbreak, collected clinical and multimodal imaging findings, and determined risk factors for ocular involvement. At baseline examination, 12 (23%) patients had retinochoroiditis; 4 patients had bilateral and 2 had macular lesions. Multimodal imaging revealed 2 distinct retinochoroiditis patterns: necrotizing focal retinochoroiditis and punctate retinochoroiditis. Older age, worse visual acuity, self-reported recent reduction of visual acuity, and presence of floaters were associated with retinochoroiditis. Among patients, persons >40 years of age had 5 times the risk for ocular involvement. Five patients had recurrences during follow-up, a rate of 22% per person-year. Recurrences were associated with binocular involvement. Two patients had late ocular involvement that occurred >34 months after initial diagnosis. Patients with acquired toxoplasmosis should have long-term ophthalmic follow-up, regardless of initial ocular involvement.

Toxoplasma gondii, an obligate intracellular parasite, is a globally prevalent pathogen capable of infecting a wide range of warm-blooded animals, including humans. Ocular toxoplasmosis (OT), a severe manifestation of T. gondii infection, can lead to potentially blinding complications. This comprehensive review delves into the current understanding of T. gondii biology, exploring its complex life cycle, diverse transmission routes, and strain diversity. This article provides an in-depth analysis of the clinical manifestations of OT, which can result from both congenital and acquired infections, presenting a spectrum of signs and symptoms. The review examines various diagnostic strategies employed for OT, including clinical examination, multimodal imaging techniques such as fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA), as well as laboratory tests including serology and molecular methods. Despite extensive research, the specific mechanisms underlying ocular involvement in T. gondii infection remain elusive, and current diagnostic options have limitations. Moreover, the treatment of active and recurrent OT remains a challenge. While existing therapies, such as antimicrobial agents and immunosuppressants, can control active infections, they do not offer a definitive cure or completely prevent recurrence. The clinical endpoints for the management of active and recurrent OT are also not yet well-established, and the available treatment methods carry the potential for adverse effects. This article highlights the need for future research to elucidate the pathogenesis of OT, investigate genetic factors influencing susceptibility to infection, and develop more sensitive and specific diagnostic tools. Enhancing global surveillance, implementing robust prevention strategies, and fostering multidisciplinary collaborations will be crucial in reducing the burden of OT and improving patient outcomes. This comprehensive review aims to provide a valuable resource for clinicians, researchers, and policymakers, contributing to a better understanding of T. gondii infection and its impact on ocular health.

Ocular toxoplasmosis (OT) remains a leading cause of posterior uveitis worldwide, where accurate differentiation between Active , Inactive , Mixed , and Healthy retinal states is critical for appropriate management. Existing deep learning studies primarily address binary classification, offering limited diagnostic granularity and interpretability. This study introduces a comprehensive and interpretable multi-model deep learning framework designed for four-class classification of OT using retinal fundus images. The framework integrates convolutional neural networks (CNNs), Vision Transformers (ViT), YOLOv8, YOLOv11, and an ensemble model, optimized through systematic hyperparameter tuning and dataset balancing. Performance was evaluated on multiple dataset variants and externally validated on independent datasets. Interpretability was assessed using SHAP and EigenCAM to ensure transparency and clinical coherence. This framework achieved a 98% classification accuracy and a Matthews Correlation Coefficient (MCC) of 0.885, demonstrating balanced and robust performance across all categories. The YOLOv11 model yielded the highest accuracy, effectively localizing lesion rich regions through anchor-free detection. The Vision Transformer provided superior contextual understanding, while green-channel preprocessing and class balancing significantly enhanced lesion contrast and model generalization. SHAP and EigenCAM analyses confirmed that predictions corresponded to clinically relevant retinal structures, supporting model transparency and interpretability. Inference benchmarking showed the accelerations of Graphics Processing Unit (GPU) and Central Processing Unit (CPU) for real-time clinical deployment, with YOLO v11 achieving a latency of 2.8ms and 65ms respectively. This framework establishes a new benchmark for interpretable AI in ocular toxoplasmosis classification. Its integration of multi-architecture design, spectral preprocessing, and explainable visual reasoning enables accurate, transparent, and generalizable diagnosis. These findings highlight this study’s potential for real-world integration into teleophthalmology, screening programs, and clinical decision-support systems, paving the way for trustworthy and scalable retinal AI solutions.