*6.2.4 Treatment of ocular toxoplasmosis during pregnancy*

Bosch-Driessen and associates, reported that seven (9%) of 82 women with ocular toxoplasmosis developed recurrences during pregnancy [10]. Some reported, recurrent toxoplasma retinochoroiditis in a pregnant woman poses minimal risk to the fetus, and treatment is not indicated for the sole purpose of preventing vertical transmission [100]. However, other studies stressed that infection by toxoplasma will need treatment using spiramycin 1 g orally every 8 hours if a seronegative pregnant patient gets infected up to 18 weeks into the pregnancy or within the 6 months prior to pregnancy [71]. Intravitreal clindamycin can be a reasonable choice of treatment in pregnant mothers.

## **6.3 Surgical management**

Vitreoretinal surgery may be indicated in cases of persistent vitreous opacities, tractional or rhegmatogenous retinal detachment. In the setting of severe refractory vitritis precluding fundus examination, pars plana vitrectomy may be used for both diagnostic and therapeutic purposes [85].

Retinal detachment was reported in 11.4% of the cases. 75% underwent pars plana vitrectomy and 25% underwent laser retinopexy. 50% presented with recurrent RD requiring scleral buckle. At final follow-up, all patients who underwent surgical repair had attached retinas; with severe vision loss of 20/200 or worse [101].

Cataract surgery with intraocular lens implantation is often indicated in cases of significant lens opacification, after resolution of inflammation.
