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Jung H, Lee J, Lee CS, Kim M, Kim SS, Byeon SH, Kwak JJ. Long-term Outcomes of Surgeries for Retinal Detachment Secondary to Parasitic or Viral Infectious Retinitis. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:236-248. [PMID: 38712388 PMCID: PMC11175980 DOI: 10.3341/kjo.2024.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE This study sought to compare the long-term outcomes of surgeries for retinal detachment (RD) secondary to viral or parasitic infectious retinitis. METHODS A total of 47 eyes that received pars plana vitrectomy with or without scleral buckling due to RD secondary to polymerase chain reaction-proven viral (cytomegalovirus, varicella zoster virus, and herpes zoster virus) or parasitic (toxoplasma and toxocara) retinitis from October 1, 2006, to June 30, 2023, in a single medical center were retrospectively enrolled. RESULTS Mean follow-up period was 59.03 ± 55.24 months in viral retinitis and 34.80 ± 33.78 months in parasitic retinitis after primary reattachment surgery. During follow-up, nine eyes (24.3%) with viral retinitis and five eyes (50.0%) with parasitic retinitis developed retinal redetachment. Visual acuity success at final follow-up was achieved in 19 eyes (51.4%) with viral retinitis and six eyes (60.0%) with parasitic retinitis (p = 0.64). The incidence of retinal redetachment during the 1st postoperative year was significantly higher in parasitic retinitis compared with viral retinitis (crude incidence, 0.21 vs. 0.85; p = 0.02). Hazard ratio analysis adjusted for age and sex showed 4.58-fold (95% confidence interval, 1.22-17.27; p = 0.03) increased risk of retinal redetachment in parasitic retinitis compared with viral retinitis during the 1st postoperative year. Tamponade with silicone oil and preoperative diagnostic vitrectomy were associated with significantly decreased risk of retinal redetachment in patients with parasitic retinitis. CONCLUSIONS Compared with RD secondary to viral retinitis, RD secondary to parasitic retinitis showed higher incidence of retinal redetachment during the 1st postoperative year. Tamponade with silicone oil and preoperative diagnostic vitrectomy were associated with significantly decreased risk of retinal redetachment in patients with parasitic retinitis.
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Affiliation(s)
- Hyunjean Jung
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Junwon Lee
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Christopher Seungkyu Lee
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Sung Soo Kim
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Suk Ho Byeon
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Jay Jiyong Kwak
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
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Shughoury A, Carr EW, Moorthy RS. Rhegmatogenous Retinal Detachment in Syphilitic Uveitis: A Case Series and Comprehensive Review of the Literature. Ocul Immunol Inflamm 2023:1-12. [PMID: 37549228 DOI: 10.1080/09273948.2023.2238810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Uveitis is the most common ocular manifestation of syphilis. However, an association between syphilitic uveitis and rhegmatogenous retinal detachment (RRD) is not widely recognized. We report a consecutive series of six new cases of syphilitic uveitis complicated by RRD and describe the typical characteristics, clinical course, and surgical management of such cases. METHODS Consecutive case series and comprehensive review of the literature. RESULTS We identified a total of 19 cases (23 eyes) with syphilitic uveitis subsequently complicated by RRD, including six new cases (seven eyes) reported here and 13 cases (16 eyes) previously reported in the literature. Fifteen patients (79%) were positive for human immunodeficiency virus (HIV) and not on combination antiretroviral therapy. Most retinal detachments developed within two months of uveitis presentation; retinal breaks were often found in areas of previous retinitis. Sixteen eyes (70%) were complicated by early proliferative vitreoretinopathy. Twenty-one eyes underwent surgical repair, of which six (26%) suffered re-detachment. Surgical management commonly involved pars-plana vitrectomy and silicone oil tamponade, with or without scleral buckling. Visual outcomes were generally poor: only six eyes (26%) attained visual acuity of 20/40 or better and 11 eyes (48%) remained 20/200 or worse. CONCLUSIONS Patients with syphilitic uveitis, as with viral retinitis, should be monitored closely for the development of retinal tears and RRD. A combination of pars plana vitrectomy with silicone oil tamponade and/or scleral buckle placement is a prudent surgical approach to most cases of syphilitic RRD, although visual prognosis remains guarded.
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Affiliation(s)
- Aumer Shughoury
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Evan W Carr
- Department of Medicine, Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA
| | - Ramana S Moorthy
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Associated Vitreoretinal and Uveitis Consultants, Indianapolis, Indiana, USA
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Xie LY, Chen C, Kong WJ, Jiang TY, Du KF, Dong HW, Guo CG, Li XN, Wei WB. Effect of Anti-CMV Therapy at Different Stages on Retinal Detachment in Patients with AIDS and CMVR. Adv Ther 2021; 38:2294-2301. [PMID: 33730351 DOI: 10.1007/s12325-021-01674-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/14/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The present study aimed to investigate the effect of anti-cytomegalovirus (anti-CMV) therapy at different stages on retinal detachment in patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus retinitis (CMVR). METHODS Ninety-seven patients with AIDS and CMVR diagnosed and treated at the Ophthalmology and Infection Center of Beijing You'an Hospital, affiliated with Capital Medical University, from November 2017 to January 2020 were retrospectively analyzed. Of the 138 eyes included, 30 eyes with concomitant retinal detachment were enrolled as the study subjects. The eyes with retinal detachment were divided into a pre-induction group, an intra-induction group, and a post-induction group of anti-CMV therapy. The occurrence and characteristics of retinal detachment at different stages of anti-CMV therapy were observed. RESULTS Retinal detachment occurred in 30 of the 138 eyes of 97 patients, with an incidence of retinal detachment of 21.74%. Retinal detachment occurred in eight eyes in the pre-induction group, with an incidence of 26.67%, and in four eyes in the intra-induction group, with an incidence of 13.33%. The difference in incidence between the two groups was statistically significant (P = 0.000). Retinal detachment occurred in 18 eyes in the post-induction group, with an incidence of 60%. The difference in incidence between the intra-induction group and the post-induction group was statistically significant (P = 0.001). CONCLUSION The incidence of retinal detachment at the intra-induction stages of anti-CMV therapy was lower than that at the pre-induction stage, and retinal detachment during the anti-CMV therapy predominantly occurred after the end of the induction stage.
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Affiliation(s)
- Lian-Yong Xie
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Chao Chen
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Wen-Jun Kong
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Tai-Yi Jiang
- Department of Infectious Diseases, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Kui-Fang Du
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Hong-Wei Dong
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Chun-Gang Guo
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Xiao-Na Li
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Sittivarakul W, Prapakornkovit V, Jirarattanasopa P, Bhurayanontachai P, Ratanasukon M. Surgical outcomes and prognostic factors following vitrectomy in acquired immune deficiency syndrome patients with cytomegalovirus retinitis-related retinal detachment. Medicine (Baltimore) 2020; 99:e22889. [PMID: 33120835 PMCID: PMC7581021 DOI: 10.1097/md.0000000000022889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
To determine the surgical outcomes and prognostic factors of cytomegalovirus (CMV) retinitis-related retinal detachment (RD) in acquired immune deficiency syndrome (AIDS) patients following vitrectomy.A retrospective charts review was carried out on AIDS patients who were diagnosed with CMV retinitis-related RD and treated with vitrectomy between 2002 and 2016. The main outcome measures were the rates of primary anatomical success and final visual acuity (VA) success defined as postoperative VA ≥20/200. Kaplan-Meier curves on the time to retinal redetachment were performed. Multivariate logistic regression models based on a directed acyclic graph were used to identify independent factors associated with achieving VA success.Forty five AIDS patients (52 eyes) were included. Over a mean follow-up period of 41.7 months, primary anatomical success was achieved in 44 eyes (84.6%) and VA success was achieved in 34 eyes (65.4%). Receiving highly active antiretroviral therapy (HAART) prior to RD (adjusted odds ratio [aOR]=4.9, P = .043), better preoperative VA (aOR = 4.3, P = .006), undergoing vitrectomy within 3 months (aOR=6.7, P = .008), absence of optic atrophy (aOR=58.1, P < .001), and absence of retinal redetachment (aOR=38.1, P = .007) increased the odds of achieving final VA success.Vitrectomy provided favorable anatomical reattachment in AIDS patients with CMV retinitis-related RD. Majority of patients was able to retain functional vision postoperatively. The use of HAART and early vitrectomy increased the probability of achieving both anatomical and VA success.
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Slingsby TJ, Pecen PE, Palestine AG. Outcomes and Complications Associated with Noninfectious Uveitis in Patients Presenting with Rhegmatogenous Retinal Detachment. Ophthalmol Retina 2020; 4:823-828. [PMID: 32307330 DOI: 10.1016/j.oret.2020.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/22/2020] [Accepted: 02/18/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the visual outcomes and complications associated with noninfectious uveitis in patients presenting with a rhegmatogenous retinal detachment (RRD). DESIGN Retrospective cohort study. PARTICIPANTS A total of 554 eyes of 523 patients presenting for RRD repair at the Department of Ophthalmology, University of Colorado School of Medicine, between July 2011 and September 2016. METHODS Analysis of risk factors, anatomic outcomes, and visual outcomes related to a history of noninfectious uveitis. MAIN OUTCOME MEASURES End point rate of reattachment, end point visual acuity (VA), postoperative proliferative vitreoretinopathy (PVR), and rate of reoperation. RESULTS A history of uveitis was identified in 5.4% of eyes. Eyes with a history of uveitis were found to have a higher risk for development of any degree of PVR (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.1-4.4, P = 0.030) and a higher risk of PVR necessitating an additional procedure (HR, 2.7; 95% CI, 1.2-6.0, P = 0.014). Anatomic and visual outcomes did not differ between the 2 groups. Preoperative VA, the distribution of race/ethnicity, age, gender, lens status, macula status, and lattice degeneration status did not vary significantly between the groups. In the analysis of a PVR subgroup, uveitis was not associated with a higher risk of PVR necessitating an additional procedure and did not show a statistically significant difference in end point VA. CONCLUSIONS A history of uveitis is associated with an increased risk of any degree of PVR and an increased risk of PVR necessitating an additional procedure. However, subgroup analysis suggests that patients with a history of uveitis who develop PVR do not necessarily have a worse visual outcome or a higher risk of additional surgery. There may be a role for perioperative steroids in patients with a history of uveitis who present with a retinal detachment, but further study is warranted to determine if this decreases the risk of PVR or improves visual outcomes.
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Affiliation(s)
- Taylor J Slingsby
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Paula E Pecen
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado.
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de Smet MD, Julian K. Management of Combined Inflammatory and Rhegmatogenous Retinal Detachment. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00112-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ebert EM, D'amico DJ. Differential Diagnosis of the Retinal Manifestations of Acquired Immunodeficiency Syndrome. Semin Ophthalmol 2009. [DOI: 10.3109/08820539309060205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Park KH, Bang JH, Park WB, Kim HB, Kim NJ, Ahn JK, Chang KH, Oh MD, Choe KW. Retrobulbar optic neuritis and meningoencephalitis following progressive outer retinal necrosis due to CMV in a patient with AIDS. Infection 2008; 36:475-9. [PMID: 18574556 DOI: 10.1007/s15010-007-6290-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 05/03/2007] [Indexed: 11/26/2022]
Abstract
We report on a 34-year-old male patient with AIDS who developed retrobulbar optic neuritis and meningoencephalitis following bilateral progressive outer retinal necrosis (PORN) caused by cytomegalovirus (CMV). This case documents the presumed association of PORN with retrobulbar optic neuritis, and CMV meningoencephalitis in an AIDS patient.
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Affiliation(s)
- K H Park
- Department of Internal medicine, Seoul National University Hospital, 28 Youngun-dong, Chongro-gu, Seoul, South Korea
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Arduino PG, Porter SR. Herpes Simplex Virus Type 1 infection: overview on relevant clinico-pathological features. J Oral Pathol Med 2008; 37:107-21. [PMID: 18197856 DOI: 10.1111/j.1600-0714.2007.00586.x] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Herpes Simplex Virus Type 1 (HSV-1) is a nuclear replicating enveloped virus, usually acquired through direct contact with infected lesions or body fluids (typically saliva). The prevalence of HSV-1 infection increases progressively from childhood, the seroprevalence being inversely related to socioeconomic background. Primary HSV-1 infections in children are either asymptomatic or following an incubation period of about 1 week gives rise to mucocutaneous vesicular eruptions. Herpetic gingivostomatitis typically affects the tongue, lips, gingival, buccal mucosa and the hard and soft palate. Most primary oro-facial HSV infection is caused by HSV-1, infection by HSV-2 is increasingly common. Recurrent infections, which occur at variable intervals, typically give rise to vesiculo-ulcerative lesions at mucocutaneous junctions particularly the lips (herpes labialis). Recurrent HSV-1 infection within the mouth is uncommon in otherwise healthy patients, although in immunocompromised patients, recurrent infection can be more extensive and/or aggressive. The diagnosis of common herpetic infection can usually be based upon the clinical history and presenting features. Confirmatory laboratory diagnosis is, however, required when patients are, or may be, immunocompromised.
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Affiliation(s)
- Paolo G Arduino
- Department of Biomedical Sciences and Human Oncology, Oral Medicine Section, University of Turin, Turin, Italy.
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You YS, Lee SJ, Lee SH, Park CH, Kwon OW. Progressive outer retinal necrosis combined with vitreous hemorrhage in a patient with acquired immunodeficiency syndrome. KOREAN JOURNAL OF OPHTHALMOLOGY 2007; 21:51-4. [PMID: 17460434 PMCID: PMC2629688 DOI: 10.3341/kjo.2007.21.1.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose To describe an unusual case of rapidly progressive outer retinal necrosis (PORN) with vitreous hemorrhage in a 41-year-old woman with acquired immunodeficiency syndrome (AIDS), who had retinitis developed from what was probably varicellar-zoster virus combined with cytomegalovirus (CMV) and herpes simplex type 1,2, as proven by the polymerase chain reaction restriction fragment length polymorphism method (PCR-RFLP). Methods This study is a case report detailing clinical follow-up and an aqueous humor test by PCR-RFLP. Results The deep, white retinal lesions coalesced and progressively expanded in a circumferential manner, with sparing of the perivascular retina. However, retinal and vitreous hemorrhages, unusual findings for PORN, could be noted around the optic nerve. Varicellar-zoster virus (VZV), cytomegalovirus (CMV), and herpes simplex types 1,2 (HSV-1,2) were detected in the aqueous humor by PCR. Conclusions PORN has been described as a variant of necrotizing herpetic retinopathy, occurring particularly in patients with AIDS. Although the etiologic agent has been reported to be VZV, concurrent or combined etiologic agents can include HSV-1, HSV-2, and CMV in AIDS patients. Therefore, combined antiviral therapy with acyclovir and ganciclovir could be more reasonable as an initial therapy.
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Affiliation(s)
| | - Sung Jin Lee
- Department of Ophthalmology, Soonchunhyang University Hospital, Seoul, Korea
| | | | - Chang Hyun Park
- Department of Ophthalmology, Soonchunhyang University Hospital, Seoul, Korea
| | - Oh Woong Kwon
- The Institute of Vision Research and Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Kappel PJ, Charonis AC, Holland GN, Narayanan R, Kulkarni AD, Yu F, Boyer DS, Engstrom RE, Kuppermann BD. Outcomes Associated with Ganciclovir Implants in Patients with AIDS-Related Cytomegalovirus Retinitis. Ophthalmology 2006; 113:683.e1-8. [PMID: 16581428 DOI: 10.1016/j.ophtha.2005.11.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Revised: 11/02/2005] [Accepted: 11/04/2005] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate complications associated with ganciclovir implants used to treat AIDS-related cytomegalovirus (CMV) retinitis, and to identify factors that predict poor outcomes. DESIGN Retrospective chart review. PARTICIPANTS Consecutive patients with AIDS-related CMV retinitis from 3 clinical facilities who underwent implantation procedures during the period January 1, 1995 through December 31, 2001. METHODS Baseline for each patient was the date of the first implantation procedure performed during the study period by one of the facilities' surgeons (index implant). Medical and ophthalmological data were collected at baseline and at specific time points after baseline. The dates on which additional implantation procedures were performed and the dates on which complications or vision loss were identified were also recorded. Relationships between potential risk factors and outcomes were studied by Kaplan-Meier analyses and Cox proportional hazards regression models. MAIN OUTCOME MEASURES Primary outcome measures included postoperative complications specifically related to or possibly related to ganciclovir implants. A secondary outcome measure was vision loss after implantation procedures. RESULTS The charts of 174 patients (one study eye per patient; 279 implants) were reviewed. Median follow-up was 14.4 months (range, 0-7 years). Complications specifically related to implants occurred throughout follow-up at a rate of 0.064 events per patient-year. Complications possibly related to implants occurred at an overall rate of 0.377 per patient-year, but seemed to be more common during the first 2 years after baseline. During the first 2 years of follow-up, retinal detachments occurred at a rate of 0.156 events per patient-year. The cumulative risk of vision loss (> or =3 lines of Snellen visual acuity) at 7 years was 70%. Poor outcomes were associated with disease factors (size and activity of lesions), lack of highly active antiretroviral therapy (HAART), and lack of HAART-associated immune reconstitution, but not with surgical factors or implant-specific complications. CONCLUSIONS Complications specifically associated with ganciclovir implants can occur many years after implantation procedures, but the incidence of such complications is low. Continued vision loss is not attributable directly to complications of implants in most cases. This information will help in planning of treatment strategies for CMV retinitis in long-term survivors of human immunodeficiency virus disease.
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Affiliation(s)
- Peter J Kappel
- Ocular Inflammatory Disease Center, Jules Stein Eye Institute, and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-7003, USA
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Silicone Oil in Vitreoretinal Surgery. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50136-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Kosobucki BR, Freeman WR. Retinal Disease in HIV-infected Patients. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50098-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kreiger AE, Gonzales CR. Management of Combined Inflammatory and Rhegmatogenous Retinal Detachments (AIDS and ARN). Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The ocular posterior segment manifestations of AIDS may be divided into four categories: retinal vasculopathy, unusual malignancies, neuro-ophthalmologic abnormalities, and opportunistic infections. Microvasculopathy is the most common manifestation. Opportunistic infections, particularly cytomegalovirus retinitis and progressive outer retinal necrosis, are the most likely to result in visual loss due to infection or subsequent retinal detachment. Diagnosis and treatment are guided by the particular conditions and immune status of the patient.
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Affiliation(s)
- Tamara R Vrabec
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Kerkhoff FT, Lamberts QJ, van den Biesen PR, Rothova A. Rhegmatogenous retinal detachment and uveitis. Ophthalmology 2003; 110:427-31. [PMID: 12578792 DOI: 10.1016/s0161-6420(02)01744-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the frequency, high-risk factors, and visual prognosis of rhegmatogenous retinal detachment (RRD) in patients with uveitis. DESIGN Retrospective case-control study. PARTICIPANTS We included 1387 consecutive patients with uveitis who consulted our uveitis clinic from January 1990 through December 1997 of whom 43 patients (46 eyes) with RRD were identified. The retinal detachment (RD) controls were 212 consecutive patients with RRD (221 eyes, first occurrence of RD, not associated with uveitis) who were admitted for surgery in the period from April 1999 to April 2000. The uveitis control group consisted of 150 age-matched patients (210 eyes) selected from the entire uveitis series. INTERVENTION Retrospective analysis of clinical data. MAIN OUTCOME MEASURES The presence of RRD and eventual risk factors for RRD, such as myopia, retinal lattice degeneration, prior intraocular surgery, anatomic location of uveitis, its specific diagnosis, and clinical manifestations. Furthermore, the surgical and nonsurgical outcomes of RRD, as well as the results of various treatment regimens, were analyzed. RESULTS RRD was identified in 3.1% of the patients with uveitis. RRD was most frequently associated with panuveitis (6.6%). RRD was associated more frequently with infectious (7.6%) than noninfectious uveitis (2.1%). At the onset of RRD, uveitis was active in most (46%) affected eyes. Proliferative vitreoretinopathy was present in 30% of the uveitic RRD eyes at presentation in contrast to 12% of the RRD control eyes. In uveitic RRD, the retina was reattached in 59% of eyes with a single operation; the final anatomic reattachment rate was 88%. Finally, a visual acuity of less than 20/200 was present in 71% of the uveitic RRD eyes, 10% of which had no light perception. CONCLUSIONS We discovered a high prevalence of RRD in patients with active panuveitis and infectious uveitis and document that uveitis in itself is a risk factor for the development of RRD. The visual prognosis of RRD in uveitis was poor because of the uveitis itself and the frequent development of proliferative vitreoretinopathy.
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Affiliation(s)
- Frank T Kerkhoff
- Department of Ophthalmology, F.C. Donders Institute, University Medical Center Utrecht, PO Box 85 500, 3508 GA Utrecht, The Netherlands
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Safety of intravitreous fomivirsen for treatment of cytomegalovirus retinitis in patients with AIDS. Am J Ophthalmol 2002; 133:484-98. [PMID: 11931782 DOI: 10.1016/s0002-9394(02)01332-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To report data regarding the safety of intravitreous fomivirsen for treatment of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS). DESIGN Critical review of safety data from three randomized controlled clinical trials with supplemental information from an expanded drug access program. METHODS Adverse ocular events reported by clinician investigators were listed using terms modified from the COSTART dictionary. Data for two doses (165-microg/injection [35 eyes, 30 patients] and 330-microg/injection [153 eyes, 120 patients]) and two 330-microg/injection dose schedules of different intensity were pooled to calculate incidence rates for each event. Rates were calculated as "events/patient-year" (based on total cumulative reported events and duration of treatment) for events that could recur during treatment. Rates were calculated as "patients with events/person-year" for the following events: retinal detachment, cataract, visual field disturbance, and retinal pigment epitheliopathy. To assess the ability to manage events, we reviewed treatments given for two events (anterior chamber inflammation, increased intraocular pressure) in one trial. We also report an analysis comparing the proportion of eyes that developed one or more key events to the cumulative number of injections. RESULTS Incidence rates were dose and schedule dependent (165 microg/injection, 4.06 events/patient-year; 330 microg/injection, 6.58 events/patient-year [less intense regimen] and 8.35 events/patient-year [more intense regimen]). The most frequently reported events were anterior chamber inflammation and increased intraocular pressure. We found no evidence that the proportion of patients with events increased as the number of injections increased. CONCLUSIONS Intravitreous fomivirsen is well tolerated with an acceptable safety profile. Adverse ocular events associated with doses and schedules used clinically can be managed successfully with medical therapy.
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Engstrom RE, Goldenberg DT, Parnell JR, Barnhart LA, Holland GN. Clear lens extraction with intraocular lens implantation during retinal detachment repair in patients with Acquired Immune Deficiency Syndrome (AIDS) [correction of autoimmune deficiency syndrome] and cytomegalovirus retinitis. Ophthalmology 2002; 109:666-73. [PMID: 11927422 DOI: 10.1016/s0161-6420(01)01051-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the outcomes of clear lens extraction with intraocular lens (IOL) implantation during repair of retinal detachment by vitrectomy with silicone oil tamponade in patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis. DESIGN Retrospective, noncomparative case series. PARTICIPANTS Twelve eyes of 10 patients with AIDS, CMV retinitis, and retinal detachment. INTERVENTION All patients underwent phacoemulsification with posterior chamber IOL placement at the time of vitrectomy with silicone oil tamponade for repair of retinal detachment. A targeted postoperative refractive error of -5.00 diopters (D) to -3.00 D was chosen in an attempt to counteract the hyperopic effect of silicone oil. MAIN OUTCOME MEASURES The following factors were evaluated: postoperative visual acuity, refractive error, and intraoperative and postoperative complications. RESULTS Median follow-up was 7 months (range, 1-46 months). For patients without macular necrosis, median best-corrected preoperative visual acuity was 20/75 (range, 20/20-20/800), and median best postoperative visual acuity was 20/50 (range, 20/20-20/400). Median final visual acuity was 20/140 (range, 20/25 to count fingers at 1 foot). The median postoperative refractive error (spherical equivalent) was -1.00 D (range, -4.00 D to +7.88 D). Reoperation was required in 3 of 12 eyes for recurrent macular detachment (1 with silicone oil underfill; 2 with proliferative vitreoretinopathy). The macula was attached in all eyes at last follow-up. Reattachment of the peripheral retina was achieved in 10 of 12 eyes. There were no anterior segment complications. CONCLUSIONS Clear lens extraction with IOL placement during repair of retinal detachment with silicone oil tamponade does not seem to increase complications and may improve long-term visual rehabilitation, improve retinitis management by allowing better posterior segment visualization throughout the postoperative course, and decrease overall cost and morbidity associated with cataract extraction as a second procedure.
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Affiliation(s)
- Robert E Engstrom
- Ocular Inflammatory Disease Center, Jules Stein Eye Institute, University of California at Los Angeles School of Medicine, 100 Stein Plaza, Los Angeles, CA 90095-7000, USA
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Abstract
Vitreoretinal disorders are one of the major causes of blindness in the developed world. Treatments of these pathologies often include repeated intravitreous injections to achieve intraocular drug levels within the therapeutical range. However, the risks of complications increase with the frequency of intravitreous injections. Controlled drug delivery formulations, offer an excellent alternative to multiple administrations. These systems are capable of delivering drugs over longer time periods than conventional formulations. Currently, several kinds of polymer devices for drug delivery to the posterior segment of the eye are under clinical use, or under investigation. Among these devices, microparticulates, such as microspheres, provide an alternative to multiple injections to obtain sustained release of the drug with a single administration. Among the polymers used to make the injectable microparticles, the most commonly used are poly(lactic acid), poly(glycolic acid) and copolymers of lactic and glycolic acids because they are biocompatible and degrade to metabolic products that are easily eliminated from the body. This article reviews the literature of biodegradable polymeric microspheres loaded with drugs, that have been investigated for delivery by intravitreous injection to treat diverse vitreoretinal diseases.
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Affiliation(s)
- R Herrero-Vanrell
- Dpto Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad Complutense, 28040, Madrid, Spain.
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Abstract
PURPOSE To review the changing epidemiology of herpes simplex disease and correlate it with the epidemiology of ocular herpes simplex disease. METHOD A review of pertinent reports in the world literature about the epidemiology of herpes simplex and specifically about ocular herpes simplex. RESULTS In developed countries, many individuals are reaching adolescence and adulthood without prior herpesvirus infection. Herpes simplex genital infection is increasing at a rapid rate in sexually active adolescents and adults, with about one in six adults now infected in the United States. Similar statistics are confirmatory worldwide in developed countries. Active herpes simplex infection is a risk factor for acquisition of human immunodeficiency virus. The Herpetic Eye Disease Study, as well as prior studies from Moorfields Eye Hospital and the Mayo Clinic in Rochester, Minnesota, provides us with the epidemiology of ocular herpes simplex. Recent studies suggest an older age of onset and perhaps overall more severe ocular disease as compared with the older literature. CONCLUSIONS Herpes simplex is a significant health concern at present with genital infections increasing in epidemic proportions. This is also reflected in a rise in the incidence of neonatal herpes. Herpes simplex virus type 1 (HSV-1) infection is being acquired for the first time in an older age group. A significant and increasing proportion of genital herpes is caused by HSV-1. Serologic studies are no longer as useful in distinguishing orofacial herpes from genital herpes. More acute retinal necrosis syndrome cases are associated with HSV-2. Speculation about the future of ocular herpes is made based on this changing epidemiology.
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Affiliation(s)
- T J Liesegang
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida 32224, USA.
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Kashiwase M, Sata T, Yamauchi Y, Minoda H, Usui N, Iwasaki T, Kurata T, Usui M. Progressive outer retinal necrosis caused by herpes simplex virus type 1 in a patient with acquired immunodeficiency syndrome. Ophthalmology 2000; 107:790-4. [PMID: 10768344 DOI: 10.1016/s0161-6420(99)00143-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE/BACKGROUND To identify the etiologic agent of rapidly progressive outer retinal necrosis (PORN) in a 32-year-old man with acquired immunodeficiency syndrome (AIDS), who had retinitis developed from cytomegalovirus (CMV). Multiple yellowish spots appeared in the deep retina without evidence of intraocular inflammation or retinal vasculitis, diagnosed clinically as PORN. Death occurred after failure of multiple organs. DESIGN Case report. METHODS Both globes were taken at autopsy, fixed in formalin, and examined histopathologically and immunohistochemically to identify causative agents in the retinal lesions. MAIN OUTCOME MEASURE Immunohistochemistry. RESULTS All layers of the retina were severely damaged and contained focal calcification. Cytomegalic inclusion bodies were found in cells in the damaged retina of the right eye. Immunohistochemical studies for herpesviruses revealed the presence of CMV antigens in the right retina at the posterior pole and herpes simplex virus type 1 (HSV-1)-specific antigen in the periphery of both retinas. No varicella-zoster virus (VZV) antigen was detected in either retina. CONCLUSIONS PORN has been described as a variant of necrotizing herpetic retinopathy, occurring particularly in patients with AIDS. Although the etiologic agent has been reported to be VZV, HSV-1 can be an etiologic agent.
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Affiliation(s)
- M Kashiwase
- Department of Ophthalmology, Tokyo Medical University, Japan
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25
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Stier PA, Glazer LC, Garretson BR, Deutsch TA. Surgical Repair of Retinal Detachment Secondary to Cytomegalovirus Retinitis. Ophthalmic Surg Lasers Imaging Retina 1999. [DOI: 10.3928/1542-8877-19990401-10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Baumal CR, Reichel E. Management of Cytomegalovirus-Related Rhegmatogenous Retinal Detachments. Ophthalmic Surg Lasers Imaging Retina 1998. [DOI: 10.3928/1542-8877-19981101-09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vrabec TR. Laser photocoagulation repair of macula-sparing cytomegalovirus-related retinal detachment. Ophthalmology 1997; 104:2062-7. [PMID: 9400766 DOI: 10.1016/s0161-6420(97)30058-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The purpose of the study is to investigate the role of laser photocoagulation in the treatment of macula-sparing cytomegalovirus (CMV)-related retinal detachment (CMVRD) in patients with acquired immune deficiency syndrome (AIDS). DESIGN Seven macula-sparing CMVRD identified between July 1995 and February 1997 were managed with laser photocoagulation and observed prospectively (group I). Seven CMVRD reattached with pars plana vitrectomy (PPV) and silicone oil injection (group II) between January 1992 and June 1996 were analyzed retrospectively. PARTICIPANTS Patients with AIDS with macula-sparing rhegmatogenous CMVRD with no proliferative vitreoretinopathy and visual acuity better than 20/30 were studied. INTERVENTION Demarcation laser photocoagulation (group I) or PPV with silicone oil injection (group II) was performed. MAIN OUTCOME MEASURES Postoperative best-corrected visual acuity (BCVA), temporary or permanent visual loss, CMVRD progression or recurrence, and cataract were measured. RESULTS Follow-up ranged from 2 to 19 months (mean, 9 months) in group I. Post-treatment BCVA was unchanged in all eyes after laser. One retina redetached 9 months after laser treatment. Final visual acuity was less than 20/40 in one eye because of progressive CMV retinitis. Follow-up ranged from 2 to 24 months (mean, 10.4 months) in group II. All group II RDs were reattached successfully with PPV and silicone oil injection. Best-corrected visual acuity was an average of 1.6 lines worse after vitrectomy. Silicone-induced hyperopic shift caused temporary visual loss in all eyes (mean duration, 5.6 weeks). Delayed visual loss due to cataract formation occurred in five eyes. Three eyes had cataract extraction within 6 months. Two partial redetachments developed. One was repaired with repeat vitrectomy. Final visual acuity was less than 20/40 in five of seven eyes because of progressive CMV retinitis (1), dense cataract (2), uncorrected refractive error (2), and uncertain cause (1). CONCLUSIONS Demarcation laser photocoagulation appears to be an effective treatment for many macula-sparing CMVRD. Loss of BCVA, temporary postoperative visual loss due to silicone-induced refractive error, and delayed visual loss due to cataract after vitrectomy with silicone oil injection may be avoided. Demarcation laser photocoagulation may be an effective alternative to vitrectomy in macula-sparing CMVRD.
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Affiliation(s)
- T R Vrabec
- Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Musch DC, Martin DF, Gordon JF, Davis MD, Kuppermann BD. Treatment of cytomegalovirus retinitis with a sustained-release ganciclovir implant. The Ganciclovir Implant Study Group. N Engl J Med 1997; 337:83-90. [PMID: 9211677 DOI: 10.1056/nejm199707103370203] [Citation(s) in RCA: 168] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sustained-release, intraocular implants that deliver ganciclovir are an alternative method for the treatment of cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome (AIDS). METHODS We conducted a randomized study of 188 patients with AIDS and newly diagnosed cytomegalovirus retinitis. The patients were randomly assigned to treatment with an implant delivering 1 microg of ganciclovir per hour, an implant delivering 2 microg of ganciclovir per hour, or intravenous ganciclovir. The primary outcome we studied was progression of cytomegalovirus retinitis. RESULTS The median time to progression of retinitis was 221 days with the 1-microg-per-hour implant (75 eyes), 191 days with the 2-microg-per-hour implant (71 eyes), and 71 days with ganciclovir administered intravenously (76 eyes; P<0.001). The risk of progression of retinitis was almost three times as great among patients treated with intravenous ganciclovir as among those treated with a ganciclovir implant (risk ratio, 2.8; P<0.001). However, the risk of disease in the initially uninvolved eye was lower with intravenous ganciclovir than with a ganciclovir implant (risk ratio, 0.5; P=0.19). Patients treated with intravenous ganciclovir were also less likely to have extraocular cytomegalovirus infections (0, vs. 10.3 percent in the two implant groups; P=0.04). CONCLUSIONS For the treatment of cytomegalovirus retinitis, the sustained-release ganciclovir implant is more effective than intravenous ganciclovir, but patients treated with a ganciclovir implant alone remain at greater risk for the development of cytomegalovirus disease outside of the treated eye.
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Affiliation(s)
- D C Musch
- Department of Ophthalmology, University of Michigan, Ann Arbor, USA
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Hannouche D, Korobelnik JF, Cochereau I, Hoang-Xuan T. Management of viral retinitis-associated retinal detachment in AIDS. Eye (Lond) 1997; 11 ( Pt 1):33-6. [PMID: 9246273 DOI: 10.1038/eye.1997.7] [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: 02/04/2023] Open
Abstract
We retrospectively reviewed the results of surgery in 27 cases of retinal detachment related to viral necrotising retinitis in acquired immune deficiency syndrome (AIDS). Vitrectomy and silicone oil tamponade were performed in all cases. Scleral buckling was applied to 9 eyes. Silicone oil was left in the eye in all cases. Mean follow-up period was 13 weeks. Post-operative flattening of the retina at the posterior pole was achieved in 89% of the eyes. Anatomical results were not related to the intraoperative use of an encircling procedure. Visual acuity improved by 2 Snellen lines or more in 40% of cases and 67% of the eyes retained a post-operative ambulatory vision. Phacosclerosis and optic atrophy developed in 29% and 22% of cases, respectively. Vitrectomy and silicone oil tamponade without scleral buckling are effective in the management of retinitis-associated retinal detachments. This procedure is short and can be performed under local anaesthesia.
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Affiliation(s)
- D Hannouche
- Department of Opthalmology, Bichat-Claude Bernard Hospital, Paris, France
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31
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Abstract
HIV retinopathy, a noninfectious microangiopathy, is the most common ocular manifestation of HIV infection. Opportunistic infections, neoplasms, neuro-ophthalmic lesions, and drug-induced lesions may also cause ocular problems. Opportunistic ocular infections, particularly CMV retinitis, are a major cause of morbidity in patients with AIDS. Because of the underlying chronic and progressive immune dysfunction, the ocular symptoms, signs, clinical course, and treatment are often atypical and severe, requiring protracted medical therapy.
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Affiliation(s)
- M L Tay-Kearney
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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32
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Williams JK, Kirsch LS, Russack V, Freeman WR. Rhegmatogenous Retinal Detachments in HIV-Positive Patients With Ocular Syphilis. Ophthalmic Surg Lasers Imaging Retina 1996. [DOI: 10.3928/1542-8877-19960801-09] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Murray JG, Gean AD, Barr RM. Intraocular silicone oil for retinal detachment in AIDS: CT and MR appearances. Clin Radiol 1996; 51:415-7. [PMID: 8654006 DOI: 10.1016/s0009-9260(96)80160-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM To describe the CT and MR features of intraocular silicone oil which is used to treat complex retinal detachments in patients with acquired immune deficiency syndrome (AIDS). PATIENTS AND METHODS Seven male patients with AIDS were treated by pars plana vitrectomy and intraocular silicone oil injection for complex retinal detachments due to biopsy proven cytomegalovirus retinitis. Two patients had bilateral therapy. RESULTS Silicone oil was hyperdense to muscle on CT with attenuation values of 106-139 HU (mean 115, SD 4.5). On MR, when compared with normal vitreous, intraocular silicone oil appeared hyperintense on T1-, proton density, and T2-weighted spin-echo sequences. A chemical shift artifact was seen on all MR images, being most marked on the T2-weighted images. CONCLUSION The high attenuation value of silicone oil on CT and its hyperintensity on T1 weighted MR images my cause diagnostic confusion with haemorrhage. These entities can be distinguished at CT by directly measuring the attenuation number (silicone oil > 100 HU; blood < 90 HU), and at MR by the presence of a chemical shift artifact.
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Affiliation(s)
- J G Murray
- Department of Radiology, San Francisco General Hospital, USA
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34
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Arevalo JF, Freeman WR. Rhegmatogenous retinal detachments in patients with acquired immunodeficiency syndrome. Semin Ophthalmol 1995; 10:183-91. [PMID: 10155632 DOI: 10.3109/08820539509059995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- J F Arevalo
- Shiley Eye Center, Department of Ophthalmology, University of California, San Diego 92093-0946, USA
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35
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Sandy CJ, Bloom PA, Graham EM, Ferris JD, Shah SM, Schulenburg WE, Migdal CS. Retinal detachment in AIDS-related cytomegalovirus retinitis. Eye (Lond) 1995; 9 ( Pt 3):277-81. [PMID: 7556732 DOI: 10.1038/eye.1995.54] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Patients with acquired immune deficiency syndrome (AIDS) and cytomegalovirus retinitis (CMVR) are surviving longer due to the use of virostatic medicines and improved treatment of opportunistic infections. As a result, retinal detachment is likely to become an increasingly common cause of visual morbidity in these patients. The incidence and outcome of retinal detachment complicating CMVR was studied at two London AIDS centres. Patients with CMVR were identified prospectively and underwent standard treatment. Retinal detachments were diagnosed during regular follow-up. If retinal reattachment surgery was performed, a standard procedure of vitrectomy and silicone oil internal tamponade was employed. Of 147 patients with CMVR, 41 (28%) developed retinal detachments (47 eyes). Forty-three detachments were rhegmatogenous and 4 were exudative. Fifteen eyes of 9 patients with rhegmatogenous detachments underwent retinal reattachment surgery. Of these, visual acuity remained stable or improved in 12 eyes (80%) in the immediate post-operative period. At the last clinic visit, 8 eyes (53%) maintained a visual acuity of 6/60 or better. The visual results of surgery are good in selected patients, bearing in mind the progressive nature of the underlying disease and poor life expectancy.
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36
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Morse LS, Mizoguchi M. Diagnosis and management of viral retinitis in the acute retinal necrosis syndrome. Semin Ophthalmol 1995; 10:28-41. [PMID: 10155697 DOI: 10.3109/08820539509059977] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- L S Morse
- University of California, Davis Department of Ophthalmology, Sacramento 95816, USA
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37
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McCluskey P, Grigg J, Playfair TJ. Retinal detachments in patients with AIDS and CMV retinopathy: a role for laser photocoagulation. Br J Ophthalmol 1995; 79:153-6. [PMID: 7696236 PMCID: PMC505047 DOI: 10.1136/bjo.79.2.153] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A retrospective review of all patients with a cytomegalovirus (CMV) related retinal detachment and HIV infection managed at the ocular immunology clinic at St Vincent's Hospital between January 1985 and June 1992 was performed. Over this period 142 patients with CMV retinopathy were managed and 17 eyes from 14 of these patients developed a retinal detachment related to CMV retinopathy. Fourteen eyes from 11 of these patients were treated surgically with combinations of laser photocoagulation, cryopexy, scleral buckling, vitrectomy, and silicone oil tamponade. The use of laser photocoagulation alone in five patients resulted in an excellent visual outcome. The majority of patients (90.9%) benefited from surgery in that vision was either stabilised or improved.
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Affiliation(s)
- P McCluskey
- Laboratory of Ocular Immunology, School of Pathology, University of New South Wales, Australia
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38
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García RF, Flores-Aguilar M, Quiceno JI, Capparelli EV, Munguia D, Kuppermann BD, Arevalo F, Freeman WR. Results of rhegmatogenous retinal detachment repair in cytomegalovirus retinitis with and without scleral buckling. Ophthalmology 1995; 102:236-45. [PMID: 7862412 DOI: 10.1016/s0161-6420(95)31030-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
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.
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Affiliation(s)
- R F García
- Department of Ophthalmology, University of California, San Diego 92093-0946
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39
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Affiliation(s)
- D J D'Amico
- Department of Ophthalmology, Harvard Medical School, Boston, MA
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40
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Lim JI, Enger C, Haller JA, Campochiaro PA, Meredith TA, de Bustros S, Dunn JP, Jabs DA. Improved visual results after surgical repair of cytomegalovirus-related retinal detachments. Ophthalmology 1994; 101:264-9. [PMID: 8115148 DOI: 10.1016/s0161-6420(13)31339-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE This study was conducted to determine whether visual outcomes have improved after repair of retinal detachments (RDs) associated with cytomegalovirus (CMV) retinitis, and, if so, whether factors such as earlier intervention and changes in surgical technique have led to these results. METHODS The authors performed a retrospective review of 35 eyes in 30 immunocompromised patients with CMV retinitis and RD who underwent pars plana vitrectomy with the use of silicone oil injection. Visual and anatomic results in eyes treated between January 1991 and April 1992 (group 1) were compared with eyes treated before January 1991 (group 2). Follow-up was limited due to patient mortality; median follow-up was 4.1 months in group 1 and 2.5 months in group 2. RESULTS Best-attained postoperative visual acuities were better for group 1 than group 2 eyes, with 71% of group 1 eyes attaining visual acuity of 20/200 or better compared with 17% of group 2 eyes (chi-square1 trend = 12.3; P < 0.001). A similar result was found among eyes with macula-off detachments. Ambulatory visual acuity of 5/200 or better was achieved in 86% of group 1 versus 33% of group 2 eyes. There was a longer interval between diagnosis and surgery in group 2 compared with group 1 (7 versus 3 days); scleral buckling in conjunction with pars plana vitrectomy and silicone oil injection was used in more group 1 eyes. CONCLUSION Earlier intervention, absence of preoperative optic atrophy, and macular CMV correlate with better postoperative visual acuity results. Pars plana vitrectomy combined with silicone oil for eyes with macula-off RDs can result in improved visual acuity.
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Affiliation(s)
- J I Lim
- Wilmer Ophthalmological Institute, Johns Hopkins Medical Institutions, Baltimore
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42
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Affiliation(s)
- B Dhillon
- Princess Alexandra Eye Pavilion, Edinburgh
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43
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Kuppermann BD, Flores-Aguilar M, Quiceno JI, Capparelli EV, Levi L, Munguia D, Freeman WR. A masked prospective evaluation of outcome parameters for cytomegalovirus-related retinal detachment surgery in patients with acquired immune deficiency syndrome. Ophthalmology 1994; 101:46-55. [PMID: 8302563 DOI: 10.1016/s0161-6420(94)31383-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
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.
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Affiliation(s)
- B D Kuppermann
- Department of Ophthalmology, University of California, San Diego, La Jolla 92093-0946
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Chirurgische Behandlung der Amotio Retinae bei CMV-Retinitis nach HIV-Infektion (AIDS). SPEKTRUM DER AUGENHEILKUNDE 1993. [DOI: 10.1007/bf03163908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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46
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Affiliation(s)
- G N Holland
- UCLA Ocular Inflammatory Disease Center, UCLA School of Medicine
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47
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Eller AW, Gardner TW, D'Antonio JA. A survey of intraocular silicone oil use in the United States. Ophthalmology 1992; 99:1174-6. [PMID: 1495799 DOI: 10.1016/s0161-6420(92)31836-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE This survey was conducted to determine the pattern of usage of intravitreal silicone oil in the United States. METHODS A questionnaire was sent to 542 members of the Retina and Vitreous Societies in December 1990, and again 6 weeks later in an attempt to improve the response rate. RESULTS Two hundred eighty-seven questionnaires (53%) were returned. Ninety-eight percent of the respondents perform vitreous surgery, and 61% of them use silicone oil. This survey determined the degree of participation in Food and Drug Administration (FDA)- and institutional review board-approved protocols and the most common indications for use of silicone oil. Ninety-six percent of the respondents indicated that the use of silicone oil represented an acceptable standard of care. CONCLUSION Silicone oil is widely used in the United States despite its lack of FDA approval.
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Affiliation(s)
- A W Eller
- Department of Ophthalmology, Eye & Ear Institute, Pittsburgh, PA 15213
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Freeman WR, Quiceno JI, Crapotta JA, Listhaus A, Munguia D, Aguilar MF. Surgical repair of rhegmatogenous retinal detachment in immunosuppressed patients with cytomegalovirus retinitis. Ophthalmology 1992; 99:466-74. [PMID: 1314364 DOI: 10.1016/s0161-6420(92)31976-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
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.
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Affiliation(s)
- W R Freeman
- Department of Ophthalmology, University of California San Diego School of Medicine 92093
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Regillo CD, Vander JF, Duker JS, Fischer DH, Belmont JB, Kleiner R. Repair of retinitis-related retinal detachments with silicone oil in patients with acquired immunodeficiency syndrome. Am J Ophthalmol 1992; 113:21-7. [PMID: 1309409 DOI: 10.1016/s0002-9394(14)75747-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To provide prompt visual rehabilitation and to reduce the need for repeated operations, we performed vitrectomy with silicone oil tamponade in 16 consecutive eyes with retinal detachments related to cytomegalovirus retinitis and acute retinal necrosis in 13 patients with acquired immunodeficiency syndrome. In all 16 eyes (100%), retinas were reattached with one operation. Preservation of ambulatory vision was achieved in six of eight eyes (75%; mean follow-up, 14.6 weeks). No patient with hand motion visual acuity or worse preoperatively recovered ambulatory vision. Visual acuity recovery was limited by optic nerve disease in five eyes (31%). Silicone oil-related side effects did not adversely affect visual outcome in any eye. Six patients (46%) have since died (mean, 4.4 months postoperatively). These data indicated that successful surgical repair of these detachments can be consistently achieved with this approach. The prognosis for ambulatory vision is strongly related to preoperative visual acuity.
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Affiliation(s)
- C D Regillo
- Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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50
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Chuang EL, Davis JL. Management of retinal detachment associated with CMV retinitis in AIDS patients. Eye (Lond) 1992; 6 ( Pt 1):28-34. [PMID: 1330757 DOI: 10.1038/eye.1992.4] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
In patients with AIDS, the most important ocular opportunistic infection, CMV retinitis, can now be treated effectively with virostatic agents. Associated retinal detachment is encountered frequently, and its management has become increasingly significant to quality of life as improvements in medical care have helped to preserve vision and extend life expectancy. Although retinal detachment in these eyes is typically rhegmatogenous, the pathophysiology is distinctive due to the association with CMV retinitis which, even in remission, is characterised by atrophic changes at all levels of affected retina and alterations of the vitreous. Despite initially successful surgical reattachment, multiple, small, often posterior holes may develop because of progressive CMV infection. For these reasons, vitrectomy and silicone oil injection with scleral buckling may currently provide the best overall means of maintaining retinal reattachment and restoring visual function. Nevertheless, management must be individualised in each case, with the realisation that progressive visual loss frequently ensues from retinitis progression.
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Affiliation(s)
- E L Chuang
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, FL 33136
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