Immune Recovery Uveitis: Pathogenesis, Clinical Symptoms, and Treatment

Urban, Beata; Bakunowicz-Łazarczyk, Alina; Michalczuk, Marta

doi:10.1155/2014/971417

Cited by 62 publications

(74 citation statements)

References 58 publications

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“…IRU is defined by five main criteria:2 (1) AIDS patient, (2) HAART therapy instituted, (3) immune reconstitution noted with CD4+ cell count >100 cells/mL for at least 2 months, (4) previous CMV retinitis and (5) presentation of new intraocular inflammation not explained by medication toxicity or a new opportunistic infection. The occurrence of IRU varies between 3% and 63.3% 2…”

Section: Discussionmentioning

confidence: 99%

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Immune recovery uveitis in a patient with previously undiagnosed cytomegalovirus retinitis

2015

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A 40-year-old man presented to the emergency service of the Department of Ophthalmology, Fundación Oftalmológica de Santander, Floridablanca, Colombia, with blurred vision in his right eye. Anamnesis revealed that he also had newly diagnosed stage C HIV. He had recently started highly active antiretroviral therapy (HAART). Examination disclosed intraocular inflammation, along with plain white peripheral non-exudative lesions with sparse haemorrhaging. The differential diagnosis included cytomegalovirus (CMV) retinitis and immune recovery uveitis (IRU). On follow-up, the patient's left eye presented with decreased visual acuity and increased vitreous haze. A vitrectomy with vitreous tap was performed for microbiological studies. PCR for CMV in the vitreous sample was negative. The patient was discharged with the final diagnosis of IRU. In HIV patients with uveitis, the knowledge of characteristic signs and symptoms of particular entities such as opportunistic infections and IRU will enable the clinician to give the appropriate treatment.

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Section: Discussionmentioning

confidence: 99%

“…IRU is associated with inactive CMV retinitis,2 but a newly reported case of IRU in a patient with inactive toxoplasmic chorioretinitis suggests that inflammation due to other causes may also be responsible for the onset of IRU 3…”

Section: Introductionmentioning

confidence: 99%

Immune recovery uveitis in a patient with previously undiagnosed cytomegalovirus retinitis

2015

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“…The condition represents an active immune response to CMV antigens that persist in the eye. [78][79][80] Posterior synechiae and posterior subcapsular cataract may develop, and after intraocular surgery, the postoperative course may be complicated by large inflammatory deposits on the surface of the intraocular lens. 78 …”

Section: Immune Recovery Uveitismentioning

confidence: 99%

Challenges of Diagnosing Viral Anterior Uveitis

Groen-Hakan

Babu²,

Tuğal-Tutkun

et al. 2017

Ocular Immunology and Inflammation

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The viral causes of anterior uveitis (AU) emerged with the use of novel molecular diagnostic tests and serologic tests adapted for small volumes (Goldmann-Witmer Coefficient). The viral causes of AU may be underestimated, and some of the presumed idiopathic AU cases will probably be proven to be of viral origin in the coming years. So far, a viral origin of AU was suspected in patients who presented with unilateral hypertensive AU. It is not clear which clinical presentations should raise a suspicion of viral etiology. There is an overlap in the clinical manifestations of AU caused by viruses and other non-viral forms of AU. A viral cause of AU should be suspected in patients with unilateral AU, exhibiting small or medium sized KPs, some form of iris atrophy, high IOP and early development of a cataract and the definitive diagnosis can be proven by aqueous humor analysis.

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“…[23] IRU can occur in 63% of patients with previous CMV retinitis [27] and can present as a mild decrease in vision with the presence of floaters, pain and redness in the affected eye. [28] Untreated CMV retinitis can lead to permanent blindness as a result of direct damage to the macula or optic nerve, or owing to retinal detachment.…”

Section: In Practicementioning

confidence: 99%

“…An important consideration in this patient would be an immune reconstitution inflammatory syndrome presenting as an immune recovery vitritis or immune recovery uveitis (IRU). IRU is a paradoxical worsening of intraocular inflammatory reactions that occurs during immune recovery after the administration of ART and can lead to substantial visual loss.[23] IRU can occur in 63% of patients with previous CMV retinitis [27] and can present as a mild decrease in vision with the presence of floaters, pain and redness in the affected eye. [28] Untreated CMV retinitis can lead to permanent blindness as a result of direct damage to the macula or optic nerve, or owing to retinal detachment.…”

mentioning

confidence: 99%

Cytomegalovirus retinitis and HIV: Case reviews from KwaZulu-Natal Province, South Africa

et al. 2017

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Background.Retinal cytomegalovirus (CMV) infection is a common opportunistic infection and remains a significant contributor to visual loss in patients with AIDS. We highlight the poor outcomes of CMV retinitis in three HIV-infected patients who were initiated on antiretroviral therapy (ART). We conducted a retrospective chart review of advanced stage HIV-infected patients with known CMV retinitis. Case 1. A 37-year-old man, with a CD4+ cell count of 35 cells/µL, presented for ART initiation with a 5-month history of visual loss in his left eye. Fundoscopy showed left eye CMV retinitis and right eye HIV retinopathy. ART and 5 months of weekly intravitreal ganciclovir injections (left eye) were commenced. Six-month outcomes included virological suppression, and visual acuity in the right eye of 6/6 and in the left eye of 3/60. Case 2. A 31-year-old woman, with a CD4+ cell count of 39 cells/µL and on tuberculosis therapy, presented for ART initiation. She presented with a 2-month history of decreased visual acuity. Fundoscopy showed bilateral CMV retinitis, which was more pronounced in the left eye. ART and 8 months of intravitreal ganciclovir injections were commenced. Six-month outcomes included virological suppression and visual acuity in the right eye of 6/9, and in the left eye of 6/24. Case 3. A 29-year-old woman, with a CD4+ cell count of 24 cells/µL, who was on tuberculosis therapy and ART, complained of blurred vision at her 2-month ART follow-up visit. Fundoscopy showed bilateral retinal detachment secondary to CMV retinitis. While silicone oil tamponade and subsequent retinectomy successfully repaired the right eye, extensive damage rendered the left eye irreparable. Six-month outcomes included virological suppression, with 6/120 visual acuity in the right eye and complete blindness in the left eye. Conclusion. CMV retinitis causes debilitating, permanent sequelae, which is preventable by ART initiation at higher CD4+ cell counts. Despite achieving virological suppression, vision could not be completely restored in these patients, irrespective of the severity of CMV retinitis. Med J 2017;107(10):843-846. DOI:10.7196/SAMJ.2017.v107i10.12740 S Afr 844October 2017, Vol. 107, No. 10 IN PRACTICEdirect damage to the macula or optic nerve, resulting in permanent blindness.[2] Blindness caused by CMV retinitis is irreversible and can occur prior to complete retinal destruction, which was responsible for >90% of HIV-associated blindness in the pre-ART era. [2] A total of 1 815 patients were enrolled into the PEPFAR-funded CAPRISA AIDS Treatment Programme (CAT) at the eThekwini site in Durban, South Africa (SA) between June 2004 and August 2013. In this report, we highlight the three patients in this cohort who developed CMV retinitis.Approval for data collection and analysis for the CAT programme was obtained from the University of KwaZulu-Natal Biomedical Research Ethics Committee (ref. no. E248/05). Case reports Case 1In June 2011, a 37-year-old man presented for ART initiation with a baseline CD4+ cell co...

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Immune Recovery Uveitis: Pathogenesis, Clinical Symptoms, and Treatment

Cited by 62 publications

References 58 publications

Immune recovery uveitis in a patient with previously undiagnosed cytomegalovirus retinitis

Immune recovery uveitis in a patient with previously undiagnosed cytomegalovirus retinitis

Challenges of Diagnosing Viral Anterior Uveitis

Cytomegalovirus retinitis and HIV: Case reviews from KwaZulu-Natal Province, South Africa

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