Título

COMPASSIONATE USE OF CLINDAMYCIN INTRAVITREAL IMPLANT FOR THE TREATMENT OF TOXOPLASMA RETINOCHOROIDITIS

Introdução / Purpose

The present study aims to report a case of retinochoroiditis by toxoplasmosis (TOXO) treated with a clindamycin (CLH) intravitreal (IV) implant associated with IV injections of CLH and dexamethasone (DEXA).

Material e Método / Methods

A 39-year-old immunocompromised patient diagnosed with ocular TOXO was treated with TMP/SMX and prednisolone. She developed pharmacodermia; an alternative treatment was performed with IV injection of CLH (1mg / 0.1mL) and DEXA (0.1mL).
After 1 month, lesion appearance and vitreitis had improved, but after 45 days of injections new active lesions were evident. Initiated oral prednisone and opted for an implant of CLH IV. This implant was developed at UFMG and is composed of PLGA/PLA and contains 183.7 μg of CLH.
After 15 days with the implant, the lesions presented the same appearance. Two new IV injections of CLH and DEXA were performed with monthly intervals for safety, while waiting for the complementary effect of the CLH released by the implant. Currently the patient has 4 months of follow-up, and 2 months after the last injection the lesions were healed.
Multifocal and full field ERGs were performed before and after the implant, showing no changes between them.

Resultados / Results

CLH IV, associated with DEXA in the treatment of TOXO in patients with intolerance, contraindications or inadequate response to oral medications has been shown to be a good therapeutic option. And the polymer implant by theoretically allowing the continuous release of the minimal therapeutic dose of CLH allows greater biocompatibility with the retina.

Discussão e Conclusões / Discussion

This case report is the first evidence in the literature of the safety of CLH IV implants, mainly due to the absence of an ERG and visual acuity worsening, as well as the absence of anatomical parameters worsening such as increased vitreous and anterior segment cellularity. This delivery system may be a good therapeutic alternative for the treatment of ocular toxoplasmosis.

Palavras Chave

Clindamycin intravitreal implant