Advice on posterior uveitis needed

[Kociozerca]

Im 28-year-old male with high myopia (around -7D in both eyes). I've been getting my eyes checked every few years and never had any problems until five months ago. In December I noticed decreased night vision, a bit different color perception and tree resembling scotoma in the very centre of my left eye's visual field along with flu-like symptoms. I rushed to the retina specialist, who found chorioretinal scars in both of of my eyes
and an active inflammation in/around (not sure now) left eye's optic disc. She ordered several blood tests, mantoux test, fluorescein angiohraphy and prescribed clarithromycine for 2 weeks. Angiography, which i did several days later (see pictures attached), showed no active lesions but scars only. In 2 weeks  the symptoms have subsided, but i noticed enlarged blind spots in my vision, especially in the left eye, as seen on my vision field test (picture).

Mantoux test came back positive (20mm), but pulmonologist after seeing my chest x-ray said I'm fine. Blood tests turned out to be positive for toxoplasmosis (240 IgG titer, normal IgM), toxocariasis (15 IgG) and CMV (144 IGG, normal IGM), so i was referred to a hospital (parasitology department), where i was told my scars are typical toxoplasmosis lesions but, again, old and inactive. I underwent brief (since there was no active inflammation) sulfidiazine/pyrimethamine treatment and was released.
In the meantime i started to experience worrisome symptoms - increase of floaters in both eyes and whole array of various photopsiae:
- pulsating zig-zags right where my blind spots are (especially left eye), visible after exposure to daylight, persist even when I close my eyes, but tend to settle down when it's dark
- brief "glitter" or "snow" of bright dots when I come out of darkened place and look at bright surfaces, particularly around blind spots and much more intense in the left eye
- bright dots flickering in peripheral vision of both eyes visible on bright days, sunny rooms, blue sky etc.
- sometimes when i duck or stand up rapidly tiny sparks moving from peripheral to central vision (both eyes)

Also, somtimes my central vision seems to shimmer slightly, like hot air over asphalt road.

With flashes, high myopia and posterior uveitis I thought I'm right to be worried about my retina being detached, so I've seen numerous eye MDs since the last few months. They all told me that my retina is generally OK, but their diagnoses seem to differ. One told me that apart from scarring my retina is perfectly healthy, other said I have lattice degeneration thus no wonder i see flashes, yet another said that for my level of myopia such degenerative changes are small and negligible. Some of them says that my lesions are typical for toxoplasmosis, some other that their location is unusal for toxo. Even my retina specialist, when i cross-questioned her a bit, admitted that from the look of it, it could as well be tuberculosis or an early stage of toxocariasis (and I'm positive for both!). I feel confused and keep inquiring for more detailed diagnosis, but most of them, including my retina specialist, turn me down saying there's no need, they just say to come and have a check up in a few months.

Now to the questions:

Am I just being hypochondriac or should I seek treatment elsewhere, including abroad(I'm from Poland)? I'd be grateful for some information about possible diagnostic procedures, if there are any.
I read somewhere that inflammation scars may cause vitreous traction, could this be the reason of all these flashes?

Can I do sports? Eye MDs i've seen say it's OK for me to run, cycle, even play football (without headers), only to avoid contact sports. But can I run, say, 15 km distances, or should I be careful and avoid excess exercise?

I'm aware there are lots of ins and outs when it comes to diseases like mine, but any general info would be appreciated:)

Thans in advance

Dominik

[John C Hagan III, MD, FACS, FAAO]

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[Booklover10]

Any update in your condition? You named several of the symptoms I've been dealing with for 4 years!! I really thought I was going nuts when I started seeing the slight shimmering effect you wrote here. Like the hot air above asphalt. I have traveling lights that start at one side and travel around the out edge. Just so frustrating to see several retina specialists and not get an answer.

[John C Hagan III, MD, FACS, FAAO]

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[Kociozerca]

Thank you so much for the reply.
I was thinking the same thing, but wondered if it's worthwile. Now I'm convinced, I guess I will try to do both.

Best regards
Dominik

[John C Hagan III, MD, FACS, FAAO]

It seems you have had a very thorough work-up of a difficult problem both diagnosis and treatment. Many of these posterior uveitis problems are very difficult, sometimes impossible, to pin a diagnosis on.

To the extent that another opinion would buy you some peace of mind it's probably  worthwhile. You have two options. One would be to find another team, perhaps at a medical school, near you that could follow and treat you if you wished to change your care. Or you could head off to a world  referral center in Germany or England or USA for a single look at your problem.

Your surgeons can best advise you but in my practice I would advise against contact sports for situations like yours (basketball, soccer, racquetball, etc). Running, swimming, fast walking would be great exercises.

The most likely DX would be toxoplasmosis.  Your problem is not typical of the toxocariasis cases I've seen.  I have little to no experience with TB.

Good luck
JCH MD