*6.2.3 Intravitreal treatment*

Intravitreal clindamycin (1 mg) and dexamethasone (400 μg) have been used, injections can be repeated at 2-week intervals, based on a 5.6-day half-life of intravitreal clindamycin.

Soheilian et al. reported the results of treating patients with ocular toxoplasmosis involving or threatening macula or optic nerve, or adjacent to a large vessel and/ or associated with severe vitritis with intravitreal treatment versus oral treatment using pyrimethamine and sulfadiazine plus prednisolone [98].

The mean number of injections in the intravitreal clindamycin was 1.6. Mean reduction in lesion size, increase in visual acuity and decrease in vitreous inflammation were not significantly different between groups, however, significantly reduction in size of lesions in IgM-positive patients who received classic treatment versus those who received intravitreal treatment was reported. This can be explained by the fact that a patient with acquired toxoplasmosis confronts a systemic infection that is treated better with systemic therapy.

The authors stressed that intravitreal clindamycin is a better alternative for pregnant and pediatric patients. Furthermore, the results of this study cannot be generalized to immunocompromised patients, monocular cases, and eyes with lesions inside the fovea (500 um). However, acquired toxoplasmosis confront systemic infection and, therefore, may benefit from systemic therapyas well, rather than just intravitreal injections [99].
