This study aims to evaluate the effectiveness of pars plana vitrectomy (PPV) combined with endolaser treatment for patients with active ocular toxoplasmosis who have not responded to conventional therapies.

We retrospectively reviewed the records of 18 consecutive patients with active ocular toxoplasmosis who failed to respond to ≥3 months of systemic therapy, experienced worsening retinitis during treatment, or developed vitreoretinal complications (retinal detachment or vitreous hemorrhage). All patients underwent 23-gauge PPV with direct 532 nm endolaser application to and around the active retinitis area.

Complete lesion resolution was achieved in 17 patients (95%; 95% CI: 74.2-99.0%). Four patients (22%; 95% CI: 9.0-45.2%) developed reactivation between 1.3 and 9 months after surgery; three responded promptly to oral therapy. Visual acuity improved in 44.5% of eyes, remained stable in 11%, and worsened in 44.5%. Postoperative complications occurred in 16 patients (89%), most frequently retinal detachment (39%) and cataract (33%). Mean follow-up was 33.3 months.

Pars plana vitrectomy combined with endolaser appears to be an effective option for patients with active ocular toxoplasmosis who do not respond to standard therapies.