RESUMEN
BACKGROUND AND OBJECTIVE: The purpose of this study was to evaluate the incidence and characteristics of retinal and choroidal manifestations of toxoplasmosis and/or Mycobacterium avium-intracellulare complex (MAC) in patients with acquired immunodeficiency syndrome (AIDS). PATIENTS AND METHODS: The authors analyzed their prospectively collected data and found 120 patients with new retinal lesions (group A) that were diagnosed 3 months or longer following the diagnosis of MAC and/or toxoplasmic encephalitis. The authors also performed a point prevalence study of retinal/choroidal findings in 25 consecutive AIDS patients (group B) without known eye disease who had been recently treated for toxoplasmic encephalitis and/or disseminated MAC infections. In addition, the characteristics of retinochoroidal toxoplasmosis scars in 5 AIDS patients were studied and compared with the characteristics of scars in 18 immunocompetent patients. RESULTS: In this study the incidence of ocular manifestations of MAC was zero (95% confidence interval [CI] 0.0% to 3.8%). Two of 25 patients (8%) (95% CI 1% to 26%) in group A and 2 of 11 patients (18.1%) (95% CI 3.3% to 51.8%) in group B had toxoplasmic retinochoroiditis. CONCLUSION: In AIDS patients, ocular manifestations of toxoplasmosis are more common than ocular MAC. In addition, when compared with immunocompetent patients, AIDS patients tend to have retinochoroidal scars with less retinal pigment epithelium hyperplasia (1.8+ vs 3+) (P = .03).
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/etiología , Bacteriemia/complicaciones , Encefalitis/parasitología , Infecciones Bacterianas del Ojo/etiología , Infección por Mycobacterium avium-intracellulare/complicaciones , Enfermedades de la Retina/parasitología , Toxoplasmosis Cerebral/complicaciones , Toxoplasmosis Ocular/etiología , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adulto , California/epidemiología , Enfermedades de la Coroides/epidemiología , Enfermedades de la Coroides/microbiología , Enfermedades de la Coroides/parasitología , Infecciones Bacterianas del Ojo/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Enfermedades de la Retina/epidemiología , Enfermedades de la Retina/microbiología , Toxoplasmosis Ocular/epidemiologíaRESUMEN
PURPOSE: To determine the extent of vision loss in a cross-sectional study of HIV-positive individuals who had no infectious retinopathy. METHODS: Visual field loss was determined by computerized achromatic automated perimetry and short-wavelength automated perimetry in both eyes in 65 HIV-positive individuals without infectious retinopathy and in one randomly selected eye each in 57 age-matched normal controls. Results were analyzed using the global index of mean defect and the Glaucoma Hemifield Test, and significance was determined through analysis of variance, chi-square, and Tukey-Kramer tests. RESULTS: We found that HIV-positive patients, compared with age-matched HIV-negative controls, demonstrated significant (at least P < .01) localized defects as well as an increased mean defect. The HIV-positive patients also had a significantly greater number of defective points, especially on short-wavelength automated perimetry, even while ophthalmoscopic examination and fundus photographs suggested that the retinas were normal. CONCLUSIONS: There is a significant loss of visual function in HIV-positive individuals that is not the result of infectious retinopathies. The finding by short-wavelength perimetry of more severe defects suggests that the vision defects are not caused by attentional or other suprachiasmatic problems because the neurologic difficulty of both achromatic and short-wavelength perimetry is similar. The effects of this vision loss on the daily living and occupational tasks of this population require further study.
Asunto(s)
Seropositividad para VIH/complicaciones , Trastornos de la Visión/complicaciones , Campos Visuales , Adulto , Estudios Transversales , Fondo de Ojo , Humanos , Persona de Mediana Edad , Fotograbar , Distribución Aleatoria , Enfermedades de la Retina/virología , Agudeza Visual , Pruebas del Campo VisualRESUMEN
PURPOSE: To determine the intraocular pressure in patients with human immunodeficiency virus (HIV) with and without cytomegalovirus retinitis, and to correlate intraocular pressure with CD4+ T-lymphocyte count and the presence, extent, and activity of cytomegalovirus retinitis. METHODS: Intraocular pressure was measured with calibrated Goldmann applanation tonometers in two groups of patients. Group A included 84 patients with HIV (120 eyes) with cytomegalovirus retinitis, and Group B included 110 patients with HIV (183 eyes) without cytomegalovirus retinitis. Thirty-three patients without HIV (66 eyes) were included as a control group. Step-wise regression analysis of intraocular pressure included correlation with cytomegalovirus retinitis (presence, extent, and activity), CD4+ T-lymphocyte count, age, and gender. RESULTS: The mean intraocular pressure was 9.8 mm Hg in Group A, 12.6 mm Hg in Group B, and 16.1 mm Hg in the control group. All three groups were statistically different from each other when intraocular pressure was compared (P < .0001). Step-wise regression showed that low CD4+ T-lymphocyte count (r2 = .20; P < .0001) and extent of cytomegalovirus retinitis (r2 = .08; P = .007) both correlated to low intraocular pressure. CONCLUSION: Intraocular pressure is lower than normal in patients with HIV. Decreased CD4+ T-lymphocyte count is the major association with low intraocular pressure (20% of the effect); extent of cytomegalovirus retinitis accounts for 8% of the effect. Knowledge of the normal range of intraocular pressure in patients with HIV will be important to the understanding and treatment of glaucoma and other disorders or treatments affecting intraocular pressure.
Asunto(s)
Linfocitos T CD4-Positivos/inmunología , Retinitis por Citomegalovirus/complicaciones , Infecciones por VIH/complicaciones , VIH-1 , Presión Intraocular , Adulto , Recuento de Linfocito CD4 , Retinitis por Citomegalovirus/inmunología , Retinitis por Citomegalovirus/fisiopatología , Femenino , Infecciones por VIH/inmunología , Infecciones por VIH/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Hipotensión Ocular/etiología , Hipotensión Ocular/fisiopatología , Estudios Prospectivos , Análisis de Regresión , Tonometría OcularRESUMEN
OBJECTIVE: To determine the the effectiveness of random particle motion, presented on a computer monitor, as a noninvasive test for detecting cytomegalovirus retinitis. DESIGN: A prospective masked study in which patients were asked to trace out any disturbances on a transparency placed over a computer monitor that displayed continuous random particle motion, while the patient fixated on a central spot (entoptic perimetry). SETTING: The Acquired Immunodeficiency Syndrome Ocular Research Unit at the University of California, San Diego, in La Jolla. PATIENTS: Twenty-two men with cytomegalovirus retinitis who were positive for human immunodeficiency virus, 11 men without cytomegalovirus retinitis who were positive for human immunodeficiency virus, and eight men who were negative for human immunodeficiency virus. INTERVENTION: None. MEASUREMENTS: Sensitivities and specificities were used to compare the results of entoptic perimetry with fundus photographs. RESULTS: Entoptic perimetry demonstrated a 95% sensitivity and a 95% specificity in detection of cytomegalovirus retinitis. CONCLUSION: Entoptic perimetry may be an effective and inexpensive screening test for cytomegalovirus retinitis in hospitals and community clinics.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Retinitis por Citomegalovirus/diagnóstico , Escotoma/diagnóstico , Pruebas del Campo Visual/métodos , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Retinitis por Citomegalovirus/complicaciones , Método Doble Ciego , Fondo de Ojo , Seronegatividad para VIH , Seropositividad para VIH , Humanos , Masculino , Estudios Prospectivos , Retina/patología , Escotoma/etiología , Sensibilidad y EspecificidadRESUMEN
This study evaluated intravitreous and plasma ganciclovir and foscarnet concentrations after intravenous administration in AIDS patients with cytomegalovirus (CMV) retinitis and retinal detachment. Undiluted vitreous samples were prospectively obtained from 60 eyes (52 patients) at the time of pars plana vitrectomy. Thirty-three plasma samples (from 27 patients in the initial group of 52) were obtained simultaneously during surgery on 33 eyes. High-pressure liquid chromatography showed the mean vitreous ganciclovir concentrations in patients on induction and maintenance therapy were, respectively, 4.74 +/- 1.49 microM (n = 24) and 3.29 +/- 1.84 microM (n = 30; P = .005). Simultaneous plasma ganciclovir concentrations were less than the vitreous concentrations in 78% of the patients. The mean intravitreous foscarnet concentrations in patients receiving induction dosages were 189 +/- 177 microM (n = 5) versus 163 +/- 167 microM (n = 4; P > .20) for those receiving maintenance therapy. The foscarnet vitreous plasma concentration ratio averaged 1.43. Current drugs and doses for CMV retinitis result in borderline or progressively subtherapeutic concentrations.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Retinitis por Citomegalovirus/tratamiento farmacológico , Foscarnet/farmacocinética , Ganciclovir/farmacocinética , Desprendimiento de Retina/tratamiento farmacológico , Cuerpo Vítreo/metabolismo , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Retinitis por Citomegalovirus/complicaciones , Quimioterapia Combinada , Femenino , Foscarnet/sangre , Ganciclovir/sangre , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Desprendimiento de Retina/complicacionesRESUMEN
PURPOSE: To determine if scleral buckling is of any benefit in surgical repair of cytomegalovirus (CMV)-associated retinal detachment if combined with vitrectomy, silicone oil, and inferior midperipheral endolaser. MATERIALS AND METHODS: Twenty-two consecutive eyes with CMV-associated retinal detachments were repaired with vitrectomy and endolaser to all breaks and to the inferior midperipheral retina using silicone oil without scleral buckling (group 1, control group) between July 1987 and May 1992. Results were compared with another series of 56 consecutive eyes undergoing vitrectomy, silicone oil injection, endolaser to all breaks, and 360 degrees encircling scleral buckling (group 2, study group) between June 1992 and July 1993. RESULTS: Total retinal reattachment rates were 84% for group 1 and 86% for group 2. Rates of macular reattachment were 91% for group 1 and 91% for group 2. Mean best postoperative refracted visual acuity was 20/66 for group 1 and 20/67 for group 2. Median best postoperative refracted visual acuity was 20/74 for group 1 and 20/80 for group 2. These differences in results between the two groups were not statistically significant. Mean postoperative refractive error was +3.95 for group 1 and +4.92 for group 2. Patients who underwent surgery with the macula attached had a better postoperative visual outcome. CONCLUSION: Scleral buckling may not be necessary in CMV-related retinal detachment if repaired with vitrectomy, silicone oil, and inferior midperipheral endolaser. Elimination of scleral buckling may reduce intraoperative time, patient morbidity, and the risk of an accidental needle stick. Patients with macula-on retinal detachments also should be considered for surgery before macular detachment.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Retinitis por Citomegalovirus/complicaciones , Infecciones Virales del Ojo/complicaciones , Desprendimiento de Retina/cirugía , Curvatura de la Esclerótica , Adulto , Fondo de Ojo , Humanos , Terapia por Láser , Persona de Mediana Edad , Desprendimiento de Retina/etiología , Desprendimiento de Retina/patología , Aceites de Silicona/administración & dosificación , Resultado del Tratamiento , Agudeza Visual , VitrectomíaRESUMEN
Varicella zoster virus retinitis in patients with the acquired immunodeficiency syndrome is known to be a devastating disease. We studied a series of six consecutive patients that sheds new light on the clinical manifestations and treatment options of this disorder. All patients had episodes of cutaneous zoster, long-term exposure to oral acyclovir, and CD4+ T lymphocyte counts less than 50 cells/mm3. Two of the six patients had simultaneous radiographically demonstrable and histologically proven varicella zoster virus encephalitis; this is an important association. Histologic examination of autopsy specimens disclosed that the retinal infection by varicella zoster virus involves the retinal pigment epithelium more heavily than the inner retina, which is consistent with the characteristic clinical impression of an outer retinal necrosis.
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Infecciones Oportunistas Relacionadas con el SIDA/patología , Retinitis/patología , Retinitis/virología , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adulto , Antivirales/uso terapéutico , Recuento de Linfocito CD4 , Encefalitis/patología , Encefalitis/virología , Herpes Zóster , Humanos , Masculino , Necrosis , Retinitis/tratamiento farmacológicoRESUMEN
PURPOSE: The management of cytomegalovirus (CMV)-related rhegmatogenous retinal detachments in patients with acquired immune deficiency syndrome (AIDS) has been the subject of recent attention and controversy because of the high degree of variability in visual outcome, as well as significant differences in the reported incidence of profound postoperative optic atrophy. This study was designed to evaluate the various parameters affecting postoperative visual outcome, and to quantitate the degree of postoperative optic disc pallor. METHODS: The results of 65 consecutive surgeries for CMV-related retinal detachments in 51 patients with AIDS were prospectively studied. Postoperative vision, survival, optic disc pallor, and retinitis extent were analyzed. Serial photographs of optic discs underwent masked evaluation. RESULTS: Mean postoperative survival was 30 weeks (range, 2-146 weeks). Mean best postoperative visual acuity was 20/66 (range, 20/20-2/200) and mean final postoperative visual acuity was 20/100 (range, 20/25-no light perception). Analysis of visual outcome for eyes with no macular or papillo-macular retinitis showed a best postoperative visual acuity of 20/60 (range, 20/25-2/200) and mean final postoperative visual acuity of 20/80 (range, 20/25-no light perception). Postoperative vision was not affected by the presence of a preoperative macular detachment, with both groups (macula on or off detachments), achieving a best postoperative visual acuity of 20/60 in the absence of macular retinitis. Mild postoperative optic disc pallor was observed in 30% of surgical eyes at the final postoperative visit, and moderate pallor was noted in 13%. The mean degree of optic disc pallor was not different from the degree of optic disc pallor seen in fellow, nonsurgical eyes with CMV retinitis (surgical versus fellow nonsurgical eyes, 29% +/- 23% versus 26% +/- 30%; P = 0.64). CONCLUSION: In this largest reported series of reattachment surgery for CMV-related retinal detachments, patients are experiencing increased postoperative survival, good vision, and relative optic nerve health.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Retinitis por Citomegalovirus/complicaciones , Desprendimiento de Retina/cirugía , Infecciones Oportunistas Relacionadas con el SIDA/patología , Adulto , Retinitis por Citomegalovirus/patología , Estudios de Evaluación como Asunto , Estudios de Seguimiento , Humanos , Incidencia , Persona de Mediana Edad , Disco Óptico/patología , Estudios Prospectivos , Desprendimiento de Retina/etiología , Desprendimiento de Retina/patología , Tasa de Supervivencia , Resultado del Tratamiento , Agudeza VisualRESUMEN
To determine whether therapeutic intravitreal concentrations of ganciclovir are achieved after intravenous administration, vitreous samples were obtained intraoperatively from 23 eyes of 22 AIDS patients with retinal detachments associated with cytomegalovirus (CMV) retinitis. The mean intravitreal ganciclovir concentration of all samples was 0.93 +/- 0.39 microgram/mL (3.6 +/- 1.5 microM). This level is near the published trough serum concentrations obtained with every-12-h intravenous dosing and well below the peak. It is significantly below the concentration of ganciclovir required to achieve 50% of viral plaque formation for many human CMV strains. Only a small decrease in vitreous drug levels was observed as a function of time after last dose. Intravenous administration of ganciclovir results in near-steady-state subtherapeutic intravitreal ganciclovir concentrations for many CMV isolates. This may explain the difficulty of long-term complete suppression of CMV retinitis.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Retinitis por Citomegalovirus/tratamiento farmacológico , Ganciclovir/farmacocinética , Cuerpo Vítreo/metabolismo , Adulto , Cromatografía Líquida de Alta Presión , Retinitis por Citomegalovirus/complicaciones , Femenino , Ganciclovir/administración & dosificación , Ganciclovir/uso terapéutico , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Análisis de Regresión , Desprendimiento de Retina/metabolismo , Desprendimiento de Retina/cirugíaRESUMEN
We studied 259 patients to determine the time-dependent risk and risk factors for the development of retinal detachment in patients with cytomegalovirus retinitis. The six-month and one-year retinal detachment rates (by eye) were 11% and 24%, respectively. Increasing retinal surface involvement outside of the posterior pole and the presence of retinitis activity were found to be the two covariates that best predicted retinal detachment. Eyes with peripheral involvement greater than 25% had a fivefold risk for detachment, compared to eyes with 10% involvement. If there was retinitis activity and more than 25% peripheral (external to major vascular arcades) involvement, the risk increased to 24-fold. The presence of a fellow eye with retinal detachment was not an independent risk factor. These observations should help in the design of a prophylactic trial intended to prevent retinal detachment and should also help ophthalmologists counsel patients with cytomegalovirus retinitis.
Asunto(s)
Retinitis por Citomegalovirus/complicaciones , Desprendimiento de Retina/etiología , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Retinitis por Citomegalovirus/tratamiento farmacológico , Estudios de Seguimiento , Foscarnet/uso terapéutico , Ganciclovir/uso terapéutico , Infecciones por VIH/complicaciones , Humanos , Incidencia , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
OBJECTIVE: To assess the clinical response and patient tolerance to daily infusions of both ganciclovir sodium and foscarnet sodium for the treatment of clinically resistant cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome. DESIGN AND PATIENTS: Nine patients with clinically resistant cytomegalovirus retinitis who had shown progression of retinitis despite extended intravenous induction single-drug therapy or alternating therapy with induction doses of ganciclovir or foscarnet at 6 weeks were subsequently treated with a combination of ganciclovir and foscarnet. The dosing regimen for induction combination therapy was ganciclovir at 5 mg/kg every 12 hours and foscarnet at 60 mg/kg every 8 hours. Maintenance combination therapy was ganciclovir at 5 mg/kg every 12 to 24 hours and foscarnet at 90 to 120 mg/kg every day. Patients were observed closely for signs of a toxic effect or intolerance to the drug regimen. RESULTS: All patients exhibited a favorable response to combination therapy, with complete healing of retinitis in 12 of 14 eyes and partial healing of retinitis with decreased border activity and a cessation of border advancement in two of 14 eyes. Two of the nine patients stopped receiving combination therapy before completion of the study owing to their dissatisfaction with the time commitment. The regimen was otherwise well tolerated, with no significant medical toxic effects attributable to the drugs requiring cessation of therapy. CONCLUSIONS: Combination anticytomegalovirus therapy should be considered in those patients who have shown a poor clinical response to sustained single-drug induction therapy and alternating drug therapy. As survival time for patients with cytomegalovirus retinitis continues to improve, clinical resistance may become more common. Further work to delineate the optimal dosing and indications for combination therapy will be important.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Retinitis por Citomegalovirus/tratamiento farmacológico , Foscarnet/uso terapéutico , Ganciclovir/uso terapéutico , Adulto , Farmacorresistencia Microbiana , Quimioterapia Combinada , Femenino , Foscarnet/efectos adversos , Ganciclovir/efectos adversos , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: To determine the incidence, pathophysiology, clinical outcome, and survival in patients with clinically resistant retinitis. METHODS: Cytomegalovirus (CMV) retinitis was prospectively studied in 100 patients with acquired immune deficiency syndrome (AIDS). In 11 of these patients, clinically resistant retinitis developed, defined as new activity or progression, despite at least 8 consecutive weeks of induction doses of either foscarnet or ganciclovir. Fundus photography, pharmacokinetics, CMV cultures and sensitivities, and survival analyses were studied. The therapeutic interventions attempted after clinically resistant retinitis was identified included continuing a high dose (induction level) of the same antiviral drug, changing the antiviral drug, and combining antiviral therapy with foscarnet and ganciclovir. RESULTS: Clinically resistant retinitis occurred in 11 (11%) of 100 patients with CMV retinitis and appeared to be a manifestation of acquired CMV antiviral drug resistance. Drug metabolism and pharmacokinetics in these patients were normal. The use of combination therapy with foscarnet and ganciclovir was effective in halting the progression of retinitis in three (75%) of four patients (6 of 7 eyes able to be evaluated) receiving combination therapy. CONCLUSION: Clinically resistant retinitis is a manifestation of infection by CMV that has acquired drug resistance. In these patients, combination antiviral drug treatment should be considered. It is likely that clinically resistant retinitis will become more frequent as patients with CMV retinitis and AIDS survive longer.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones Virales del Ojo/tratamiento farmacológico , Ganciclovir/uso terapéutico , Retinitis/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/fisiopatología , Adulto , Citomegalovirus/efectos de los fármacos , Infecciones por Citomegalovirus/fisiopatología , Farmacorresistencia Microbiana , Quimioterapia Combinada , Infecciones Virales del Ojo/fisiopatología , Femenino , Foscarnet/farmacocinética , Foscarnet/uso terapéutico , Fondo de Ojo , Ganciclovir/farmacocinética , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Estudios Prospectivos , Retinitis/microbiología , Retinitis/fisiopatología , Tasa de Supervivencia , Agudeza VisualRESUMEN
PURPOSE: To analyze a phenomenon seen in patients with acquired immune deficiency syndrome (AIDS) with cytomegalovirus (CMV) retinitis undergoing systemic antiviral treatment: a persistent white border opacification on the edge of healed CMV retinitis. PATIENTS AND METHODS: The authors prospectively evaluated a population of 137 patients with AIDS and CMV retinitis during a 44-month period. Eleven patients (12 eyes) who were undergoing maintenance antiviral treatment were identified with an atypical healing response--the persistence of a white flat border opacification that did not advance for many weeks to months. Patient records and photographs were reviewed. Results of one autopsy were analyzed with histopathology and special stains. RESULTS: The persistent white edge maintained (without advancement or smoldering) for an average of 11.6 weeks (range, 4 to 41 weeks). This border opacification was not affected by reinduction treatment in the six patients to whom reinduction was given. Results from histopathologic examination of one patient with a persistent white border are presented: these results show that dead cytomegalic cells formed stable structures within the retina, causing white opacification that could be confused with active lesions. Immunoperoxidase stains identified CMV antigens. CONCLUSION: This persistent white border opacification, which does not advance or smolder, represents an important clinical entity that should be recognized during antiviral treatment for CMV retinitis. It can often be observed. If it is not recognized as a stable configuration, patients may undergo unnecessary reinductions with potentially toxic doses of antiviral medications.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/patología , Infecciones por Citomegalovirus/patología , Infecciones Virales del Ojo/patología , Retinitis/patología , Antivirales/uso terapéutico , Citomegalovirus/crecimiento & desarrollo , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones Virales del Ojo/tratamiento farmacológico , Femenino , Foscarnet/uso terapéutico , Fondo de Ojo , Ganciclovir/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Retina/microbiología , Retinitis/tratamiento farmacológico , Retinitis/microbiología , Replicación Viral , Cicatrización de HeridasRESUMEN
The authors performed retinal reattachment surgery in 29 eyes of 24 patients with acquired immune deficiency syndrome virus with retinal detachment associated with cytomegalovirus (CMV) retinitis and documented the course of eight additional untreated eyes. Retinal detachment repair using vitrectomy, posterior hyaloid removal, and intraocular tamponade with silicone oil or SF-6 gas resulted in a total retinal reattachment rate of 76% and a macular attachment rate of 90% in one operation. The mean postoperative visual acuity (best corrected) was 20/60, but, in some patients, the visual acuity decreased because of progressive retinitis. Prophylactic laser photocoagulation of fellow eyes to surround CMV lesions did not appear to prevent retinal detachment. The mean postoperative survival was 37 weeks (range, 8 to 127 weeks). The surgical techniques used and pathophysiology of these retinal detachments are discussed.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Infecciones por Citomegalovirus/complicaciones , Infecciones Virales del Ojo/complicaciones , Huésped Inmunocomprometido , Desprendimiento de Retina/cirugía , Retinitis/complicaciones , Adulto , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Desprendimiento de Retina/complicaciones , Retinitis/microbiología , Resultado del Tratamiento , Agudeza Visual , VitrectomíaRESUMEN
Patients with human immunodeficiency virus infection may have noninfectious and infectious retinopathies, as well as clinical symptoms consistent with optic nerve dysfunction. Noninfectious acquired immunodeficiency syndrome-related retinopathy is seen in most patients with AIDS. Morphologic studies have shown that the number of retrobulbar optic nerve fibers in patients with AIDS is decreased compared to the number of optic nerve fibers in normal control eyes. To determine whether these patients had a visual dysfunction consistent with damage to the macula and optic nerve, 78 subjects (156 eyes) were studied using color-vision and contrast-sensitivity testing. The Farnsworth-Munsell 100-Hue color-vision test was performed on all subjects and age-corrected color-vision scores for all groups were compared. A significant decrease in color discrimination was found in the patients with AIDS (P less than .001). Contrast-sensitivity testing disclosed a deficit of contrast threshold in patients with AIDS at four of five spatial frequencies and in patients with AIDS-related complex at three of the five spatial frequencies examined. This study demonstrated a functional visual deficit in eyes without retinitis consistent with dysfunction of the macula or optic nerve in patients with AIDS.