201
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Dugel PU, Liggett PE, Lee MB, Ziogas A, Forster DJ, Smith RE, Rao NA. Repair of retinal detachment caused by cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol 1991; 112:235-42. [PMID: 1652897 DOI: 10.1016/s0002-9394(14)76723-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Twenty-two eyes of 19 patients with the acquired immunodeficiency syndrome who had pars plana vitrectomy and silicone-oil injection after retinal detachment caused by cytomegalovirus retinitis were studied. All patients but one were monitored until time of death. The postoperative survival time and the factors that predicted anatomic success (retinal attachment) and functional success (visual acuity) were analyzed. No intraoperative complications were encountered. The mean survival time after surgery was four months. Of all of the preoperative and intraoperative factors studied, only the duration of cytomegalovirus retinitis was predictive of survival (P less than .03). The anatomic success rate was 89.5% (17 of 19 patients). None of the factors showed a trend or statistical significance in relation to anatomic success. Fifteen of 19 patients (79%) had lost at least two lines of Snellen visual acuity at time of death. Vision declined in a bimodal pattern (within the first postoperative month and after four months postoperatively). The optic nerve was pink and well perfused preoperatively in 16 of 19 patients (81.8%), but optic-nerve atrophy was observed postoperatively in 18 of 19 patients (95.5%). There was a trend for functional success to be influenced by increased intraocular pressure and optic-nerve atrophy, although our sample size was too small for statistical significance.
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Affiliation(s)
- P U Dugel
- Doheny Eye Institute, Los Angeles, CA 90033
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202
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Sison RF, Holland GN, MacArthur LJ, Wheeler NC, Gottlieb MS. Cytomegalovirus retinopathy as the initial manifestation of the acquired immunodeficiency syndrome. Am J Ophthalmol 1991; 112:243-9. [PMID: 1652898 DOI: 10.1016/s0002-9394(14)76724-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Of 100 consecutive patients with human immunodeficiency virus infection and cytomegalovirus retinopathy, 15 did not have a previous diagnosis of the acquired immunodeficiency syndrome before the ocular infection. All had other HIV-related disorders that would place them in Group IV of the Centers for Disease Control hierarchical classification system for HIV infections. In nine patients, cytomegalovirus retinopathy was the only disorder that fulfilled the Centers for Disease Control criteria for diagnosis of AIDS. In the other six, examination disclosed additional preexistent or concurrent nonocular disorders that were also diagnostic of AIDS. No demographic, medical, or ophthalmic characteristics distinguished the nine patients for whom cytomegalovirus retinopathy was initially the only manifestation of AIDS. On the basis of published figures for the prevalence of cytomegalovirus retinopathy in patients with AIDS, and the incidence with which HIV-infected persons develop AIDS, it is estimated that approximately 1.8% of patients with AIDS have cytomegalovirus retinopathy as the first manifestation and that less than 1% of HIV-infected persons will develop cytomegalovirus retinopathy as the initial manifestation of AIDS during the first seven years after infection with HIV.
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Affiliation(s)
- R F Sison
- UCLA Ocular Inflammatory Disease Center, Jules Stein Eye Institute 90024-7003
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203
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Affiliation(s)
- D P Kotler
- Department of Medicine, St. Luke's-Roosevelt Hospital Center, New York, New York 10025
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204
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205
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Peters BS, Beck EJ, Anderson S, Coleman D, Coker R, Main J, Migdal C, Harris JR, Pinching AJ. Cytomegalovirus infection in AIDS. Patterns of disease, response to therapy and trends in survival. J Infect 1991; 23:129-37. [PMID: 1661316 DOI: 10.1016/0163-4453(91)91987-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Among 347 AIDS patients seen at St Mary's Hospital, London between 1983 and 1989, cytomegalovirus (CMV) disease was observed in 75 (22%). Of these, 58 (77%) had CMV retinitis, 26 (35%) CMV colitis, and 12 (16%) had CMV infection diagnosed at other sites. Relapse occurred in 71%. A favourable response to the use of ganciclovir as induction therapy for CMV retinitis was observed in 92%. Relapse of CMV retinitis occurred in 54% at a median time of 97 days. Neutropenia was the most frequent and serious side-effect of ganciclovir, 76% patients having neutrophil counts less than 1.0 x 10(9)/l and 48% less than 0.5 x 10(9)/l at some stage of therapy. Thrombocytopenia was also common, and platelet counts of less than 50 x 10(9)/l occurred in 43% patients on ganciclovir. The concurrent use of zidovudine made the development of severe neutropenia and thrombocytopenia more likely. Median survival following the diagnosis of CMV disease increased from 5-8 months between 1984 and 1987, to over 12 months in 1988. Patients with CMV colitis had a worse prognosis than patients with CMV retinitis, with median survival of 4.5 and 7 months respectively. In conclusion, CMV is an important opportunist infection in AIDS and both the disease and its treatment cause considerable morbidity. Hence, it is important to develop more effective and less toxic forms of therapy for CMV infection.
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Affiliation(s)
- B S Peters
- Department of Immunology, St Mary's Hospital Medical School, London, U.K
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206
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Palestine AG, Frishberg B. Macular edema in acquired immunodeficiency syndrome-related microvasculopathy. Am J Ophthalmol 1991; 111:770-1. [PMID: 2039052 DOI: 10.1016/s0002-9394(14)76788-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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207
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Conway M, Davison‐Fairburn B, Martin L, Insler M, Murphey‐Corb M. Infection of rhesus monkeys with topical instillation of simian immunodeficiency virus (SIV)
B670
into the conjunctival sac. J Med Primatol 1991. [DOI: 10.1111/j.1600-0684.1991.tb00510.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - L.N. Martin
- Delta Regional Primate Research CenterTulane UniversityCovingtonLAUSA
| | | | - M. Murphey‐Corb
- Delta Regional Primate Research CenterTulane UniversityCovingtonLAUSA
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208
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Orellana J, Teich SA, Lieberman RM, Restrepo S, Peairs R. Treatment of retinal detachments in patients with the acquired immune deficiency syndrome. Ophthalmology 1991; 98:939-43. [PMID: 1650938 DOI: 10.1016/s0161-6420(91)32217-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Thirty-nine eyes from 31 patients with retinal detachment due to cytomegalovirus (CMV) retinitis were treated by either laser photocoagulation (22 eyes), scleral buckle (9 eyes), pars plana vitrectomy (5 eyes), or no therapy (3 eyes). The success rates for photocoagulation (77.2%), scleral buckle (77.7%), and vitrectomy (with gas or oil, 80%) were similar. The median survival time was 95 days (range, of 7 to 280 days). The extent of detachment, the presence of active disease in either the periphery or the posterior pole, and overall health served to determine what type of therapy was best suited for each patient. Although silicone oil appears to be best for patients with a total retinal detachment and active disease, this small series suggests that conservative modes of therapy such as laser photocoagulation and scleral buckles can be used successfully to treat these patients if there is an absence of active retinitis.
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Affiliation(s)
- J Orellana
- Department of Ophthalmology, Mount Sinai School of Medicine, New York
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209
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Zuccati G, Tiradritti L, Mastrolorenzo A, Traversa G, Staderini C, Starnotti L. AIDS-related Kaposi's sarcoma of the eye. Int J STD AIDS 1991; 2:136-7. [PMID: 2043707 DOI: 10.1177/095646249100200213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- G Zuccati
- Institute of Dermatology, Department of Sexually Transmitted Diseases, University of Florence, Italy
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210
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Sidikaro Y, Silver L, Holland GN, Kreiger AE. Rhegmatogenous Retinal Detachments in Patients with AIDS and Necrotizing Retinal Infections. Ophthalmology 1991. [DOI: 10.1016/s0161-6420(91)32332-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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211
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Hall AJ, Jennens ID, Lucas CR, MacLean H, Sandland AM. Low frequency maintenance ganciclovir for cytomegalovirus retinitis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1991; 23:43-6. [PMID: 1851324 DOI: 10.3109/00365549109023373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
45 patients on maintenance ganciclovir for treated cytomegalovirus (CMV) retinitis were reviewed retrospectively. Treatment was given at 30 mg/kg/week in 3 divided doses: Monday, Wednesday, Friday. The median time to clinical relapse was 5.4 months. This is similar to that reported with higher frequency maintenance regimens. The high degree of immunodeficiency (median CD4 count 16 cells/microliters) and poor prognosis (median survival 8.2 months) associated with CMV retinitis were confirmed.
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Affiliation(s)
- A J Hall
- University of Melbourne, Department of Ophthalmology, Victoria, Australia
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212
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Schanzer MC, Font RL, O'Malley RE. Primary ocular malignant lymphoma associated with the acquired immune deficiency syndrome. Ophthalmology 1991; 98:88-91. [PMID: 2023740 DOI: 10.1016/s0161-6420(91)32335-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A 42-year-old man who was human immunodeficiency virus (HIV)-positive complained of floaters in his right eye, which had existed for 1 week, followed by loss of central vision. Results of ophthalmoscopic examination disclosed confluent yellowish-white retinochoroidal infiltrates with perivascular sheathing, which were more prominent superiorly in the right eye. Approximately 10 small, white, intraretinal and choroidal lesions were observed in the nasal periphery of the left eye. Results of cytologic examination of the vitreous of the right eye showed neoplastic cells characteristic of large cell type malignant lymphoma. Shortly thereafter, cytologic examination of the cerebrospinal fluid also showed large cell malignant lymphoma. Magnetic resonance imaging (MRI) showed a mass involving the left cerebellar hemisphere. After bilateral whole-eye radiation therapy, there was complete resolution of the lymphomatous retinochoroidal infiltrates in both eyes. The ophthalmologic and neurologic manifestations of acquired immune deficiency syndrome (AIDS) are discussed. The authors believe this is the first report of ocular malignant lymphoma occurring in a patient with AIDS.
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213
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Jehn U. New antiviral drugs for treatment of viral infections in immunocompromised patients. Recent Results Cancer Res 1991; 121:353-9. [PMID: 1857874 DOI: 10.1007/978-3-642-84138-5_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- U Jehn
- Medizinische Klinik III, Ludwig-Maximilian-Universität, München, FRG
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214
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McCluskey P, Wakefield D, Morgan M, Binneter R. Cytomegalovirus retinopathy and the acquired immune deficiency syndrome: results of treatment with ganciclovir. AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY 1990; 18:385-91. [PMID: 1963790 DOI: 10.1111/j.1442-9071.1990.tb01822.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cytomegalovirus (CMV) infection of the retina is the commonest potentially blinding ocular manifestation of AIDS. Recently the acyclic nucleoside dihydroxypropoxymethyl guanine (DHPG, ganciclovir) has become available to treat sight-threatening CMV retinopathy. This paper reports the clinical features and results of ganciclovir therapy in 48 patients seen over a four-year period. Seven patients were excluded from the study due to inadequate follow-up, leaving 41 patients as the study group. All patients responded clinically to this therapy. Patients were treated initially with high-dose ganciclovir (10 mg/kg/day) and then continued on lower dose treatment (5 mg/kg/day) indefinitely. Significant bone marrow toxicity developed in 12 patients (29.3%) requiring temporary cessation of therapy. Patients treated with ganciclovir retained vision and had increased survival times when compared to untreated patients. A poor visual outcome occurred when there was involvement of the macula or optic nerve head at presentation or when there was an interruption of ganciclovir therapy.
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Affiliation(s)
- P McCluskey
- Laboratory of Ocular Immunology, School of Pathology, University of NSW, Kensington, Australia
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215
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Glynne-Jones R, Hungerford JL, Johnson MA, Plowman PN. Epidemic Kaposi's sarcoma of the conjunctiva: considerations for radiotherapy. Clin Oncol (R Coll Radiol) 1990; 2:358-61. [PMID: 2278896 DOI: 10.1016/s0936-6555(05)81001-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A case of epidemic Kaposi's sarcoma involving the conjunctiva is reported. The lesion responded completely to local irradiation without the loss of normal tissue tolerance which has been described at other sides. A review of the literature and guidelines for therapy are presented.
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Affiliation(s)
- R Glynne-Jones
- Department of Radiotherapy, St. Bartholomew's Hospital, London, UK
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216
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Abstract
Seven cases of bilateral, scattered, yellow-white choroidal lesions have been seen in AIDS patients since January 1988. One resulted from presumed extension of cryptococcal meningitis into the optic nerve and choroid. All the remaining six patients had pneumocystis pneumonia at some time during the course of the disease and were receiving aerosolised pentamidine therapy. None died quickly of disseminated Pneumocystis carinii infection, unlike previously reported patients. Mycobacterial infection was also present in five of these six patients. The differential diagnosis of this entity in AIDS patients is discussed.
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Affiliation(s)
- M A Rosenblatt
- Department of Ophthalmology, Mt Sinai School of Medicine, New York, NY
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217
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Millar AB, Miller RF, Patou G, Mindel A, Marsh R, Semple SJ. Treatment of cytomegalovirus retinitis with zidovudine and ganciclovir in patients with AIDS: outcome and toxicity. Genitourin Med 1990; 66:156-8. [PMID: 2164492 PMCID: PMC1194494 DOI: 10.1136/sti.66.3.156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Sixteen patients with the Acquired Immunodeficiency Syndrome (AIDS) and cytomegalovirus retinitis were treated with ganciclovir alone (9 patients) or ganciclovir and zidovudine (6 patients). The duration of effective treatment, that is the number of weeks during which there was no deterioration in visual symptoms or retinal appearance, was comparable in both groups. However, six of the seven patients receiving concurrent therapy had to cease treatment temporarily because of bone marrow toxicity compared with one of the nine patients treated with ganciclovir alone. It is concluded that continuous concurrent therapy with oral zidovudine and intravenous ganciclovir is not possible unless unlimited supportive therapy including blood transfusion, is available.
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Affiliation(s)
- A B Millar
- University College and Middlesex School of Medicine, London
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218
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Crouse CA, Pflugfelder SC, Pereira I, Cleary T, Rabinowitz S, Atherton SS. Detection of herpes viral genomes in normal and diseased corneal epithelium. Curr Eye Res 1990; 9:569-81. [PMID: 2167192 DOI: 10.3109/02713689008999597] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Herpetic ocular disease is one of the major causes of corneal blindness. Clinical diagnosis of corneal disease is based principally on corneal appearance. However, abnormal morphology of the corneal epithelium (CE) is not an indicator for the presence of a herpes virus. Further, it has not been established if herpes viruses are present in normal corneal epithelial tissue. In these studies, the polymerase chain reaction was used to evaluate normal and diseased corneal epithelium for the presence of herpes simplex virus type 1 (HSV-1), Epstein-Barr virus (EBV) and cytomegalovirus (CMV) genomic sequences. Thirty-two normal corneal epithelium specimens obtained from cadavers shortly after death were analyzed for HSV-1, EBV and CMV genomic sequences. Three of the 32 normal CE specimens were positive for amplified EBV DNA, 1 was positive for HSV-1 DNA, and none was positive for CMV DNA. We also tested eight herpetic dendritic lesions of which 3 were HSV-1 culture and PCR positive. The remaining five dendritic lesions were HSV-1 culture and PCR negative. Since these lesions were not evaluated for other herpesviruses, the etiology of these dendritic lesions is unknown. Six corneal epithelium samples from HIV-infected donors were negative for EBV, CMV and HSV-1 amplified sequences. Positive EBV, CMV and HSV-1 serology on all normal donors and on donors with clinically apparent disease did not correlate with positive PCR results. The results of these studies suggest that EBV and HSV-1 DNA can be amplified from a small percentage of apparently normal corneal epithelium.
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Affiliation(s)
- C A Crouse
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, FL
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219
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Gross JG, Bozzette SA, Mathews WC, Spector SA, Abramson IS, McCutchan JA, Mendez T, Munguia D, Freeman WR. Longitudinal study of cytomegalovirus retinitis in acquired immune deficiency syndrome. Ophthalmology 1990; 97:681-6. [PMID: 2160634 DOI: 10.1016/s0161-6420(90)32552-6] [Citation(s) in RCA: 114] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The authors prospectively evaluated 67 consecutive patients with the acquired immune deficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis during a 33-month period to assess the clinical patterns of retinal infection, efficacy of treatment, long-term survival, and relationship of retinitis to immune function. Immediately sight-threatening retinitis presented in six patients (9%) with peripapillary disease; primary foveal infection was not observed. Eighty-seven percent of patients were treated with ganciclovir. Thirty-nine patients (58%) presented with unilateral disease and contralateral infection developed in 15% of those while on ganciclovir. Smoldering (incompletely responsive) retinitis was seen in 33% of the 21 patients whose retinitis progressed while receiving ganciclovir. Progression of treated retinitis was associated with a lower lymphocyte count (P = 0.04). Median survival after diagnosis of CMV retinitis was 8 months. This represents the largest reported prospective study of CMV retinitis and indicates that (1) CMV infrequently poses an immediate threat to vision on presentation, (2) response to therapy may be related to immune function, and (3) smoldering retinitis should be recognized as an important clinical entity associated with treatment failure.
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Affiliation(s)
- J G Gross
- Department of Ophthalmology, University of California San Diego School of Medicine
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220
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Affiliation(s)
- P Kestelyn
- Department of Ophthalmology, Centre Hospitalier de Kigali, Rwanda
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221
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Engstrom RE, Holland GN, Hardy WD, Meiselman HJ. Hemorheologic abnormalities in patients with human immunodeficiency virus infection and ophthalmic microvasculopathy. Am J Ophthalmol 1990; 109:153-61. [PMID: 2301526 DOI: 10.1016/s0002-9394(14)75980-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The severity of conjunctival microvascular changes and the presence of cotton-wool spots were compared to factors that may affect blood flow (hematocrit level, red cell aggregation, fibrinogen level, plasma viscosity, circulating immune complexes, and quantitative immunoglobulin levels) in 22 human immunodeficiency virus-infected individuals. The severity of conjunctival disease was associated with increased zeta sedimentation ratios (a measure of red cell aggregation) and fibrinogen levels. The presence of cotton-wool spots was also associated with higher fibrinogen levels. Plasma viscosity and quantitative IgG levels were above normal levels in most patients, although a relationship to disease severity was not established. Altered blood flow may contribute to vascular damage and ocular ischemic lesions in patients with human immunodeficiency virus infection.
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Affiliation(s)
- R E Engstrom
- Jules Stein Eye Institute, UCLA Medical Center 90024-1771
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222
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Holland GN, Sison RF, Jatulis DE, Haslop MG, Sakamoto MJ, Wheeler NC. Survival of patients with the acquired immune deficiency syndrome after development of cytomegalovirus retinopathy. UCLA CMV Retinopathy Study Group. Ophthalmology 1990; 97:204-11. [PMID: 2158029 DOI: 10.1016/s0161-6420(90)32616-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
To study the survival of patients with acquired immune deficiency syndrome (AIDS) who develop cytomegalovirus (CMV) retinopathy, the medical records of 100 consecutive patients with AIDS and CMV retinopathy were reviewed Data of AIDS diagnosis, CMV retinopathy diagnosis, and death were determined for each patient. The median interval from CMV retinopathy diagnosis to death for patients whose infection was diagnosed between May 1984 and September 1987 was 5 months. The interval had increased significantly since 1981. The interval from AIDS diagnosis to CMV retinopathy diagnosis (median, 9 months) did not increase. Based on extent and location of retinal lesions at the time patients were first examined, increased survival could not be attributed to earlier diagnosis of CMV retinopathy. Patients treated with ganciclovir lived longer after diagnosis of CMV retinopathy (median, 7 months) than untreated patients (median, 2 months; P less than 0.001). Although this finding suggests that ganciclovir may prolong survival, the effect of treatment cannot be established conclusively because patients were not randomly assigned to treatment or no treatment groups. The location of retinal lesions had no apparent prognostic significance for survival. Survival after diagnosis of AIDS was significantly shorter if CMV retinopathy was the initial manifestation of the syndrome.
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Affiliation(s)
- G N Holland
- AIDS Unit of the UCLA Uveitis Center, Jules Stein Eye Institute 90024-1771
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223
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Schmidt D, Horl WH. Central retinal vein occlusion after transplantation of the kidney. Neuroophthalmology 1990. [DOI: 10.3109/01658109008997286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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224
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Luyendijk L, vd Horn GJ, Visser OH, Suttorp-Schulten MS, vd Biesen PR, Rothova A, Kijlstra A. Detection of locally produced antibodies to herpes viruses in the aqueous of patients with acquired immune deficiency syndrome (AIDS) or acute retinal necrosis syndrome (ARN). Curr Eye Res 1990; 9 Suppl:7-11. [PMID: 2166640 DOI: 10.3109/02713689008999412] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Intraocular synthesis of IgG antibodies against HSV (herpes simplex virus), CMV (cytomegalovirus) and VZV (varicella zoster virus) is considered as an indirect proof of uveoretinal infection. Paired serum and aqueous samples obtained from 16 patients with retinitis associated with AIDS, 3 patients with ARN, 8 patients with posterior uveitis not related to AIDS or ARN and 5 patients with senile cataract were tested for total immunoglobulin G levels and antibodies to HSV, CMV and VZV by the fixed cell immunofluorescence technique. Since therapy must often be started before results of cultures are available, rapid detection of locally produced anti-Herpes Virus antibodies can be a precious tool in the diagnosis of ocular viral infection. Using this technique we were able to confirm the clinically suspected diagnosis in more than 50% of AIDS patients with retinitis and in two out of three patients with ARN.
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Affiliation(s)
- L Luyendijk
- Department of Ophthalmo-Immunology, The Netherlands Ophthalmic Research Institute
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225
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Brezin A, Girard B, Rosenheim M, Marcel P, Gentilini M, Le Hoang P. Cotton-wool spots and AIDS related complex. Int Ophthalmol 1990; 14:37-41. [PMID: 2323892 DOI: 10.1007/bf00131167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Twenty-nine patients with the AIDS Related Complex (ARC) were studied retrospectively. Cotton-wool spots (CWSs) were the main ophthalmological finding, present in 9 patients (31%) at this stage of the disease. The CWSs were asymptomatic and were therefore discovered during a routine examination. The proportion of patients with significant weight loss was greater among ARC patients with CWSs than among those with normal fundi. Leukocyte counts were found to be significantly lower (p = 0.03, odds ratio 10.0 [1.24 to 80.4]) among ARC patients with CWSs. Lymphocyte counts and the CD4/CD8 ratio were also found to be diminished in these patients. Among the nine patients with CWSs during ARC, seven developed major opportunistic infections or HIV (Human Immunodeficiency Virus) related neoplasias during the following months (3.8 +/- 3.5 months). These findings are consistent with a poorer prognosis for HIV infected patients who have CWSs.
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Affiliation(s)
- A Brezin
- Hopital de la Pitié-Salpétrière, Paris, France
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226
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Weisenthal RW, Sinclair SH, Frank I, Rubin DH. Long-term outpatient treatment of CMV retinitis with ganciclovir in AIDS patients. Br J Ophthalmol 1989; 73:996-1001. [PMID: 2558708 PMCID: PMC1041953 DOI: 10.1136/bjo.73.12.996] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cytomegaloviral retinitis was diagnosed in nine eyes of seven patients with acquired immune deficiency syndrome (AIDS) on the basis of the characteristic ocular findings and a positive culture for cytomegalovirus (CMV) obtained systemically. Treatment with ganciclovir was begun on a protocol which provided two weeks of inpatient therapy at daily doses of 2.5 to 10 mg/kg followed by outpatient therapy at a reduced dosage three to six days per week. Outpatient maintenance dosage ranged from 15 mg/kg per week to 30 mg/kg per week. In seven eyes of six patients the treatment decreased retinal inflammation and stabilised the margins of the lesions. Six patients have tolerated long term maintenance therapy for 10-30 weeks. Six of seven patients (85%) in this study developed side effects from ganciclovir which required periods of a reduction in dosage or interruption of therapy. The side effects from ganciclovir included neutropenia, thrombocytopenia, drug fever, and neuropathy. Physicians using ganciclovir in AIDS patients must watch for the signs of drug toxicity and adjust treatment accordingly. Ganciclovir appears to be a promising therapy for CMV retinitis, but further work is necessary to determine the best regimen for optimal efficacy with minimal side effects.
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Affiliation(s)
- R W Weisenthal
- Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia
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227
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Abstract
Cytomegalovirus (CMV) retinitis is a common and one of the most serious ophthalmic manifestations of the acquired immunodeficiency syndrome (AIDS). Early recognition is essential in the proper management of this necrotizing and progressive infection. We discuss an unusual presentation of CMV retinitis which appeared initially only in the foveal region.
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Affiliation(s)
- K W To
- Department of Ophthalmology, Lenox Hill Hospital, New York, NY 10021
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228
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Abstract
Cytomegalovirus retinitis is a frequent and serious complication of various conditions, including diseases characterized by impaired immunity, such as the acquired immunodeficiency syndrome. Due to recent advances in the treatment of cytomegalovirus retinitis, accurate diagnosis and management have become increasingly important. In this review, the authors present the epidemiology, clinical features, diagnostic testing, treatment with complications, and prognosis of cytomegalovirus retinitis. A differential diagnosis is presented and the characteristic ocular lesions are illustrated.
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Affiliation(s)
- H L Hennis
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston
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229
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Fan-Havard P, Nahata MC, Brady MT. Ganciclovir--a review of pharmacology, therapeutic efficacy and potential use for treatment of congenital cytomegalovirus infections. J Clin Pharm Ther 1989; 14:329-40. [PMID: 2555373 DOI: 10.1111/j.1365-2710.1989.tb00256.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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230
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Sasaki K, Morooka I, Inomata H, Kashio N, Akamine T, Osame M. Retinal vasculitis in human T-lymphotropic virus type I associated myelopathy. Br J Ophthalmol 1989; 73:812-5. [PMID: 2818990 PMCID: PMC1041891 DOI: 10.1136/bjo.73.10.812] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Human T-lymphotropic virus type I (HTLV-I) has been recently found to be associated with slowly progressive myelopathy. We have seen 12 patients with HTLV-I associated myelopathy (HAM), three of whom showed retinal vasculitis. In addition two patients had ocular symptoms of vitreous opacity. Retinal vasculitis in these patients appears to be phlebitis and sheathing of retinal veins in the periphery of the fundus.
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Affiliation(s)
- K Sasaki
- Miyazaki Prefectural Hospital, Kyushu University, Japan
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231
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Miceli MV, Newsome DA, Novak LC, Beuerman RW. Cytomegalovirus replication in cultured human retinal pigment epithelial cells. Curr Eye Res 1989; 8:835-9. [PMID: 2551575 DOI: 10.3109/02713688909000873] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Retinal pigment epithelium (RPE) was isolated from the globe of a donor positive for human immunodeficiency virus (HIV) who had cytomegalovirus (CMV) retinitis secondary to acquired immunodeficiency syndrome (AIDS). In culture, the cells exhibited normal epithelioid morphology by phase contrast microscopy. After two weeks the cells developed cytomegaly and dense intranuclear and cytoplasmic inclusions and, eventually, died. Transmission electron microscopy (EM) demonstrated intranuclear nonenveloped virus particles 80-120 nm in diameter consistent with a herpes type infection. Immunofluorescence staining demonstrated the presence of CMV antigens. Conditioned medium from the infected cells caused infection in RPE cells isolated from normal donors. Hybridization assay demonstrated the presence of CMV DNA and indicated that the time course of the infection was similar, but not identical to infection in MRC-5 and HEL cells. We conclude that cultured human RPE is a permissive host for CMV.
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Affiliation(s)
- M V Miceli
- Department of Ophthalmology, LSU Eye Center, Louisiana State University Medical Center School of Medicine, New Orleans 70112
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232
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Jabs DA, Green WR, Fox R, Polk BF, Bartlett JG. Ocular manifestations of acquired immune deficiency syndrome. Ophthalmology 1989; 96:1092-9. [PMID: 2549483 DOI: 10.1016/s0161-6420(89)32794-1] [Citation(s) in RCA: 222] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The ocular complications of acquired immune deficiency syndrome (AIDS) include: (1) a noninfectious microangiopathy, most often seen in the retina, consisting of cotton-wool spots with or without intraretinal hemorrhages and other microvascular abnormalities; (2) opportunistic ocular infections, primarily cytomegalovirus (CMV) retinitis; (3) conjunctival, eyelid, or orbital involvement by those neoplasms seen in patients with AIDS (i.e., Kaposi's sarcoma and lymphoma); and (4) neuro-ophthalmic lesions. In a series of 200 AIDS patients evaluated clinically, AIDS retinopathy was present in 66.5%. Sixty-four percent had cotton-wool spots, and 12% had intraretinal hemorrhages. Cytomegalovirus retinitis was diagnosed in 28% of AIDS patients. Neuro-ophthalmic lesions were found in 8% of all AIDS patients and were present in 33% of those patients with cryptococcal meningitis. Acquired immune deficiency syndrome retinopathy was present in 40% of 35 patients with the AIDS-related complex (ARC) and in 1.3% of 232 patients with asymptomatic human immunodeficiency virus (HIV) infection, evaluated photographically. These results suggest that the prevalence of AIDS retinopathy increases with increasing severity of HIV infection, and that CMV retinitis presents a significant vision-threatening problem in AIDS patients.
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Affiliation(s)
- D A Jabs
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205
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233
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Beauvais DA, Michelson JB, Seybold ME, Friedlaender MH, Boyden DG. Retroviruses and their play-pals. Surv Ophthalmol 1989; 34:59-64. [PMID: 2552598 DOI: 10.1016/0039-6257(89)90130-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A 28-year-old man with a previous history of Neissena infection presented with diminished vision, disc swelling, and panuveitis. Serologic tests revealed positive titers for both HIV and syphilis. Current epidemiology and treatment of such cases are discussed.
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Affiliation(s)
- D A Beauvais
- Division of Ophthalmology, Scripps Clinic and Research Foundation, La Jolla, California
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234
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Davis JL, Nussenblatt RB, Bachman DM, Chan CC, Palestine AG. Endogenous bacterial retinitis in AIDS. Am J Ophthalmol 1989; 107:613-23. [PMID: 2658616 DOI: 10.1016/0002-9394(89)90258-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We studied two patients, one with histologically confirmed endogenous bacterial retinitis associated with the acquired immunodeficiency syndrome and a second with ophthalmoscopically identical findings who also responded to antibiotic treatment. Both patients had focal, discrete patches of retinitis that enlarged slowly over weeks and ultimately accumulated large amounts of subretinal fluid and retinal exudate. One patient underwent retinal biopsy after systemic and vitreous cultures were negative. Histopathologic sections showed necrotic retina infiltrated with multiple histiocytes containing intracytoplasmic, iodine-positive, pleomorphic, encapsulated bacterial forms. The organism was not grown from the retinal biopsy specimen. Treatment with antibiotics resulted in improved vision in both patients. Our results indicate that endogenous bacterial infection should be considered in the differential diagnosis of retinitis associated with the acquired immunodeficiency syndrome.
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Affiliation(s)
- J L Davis
- National Eye Institute, Laboratory of Immunology, Bethesda, Maryland 20892
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235
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Lehoang P, Girard B, Robinet M, Marcel P, Zazoun L, Matheron S, Rozenbaum W, Katlama C, Morer I, Lernestedt JO. Foscarnet in the treatment of cytomegalovirus retinitis in acquired immune deficiency syndrome. Ophthalmology 1989; 96:865-73; discussion 873-4. [PMID: 2544840 DOI: 10.1016/s0161-6420(89)32824-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Cytomegalovirus (CMV) retinitis is the major cause of visual loss in acquired immune deficiency syndrome (AIDS). Thirty-one patients with active CMV retinitis were treated with the new antiviral drug, Foscarnet (trisodium phosphonoformate). After a 3-week course of induction therapy, the retinitis improved in 29 of 31 patients (93.5%). Complete resolution of the retinitis was seen in 19 cases (61.3%). Ten patients had partial resolution (32.2%) and two (6.5%) failed to respond. After induction therapy, six patients were put on a low-dose maintenance regimen. All patients without maintenance therapy relapsed within 3 weeks after discontinuation of Foscarnet. The rate of relapse on maintenance therapy was 50% (3/6) within the first 5 weeks. The three other patients of Foscarnet maintenance did not relapse after a follow-up period of 12 weeks. In contrast to ganciclovir, Foscarnet did not induce neutropenia but it produced kidney toxicity that led to reversible renal insufficiency in three cases. Thus, Foscarnet appears to be a useful alternative to ganciclovir, particularly when combined with bone marrow toxic drugs, such as zidovudine (azidothymidine).
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Affiliation(s)
- P Lehoang
- Department of Ophthalmology, Pitié-Salpétrière Hospital, Paris, France
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236
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Lipson BK, Freeman WR, Beniz J, Goldbaum MH, Hesselink JR, Weinreb RN, Sadun AA. Optic neuropathy associated with cryptococcal arachnoiditis in AIDS patients. Am J Ophthalmol 1989; 107:523-7. [PMID: 2540660 DOI: 10.1016/0002-9394(89)90498-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We studied two cases of bilateral visual loss secondary to an optic neuropathy in patients with cryptococcal meningitis. In both cases a history of visual loss after the onset of an episode of cryptococcal meningitis was elicited. Visual fields were consistent with optic nerve disease. The patients' visual loss appeared to be the result of perineuritic adhesive arachnoiditis. Although no surgical interventions were carried out in our patients, medical or surgical intervention may be useful to prevent or relieve constrictive arachnoiditis and preserve vision in selected patients.
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Affiliation(s)
- B K Lipson
- Department of Ophthalmology, University of California, San Diego School of Medicine, La Jolla
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237
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Skolnik PR, Pomerantz RJ, de la Monte SM, Lee SF, Hsiung GD, Foos RY, Cowan GM, Kosloff BR, Hirsch MS, Pepose JS. Dual infection of retina with human immunodeficiency virus type 1 and cytomegalovirus. Am J Ophthalmol 1989; 107:361-72. [PMID: 2539019 DOI: 10.1016/0002-9394(89)90659-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We examined retinal tissue from eight human immunodeficiency virus type 1 (HIV-1) seropositive patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex for evidence of dual infection with HIV-1 and cytomegalovirus. Culture demonstrated simultaneous infection with HIV-1 and cytomegalovirus in two of 13 retinal specimens. This was confirmed by both immunofluorescence and immunohistochemical staining. Moreover, coinfection of individual cells with cytomegalovirus and HIV-1 was observed by immunohistochemical staining. Infection of retina with cytomegalovirus or HIV-1 alone occurred in one and six of the 13 retinal specimens, respectively. HIV-1 antigens were present on scattered cells in all layers of the retina and on retinal vascular endothelium. HIV-1 was isolated from retinal tissue derived from eyes both with and without gross ocular lesions. Cytomegalovirus antigens were found in all layers of the retina, but not on vascular endothelial cells. The atypically rapid clinical progression of retinitis in one of the patients with dual HIV-1 and cytomegalovirus infection suggests the possibility that interactions between these two viruses may influence retinal disease in patients with AIDS.
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Affiliation(s)
- P R Skolnik
- Division of Geographic Medicine and Infectious Diseases, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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238
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Freeman WR, Chen A, Henderly DE, Levine AM, Luttrull JK, Urrea PT, Arthur J, Rasheed S, Cohen JL, Neuberg D. Prevalence and significance of acquired immunodeficiency syndrome-related retinal microvasculopathy. Am J Ophthalmol 1989; 107:229-35. [PMID: 2522276 DOI: 10.1016/0002-9394(89)90304-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We performed ophthalmologic examinations on 127 subjects with or at risk for human immunodeficiency virus (HIV) infection over a one-year period to determine the prevalence and significance of retinal cotton-wool spots and hemorrhages (AIDS-related retinal microvasculopathy). Of 26 asymptomatic homosexual men, of whom 13 were HIV seronegative and 13 were HIV seropositive, none manifested this retinopathy. Three of 34 patients (9%) with AIDS-related complex and 29 of 67 patients (43%) with AIDS manifested retinopathy on the initial examination. This difference in the prevalence of retinopathy between groups was statistically significant (P less than .05). Patients with AIDS demonstrated 7.2 times greater odds of manifesting retinopathy than patients with AIDS-related complex (P less than .05). Within the group of patients with AIDS, the T helper (CD4) to suppressor (CD8) cell ratio was significantly associated with retinopathy at the initial ocular examination. The CD4:CD8 ratio of the total group of AIDS and AIDS-related complex patients with retinopathy was significantly lower than that of patients without retinopathy (P less than .05). There was no significant association between retinopathy and any specific past or concurrent opportunistic infection or neoplasm. The presence of retinopathy was not associated with symptoms in any patient. The lesions of AIDS-related retinal microvasculopathy may be an important finding in the evaluation of patients suspected to have HIV-related disease.
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Affiliation(s)
- W R Freeman
- Department of Ophthalmology, University of California, San Diego School of Medicine
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239
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Cantrill HL, Henry K, Melroe NH, Knobloch WH, Ramsay RC, Balfour HH. Treatment of cytomegalovirus retinitis with intravitreal ganciclovir. Long-term results. Ophthalmology 1989; 96:367-74. [PMID: 2540470 DOI: 10.1016/s0161-6420(89)32900-9] [Citation(s) in RCA: 130] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Long-term management of cytomegalovirus (CMV) retinitis by intravitreal injection of ganciclovir was evaluated in ten patients with acquired immune deficiency syndrome (AIDS). Patients were unable to tolerate systemic ganciclovir because of severe neutropenia (8 cases), catheter-induced sepsis (1 case), or the need to continue therapy for human immunodeficiency virus (HIV) with zidovudine (ZDV) (1 case). All patients had a favorable response to initial treatment. Cytomegalovirus retinitis progressed in four fellow eyes in which treatment was deferred. Vision improved or remained stable in all but one eye. Patients were followed for a mean of 4 months and received an average of 16.6 intravitreal injections in each eye. Relapse occurred late in the course while on maintenance treatment in five eyes (33%). There was no evidence of toxicity from repeated intravitreal injections. Treatment was very well tolerated. The only severe complication in a total of 249 injections was a single case of Staphylococcus epidermidis endophthalmitis which responded to intravitreal antibiotic treatment. Intravitreal ganciclovir is an effective alternative to systemic ganciclovir in those patients with severe neutropenia and in those patients who desire to remain on systemic ZDV.
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Affiliation(s)
- H L Cantrill
- Department of Ophthalmology, University of Minnesota School of Medicine, Minneapolis
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240
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Schmidt D, Horl WH. Central retinal vein occlusion after transplantation of the kidney. Neuroophthalmology 1989. [DOI: 10.3109/01658108908997355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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241
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242
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Holland GN, Engstrom RE, Glasgow BJ, Berger BB, Daniels SA, Sidikaro Y, Harmon JA, Fischer DH, Boyer DS, Rao NA. Ocular toxoplasmosis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol 1988; 106:653-67. [PMID: 3195645 DOI: 10.1016/0002-9394(88)90697-6] [Citation(s) in RCA: 160] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In seven of eight cases of presumed ocular toxoplasmosis in patients with AIDS, the diagnosis was supported by a reduction or resolution of intraocular inflammation and healing of necrotic retinal lesions after initiation of antiparasitic drug therapy including one or more of the following medications: pyrimethamine, sulfadiazine, clindamycin, tetracycline, or spiramycin. In two cases the diagnosis was confirmed histologically. The cases differed clinically and histopathologically from those in immunocompetent patients. There was no evidence that disease originated in preexisting retinochoroidal scars. Lesions frequently were bilateral and multifocal. Vitreous inflammatory reaction was a common clinical finding, but histopathologic examination demonstrated scant retinal inflammation in areas of necrosis. Ocular toxoplasmosis in these patients with AIDS probably resulted from newly acquired infection or dissemination of organisms from nonocular sites of disease. Infections became clinically inactive with drug therapy in all treated patients, but reactivation and progression of disease occurred when therapy was stopped in two of three patients. Severe retinal necrosis led to retinal tears or detachment in three cases. Ocular lesions were the first manifestation of Toxoplasma gondii infection in four of five patients with evidence of multisystem infection.
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Affiliation(s)
- G N Holland
- AIDS Unit, UCLA Uveitis Center, Jules Stein Eye Institute 90024-1771
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243
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Schulman JA, Peyman GA. Management of Viral Retinitis. Ophthalmic Surg Lasers Imaging Retina 1988. [DOI: 10.3928/1542-8877-19881201-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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244
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Cowan WT, Wahab S, Lucia HL. Detection of human immunodeficiency virus antigen in vitreous humor. J Clin Microbiol 1988; 26:2421-2. [PMID: 3235668 PMCID: PMC266904 DOI: 10.1128/jcm.26.11.2421-2422.1988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The vitreous humor from 11 patients with acquired immunodeficiency syndrome was obtained at postmortem examination and tested for human immunodeficiency virus antigen and antibody by using the Abbott enzyme-linked immunosorbent assay procedures. Five patients had detectable antigen, supporting the recent observation that the virus may directly infect the retina.
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Affiliation(s)
- W T Cowan
- Department of Pathology, University of Texas Medical Branch, Galveston 77550
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245
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Cantrill HL, Henry K, Jackson B, Erice A, Ussery FM, Balfour HH. Recovery of human immunodeficiency virus from ocular tissues in patients with acquired immune deficiency syndrome. Ophthalmology 1988; 95:1458-62. [PMID: 2852338 DOI: 10.1016/s0161-6420(88)33011-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Human immunodeficiency virus (HIV) was recovered from multiple ocular tissues in three patients with acquired immune deficiency syndrome (AIDS). Consistently found in the retina, HIV was also detected in the conjunctiva, cornea, and iris. In two cases, HIV was detectable despite treatment with oral zidovudine. All three patients had bilateral cytomegalovirus (CMV) retinitis managed by intravitreal injection of ganciclovir. Culture of the retina for CMV was negative in all three cases. The finding of HIV in multiple ocular tissues is consistent with the neurotropic nature of the virus, and may explain some of the common ocular manifestations of AIDS such as AIDS retinopathy. Infection with HIV may predispose the retina to other opportunistic infections and may explain the high incidence of CMV retinitis in AIDS patients. This is the first report of HIV isolation from tissue within the eye.
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Affiliation(s)
- H L Cantrill
- Department of Ophthalmology, University of Minnesota School of Medicine, Minneapolis
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246
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247
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Farrell PL, Heinemann MH, Roberts CW, Polsky B, Gold JW, Mamelok A. Response of human immunodeficiency virus-associated uveitis to zidovudine. Am J Ophthalmol 1988; 106:7-10. [PMID: 3164982 DOI: 10.1016/s0002-9394(14)76379-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A patient with human immunodeficiency virus (HIV) type 1 infection developed chronic iridocyclitis and anterior vitritis that were poorly responsive to topical and systemic corticosteroid therapy. Anterior chamber paracentesis was performed and HIV was isolated from culture of aqueous humor. Subsequent treatment with oral zidovudine resulted in resolution of the iridocyclitis and vitritis and full functional recovery of the eye. This case suggests that HIV may be a cause of uveitis responsive to systemic zidovudine therapy.
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Affiliation(s)
- P L Farrell
- Department of Ophthalmology, New York Hospital Cornell Medical Center, NY 10021
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248
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Abstract
We diagnosed ocular syphilis in three homosexual men infected with human immunodeficiency virus (HIV). Ocular inflammation included uveitis, optic neuritis, and retinitis. Dermatologic and central nervous system manifestations of secondary syphilis were also present. The history of homosexuality was difficult to obtain. Concomitant infection with HIV may alter the course of syphilis, obscure the diagnosis, and impair the response to therapy.
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Affiliation(s)
- M S Passo
- Department of Ophthalmology, Veteran's Administration Hospital, Portland, Oregon
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249
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Brown HH, Glasgow BJ, Holland GN, Foos RY. Cytomegalovirus infection of the conjunctiva in AIDS. Am J Ophthalmol 1988; 106:102-4. [PMID: 2839986 DOI: 10.1016/s0002-9394(14)76402-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- H H Brown
- Department of Pathology, Jules Stein Eye Institute, UCLA Center for the Health Sciences 90024
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250
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Orellana J, Teich SA, Winterkorn JS, Mathur-Wagh U, Handwerger S, Schlamm H, Malamud SC, Yancovitz SR, Cederberg DM, Mildvan DS. Treatment of cytomegalovirus retinitis with ganciclovir (9-[2-hydroxy-1-(hydroxymethyl) ethoxymethyl] guanine (BW B759U). Br J Ophthalmol 1988; 72:525-9. [PMID: 2843219 PMCID: PMC1041518 DOI: 10.1136/bjo.72.7.525] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Six patients (11 eyes) with virologically confirmed cytomegalovirus (CMV) retinitis involving the posterior pole of the eye were treated with a new drug, ganciclovir. Treatment with intravenous ganciclovir consistently halted progression of retinitis and produced improvement in measures of visual function. However, within three weeks after cessation of therapy renewed CMV activity and worsening of visual function were observed in most cases. Maintenance therapy with ganciclovir extended the period of remission from CMV retinitis.
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Affiliation(s)
- J Orellana
- Department of Ophthalmology, Beth Israel Medical Center, New York, New York 10003
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