AIDS-related optic neuropathy: a histological, virological and ultrastructural study

Sadun, Alfredo A.; Pepose, Jay S.; Madigan, Michele C.; Laycock, Keith A.; Tenhula, Wendy N.; Freeman, William R.

doi:10.1007/bf00180941

Cited by 47 publications

(36 citation statements)

References 62 publications

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“…Alternately, the degenerative process could be occurring in the optic nerve itself. A study, 15 with light microscopy showed thickened meninges, axonal degeneration with various stages occurring in each optic nerve, degeneration of oligodendrocytes, and activated microglia. Cases have been reported where all the recognised causes of optic neuropathy in HIV-infected patients were excluded.…”

Section: Discussionmentioning

confidence: 96%

Delayed diagnosis of HIV infection in ophthalmic practice

Wadood

Dhillon

McIlwaine

et al. 2004

Eye

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Section: Discussionmentioning

confidence: 96%

Delayed diagnosis of HIV infection in ophthalmic practice

Wadood

Dhillon

McIlwaine

et al. 2004

Eye

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“…In patients with AIDS there is a 3% to 8% incidence of neuroophthalmological disorders (Jabs et al, 1989;Mansour, 1990;Ziegler, 1991;Sadun, 1995).…”

Section: Labh Rk Et Al Eye Changes Among Hiv Positive Patientsmentioning

confidence: 99%

Eye changes among HIV positive patients on antiretroviral therapy in Nepal

2016

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Background: HIV/AIDS has various ocular manifestations. Objective: To find out eye findings among HIV positive patients in the era of antiretroviral therapy. Method This Hospital based cross sectional descriptive study was carried at B. P. Koirala Lions Centre for Ophthalmic Studies. Patient profile, WHO clinical stage, CD4+ cell count, duration of HIV, antiretroviral therapy, and systemic diseases were recorded. All the cases underwent ocular examination as per the study protocol and the findings were noted in a proforma developed for the study. The results were analysed with SPSS 14.0. Results: Of 100 HIV positive cases (including 55 antiretroviral therapy patients) 62% patients were male and 38% were female. The mean age of presentation was 27.72 years. Heterosexual transmission (62%) was the commonest mode of transmission of HIV. Thirty seven percent patients were illiterate. Systemic disease was present in 20% cases. Ocular complaint was present in 53% patients. Ocular disease was present in 40% HIV positive patients. Almost 55% of these cases were on antiretroviral therapy. Moderate to lower CD4 count patient had frequent eye disease. Patients in WHO Stage III and IV also had frequent eye problems. Anterior segment and external ocular disorder was present in 25% patients. The commonest manifestation was conjunctivitis in10% of total cases. Posterior segment manifestation was present in 11%, neuro-ophthalmic lesion in 4% and orbital lesion in 1% patient. Conclusion: Anterior segment manifestation is still common ocular manifestations in HIV positive patients in Nepal. Patients in WHO Stage III and IV are more vulnerable for eye changes. Young aged male and migrant workers are at risk of acquiring HIV in developing country like Nepal. Eye findings even in patientson antiretroviral therapy are similar. However, large sample size and long follow up study is required to have final disclosure.

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“…The likely mechanism of the HIV induced direct damage to the optic nerve was analysed in a study by Sadun et al They reported axonal degeneration, vacuolation of oligodendrocytes and infiltration by mononuclear cells which was indicative of optic nerve degeneration occurred due to HIV infected macrophages. 7 The current knowledge is supportive of a immune mediated mechanism may be because of the cytokines released by the virus infected macrophages, one of which is the TNF-a, which is the main…”

Section: Financial and Competing Interest Disclosurementioning

confidence: 99%

A Rare Case of Pseudo Foster Kennedy Syndrome In a HIV Positive Patient

Padmavathy¹,

A²,

Ramakrishnan³

2014

DJO

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A 39 year old male patient presented with complaints of sudden onset diminished vision in the right eye since two weeks and in the left eye since four days associated with painful ocular movements. On examination patient had optic disc edema in the right eye and the left eye showed optic disc pallor. Patient was also suffering from human immunodeficiency virus (HIV) infection. In this case study we report that the patient had pseudo Foster Kennedy syndrome directly attributed to HIV. Patient was started on intravenous steroids and responded with the improvement in vision in the right eye. Pseudo foster kennedy syndrome is a very rare disease and HIV as a predisposing factor is even more uncommon . It is important to rule out the opportunistic infections which occur in an HIV positive patient. Steroids have been found to be effective in improving the visual outcome and decreasing the morbidity in such patients. In 1911, Foster kennedy published six cases in which he demonstrated ipsilateral optic atrophy with contralateral papilledema due to expanding frontal lobe lesions. These signs were pathognomic for space occupying lesion in the region of basofrontal area on the side of the optic atrophy. 1In 1916, Foster kennedy published a paper in which he added ipsilateral anosmia to his previously described signs. 2 The Foster Kennedy syndrome then became a triad consisting of ipsilateral optic atrophy, contralateral disc edema, and ipsilateral anosmia. This syndrome is due to optic nerve compression, olfactory nerve compression, and increased intracranial pressure (ICP) secondary to a space occupying lesion (such as meningioma or plasmacytoma, usually an olfactory groove meningioma). Pseudo foster kennedy syndrome is defined as one-sided optic atrophy with papilledema in the other eye but with the absence of a space occupying lesion.3 HIV infection as a direct cause of optic neuropathy has been postulated. It is an uncommon presentation and a diagnosis of exclusion, with only a few case reports and case series in the literature. In our case also no cause for the asymmetric optic nerve involvement could be found besides the direct effect from the HIV virus. Our case had a rare presentation of pseudo-Foster Kennedy syndrome in a HIV positive patient. A Thirty nine years old male patient presented with complaints of sudden onset defective vision in the right eye since two weeks and in the left eye since four days associated with painful ocular movements. Patient was diagnosed with HIV in 2010 and was on anti-retro viral treatment since then with no other systemic illness. On examination the best corrected visual acuity (BCVA) was 1/60 in both eyes. On ocular examination in both eyes the pupils showed afferent pupillary defect. Fundus examination showed disc edema in the right eye (Figure 1) and in the left eye there was disc pallor (Figure 2). MRI of brain (flair, DWI, constrast) showed left optic atrophy and there was no evidence of demyelination, space occupying lesion, infection in the brain parenchyma. Total leucocyt...

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AIDS-related optic neuropathy: a histological, virological and ultrastructural study

Abstract: Degeneration in the optic nerve may be mediated by HIV-infected macrophages rather than by direct viral infection of neurons. Axonal degeneration due to AIDS at the level of the optic nerve can occur independently of retinal infection.

Cited by 47 publications

References 62 publications

Delayed diagnosis of HIV infection in ophthalmic practice

Delayed diagnosis of HIV infection in ophthalmic practice

Eye changes among HIV positive patients on antiretroviral therapy in Nepal

A Rare Case of Pseudo Foster Kennedy Syndrome In a HIV Positive Patient

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