Clinical features of ocular toxoplasmosis during pregnancy.

PURPOSE: To evaluate the ocular characteristics of active ocular toxoplasmosis (OT) during pregnancy in nine female patients and to compare these attacks with those in the nonpregnant periods. METHODS: Retrospective analysis of active OT during pregnancy and the nonpregnant periods. Outcome measurements consisted of the duration of attacks, the size of the retinal lesions, treatment strategies, and diverse ocular features and outcomes. RESULTS: The 9 patients had 10 attacks during pregnancy and 24 attacks while not pregnant. One woman had recurrences during several pregnancies, and in total, three female patients had attacks only when pregnant. In general, the severity of the attacks during the pregnant and nonpregnant periods did not differ. CONCLUSION: The attacks during pregnancy were not distinctively different in severity, duration, or outcome from the OT attacks outside pregnancy.

Human leukocyte antigen-B27-associated uveitis: long-term follow-up and gender differences.

PURPOSE: To evaluate clinical features and gender differences in human leukocyte antigen (HLA)-B27-associated acute anterior uveitis (AAU) in long-term follow-up. DESIGN: Retrospective cohort study. METHODS: The clinical records of 177 HLA-B27-positive patients (96 males [54%] and 81 females [46%]) who sought treatment for acute anterior uveitis (AAU) at the University Medical Center Utrecht between January 1995 and December 2005 were evaluated. All patients had a minimum follow-up of at least one year. The clinical data were analyzed at standardized intervals (one, five, and 10 years after the onset of uveitis). RESULTS: Average age at onset of AAU was 36 years, with no differences between males and females. HLA-B27-associated systemic disease developed earlier in males than in females (31 vs 37 years; P=.021). Consequently, at onset of AAU, HLA-B27-associated systemic disease were more frequent in males than in females (25/75 [33%] males vs nine/54 [17%] females; P=.030); however over time, males and females were at equal risk of developing a HLA-B27-associated systemic disease. Bilateral uveitis developed more frequently in females (6/45 [13%] of males vs 11/35, [31%] of females; P=.05). In none of the patients did bilateral visual acuity of less than 0.5 develop after the follow-up of 10 years. CONCLUSIONS: The long-term visual prognosis of HLA-B27-associated AAU was favorable, despite the frequent attacks of severe AAU. At the onset of AAU, the prevalence of HLA-B27-associated systemic disease was more frequent in males, but after the onset of uveitis, the risk of developing a HLA-B27-associated systemic disease is similar for both males and females.

Recurrence rates of ocular toxoplasmosis during pregnancy.

PURPOSE: To investigate whether recurrence rates of ocular toxoplasmosis are higher during pregnancy in women of childbearing age. DESIGN: Retrospective longitudinal cohort study. METHODS: We reviewed medical records of all women seen at a university eye clinic (Utrecht, Netherlands) during episodes of active toxoplasmic retinochoroiditis that occurred while the women were of childbearing age (16-42 years). Each woman was sent a questionnaire requesting information regarding all pregnancies and episodes of ocular toxoplasmosis, whether or not episodes were observed at the eye clinic. Conditional fixed-effects Poisson regression was used to model incidence rate ratios of recurrence during pregnant versus nonpregnant intervals, adjusted for potential confounders, including age at time of active toxoplasmic retinochoroiditis and interval since last episode of active disease, which are known to influence risk for recurrence. RESULTS: Questionnaires were returned by 50 (58%) of 86 women, 34 of whom had had 69 pregnancies during 584 person-years of study. There were 128 episodes of ocular toxoplasmosis during the study period (6 during pregnancy). First episodes of ocular toxoplasmosis occurred between ages 9.6 and 38.5 years. The youngest age at pregnancy was 16.1 years; the oldest age at childbirth was 40.9 years. The incidence-rate ratios for pregnant versus nonpregnant intervals were in the direction of lower recurrence rates during pregnancy, with point estimates of 0.54 and 0.75 under 2 different approaches, but the ratios were not significantly different from the null value (P values of 0.16 and 0.55). CONCLUSIONS: Recurrence rates of ocular toxoplasmosis are probably not higher during pregnancy, in contrast to traditional beliefs.