An imaging-based treatment algorithm for posterior focal retinitis

BACKGROUND: In this paper, our aim was to describe an imaging-based empirical approach for categorizing and initiating treatment of immunocompetent patients with posterior focal retinitis, prior to the availability of results of expensive laboratory investigations. MATERIALS AND METHODS: The hospital records of 13 patients with posterior focal retinitis were reviewed. RESULTS: Of the 13 patients, 9 were women and 4 were men. The mean age was 24 ± 8 years. Based on similarities in clinical presentation and imaging, we categorized our cases into three groups with different first-line therapeutic strategies. In the first group, patients had presumed toxoplasmosis (treated with oral cotrimoxazole); in the second group, patients had presumed viral (herpetic) etiology (treated with oral valacyclovir); and in the third group, patients had presumed nonherpetic, nontoxoplasma retinitis (treated with oral doxycycline). Positive serology results included Rickettsia (two patients), Borrelia (one patient), Toxoplasma (two patients), and herpes simplex virus (one patient). CONCLUSION: An empirical approach for early initiation of therapy in retinitis cases based on imaging features is described.