Visual prognosis of AIDS patients with cytomegalovirus retinitis

Recent developments in the treatment of posterior uveitis

Uveitis is an intraocular inflammation that can be caused by infection, autoimmune disease, trauma or malignancy. It is a serious cause of visual handicap and therapy is targeted at: removal of possible infectious agents, the immunological processes that lead to or sustain the inflammation and finally to prevent or treat the destructive effects of the inflammation on the delicate ocular structures. In this review the latest developments concerning the treatment of posterior uveitis are illuminated, e. g., new approaches concerning the treatment of infectious uveitis including the therapy of herpes virus (VZV, HSV and CMV), bacterial and toxoplasma infections of the eye. Several new ways to influence the immune response and inflammation are described including the use of interferons, modulation of cytokines, soft steroids, other new immunosuppressive drugs and treatment of autoimmune uveitis by oral tolerization. An overview is given to illustrate new ways to administer drugs into eyes, such as intravitreal devices. Finally new developments in the field of the treatment of the various complications of uveitis (cystoid macular edema) are described.

Changing trends in cytomegalovirus retinitis with triple therapy

PURPOSE

Cytomegalovirus retinitis (CMVR) has been the most common cause of visual loss in AIDS patients. We investigate whether the pattern of disease has changed since the introduction of triple therapy.

METHODS

We reviewed the records of all patients with CMVR in one teaching hospital HIV unit over a 2 year period (n = 24). This included the opthalmic and systemic findings, HIV and CMV treatment, survival after diagnosis and CD4 results.

RESULTS

There has been a marked decrease in the number of patients developing new CMVR: from 21 eyes (15 patients) to 4 eyes (4 patients) in two consecutive 12 month periods between January 1996 and December 1997, coinciding with the introduction of triple therapy in October 1996. Median survival has increased from 376 days in the deceased patients to 598 days in the survivors on triple therapy. Median time to CMVR relapse has lengthened from 79 to 179 days in the triple therapy cohort. The pattern of ocular morbidity in the 11 eyes of the 7 surviving patients is also changing, with no new zone 1 disease, and a marked rise in the incidence of uveitis, maculopathy and cataracts.

CONCLUSION

Results suggest that triple therapy is associated with an increase in survival, a decrease in CMVR relapse and changes in ocular features. This transition has implications for current screening and treatment protocols.