Macular Serous Exudation in Patients With Acquired Immunodeficiency Syndrome and Cytomegalovirus Retinitis

Gangan, Pacifico; Besen, Gilberto; Munguia, David; Freeman, William R.

doi:10.1016/s0002-9394(14)72901-0

Cited by 30 publications

(12 citation statements)

References 19 publications

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“…Cystoid macular edema, submacular exudates, or papillitis may be seen with CMV retinitis in immediate proximity to the optic nerve or macula but is not seen in eyes such as the one we report with peripheral involvement which came no closer than 6,000 m from these structures. 5 In a previous study, we showed that in CMV retinitis, the IL-6 levels are elevated. In CMV retinitis with immune recovery uveitis, we showed that IL-12 levels and IL-6 levels are elevated.…”

Section: Discussionmentioning

confidence: 84%

Immune Recovery Uveitis in a CMV Retinitis Patient Without Hiv Infection

Bessho

Schrier²,

Freeman³

2007

RETINAL Cases &Amp; Brief Reports

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Section: Discussionmentioning

confidence: 84%

Immune Recovery Uveitis in a CMV Retinitis Patient Without Hiv Infection

Bessho

Schrier²,

Freeman³

2007

RETINAL Cases &Amp; Brief Reports

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“…CMVR has recently been diagnosed in patients with relatively high CD4+ counts (197–270/μl) following the initiation of HAART 6. A syndrome of macular serous exudation7 has recently been described, and there are reports of iritis8 in patients on intravitreal cidofovir. However, only a few cases with CMO have been described 9…”

Section: Commentmentioning

confidence: 99%

Cystoid macular oedema in patients with AIDS and cytomegalovirus retinitis on highly active antiretroviral therapy

Newsom

Casswell

O’Moore

et al. 1998

British Journal of Ophthalmology

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Cystoid macular oedema in patients with AIDS and cytomegalovirus retinitis on highly active antiretroviral therapy EDITOR,-Between 16% and 40% of patients with AIDS develop cytomegalovirus retinitis (CMVR).1 2 This typically presents when the CD4+ count drops below 75 cells/µl. 3 Visual loss is usually due to retinal detachment, macular or optic nerve infection, or vascular occlusion. Typically a minimal inflammatory response is mounted. Patients with CMVR not associated with HIV infection may develop a vitritis with cystoid macular oedema (CMO) during immune restoration. 4 With the advent of highly active antiretroviral therapy (HAART) patients with AIDS are enjoying improvement in their immune status, with falling HIV viral loads and rising CD4+ counts. Such patients may mount a significant inflammatory response against CMVR, causing a regression of the CMV infection but a paradoxical visual loss due to the inflammation. 5 We describe two such patients with CMVR and vitritis, who lost vision as a result of CMO. CASE REPORTSPatient 1 was diagnosed with zone 2 CMVR aVecting the left eye in May 1996. He was induced on intravenous ganciclovir 5 mg/kg twice daily for 2 weeks and maintained on intravenous ganciclovir 5 mg/kg once daily for 5 months until progression of CMVR occurred. He was then induced on intravenous cidofovir 5 mg/kg/week followed by intravenous cidofovir 5 mg/kg twice a month maintenance. At the same time he was started on HAART therapy consisting of D4T, 3TC, and indinivir. There was a rapid resolution of active CMVR with a rise in CD4+ count and a fall in the HIV viral load (Fig 1). However, 2 months later his vision dropped to from 6/12 to 6/24 and vitritis, optic nerve swelling, and CMO were noted (Figs 2 and 3). Vision in the right eye was maintained with no sign of CMVR.Patient 2 was diagnosed with zone 2 CMVR aVecting the right eye in October 1996 (Fig 4). He was induced on intravenous ganciclovir 5 mg/kg twice daily for 2 weeks followed by maintenance on ganciclovir by mouth 3 g/day for 4 months until progression of the CMVR occurred into zone 1 in the right eye and zone 3 in the left eye. He was treated with bilateral ganciclovir implants with no systemic cover. Treatment of HIV with AZT and 3TC was continued. Immune recovery followed the successful treatment of pulmonary tuberculosis. In May 1997 his CD4+ count had risen to 250/µl with a low HIV viral load. Vision in the right eye fell from 6/9 to 6/24 due to macular oedema and mild vitritis. Treatment with topical prednisolone four times daily and with acetazolamide 250 mg twice daily, produced a sustained two line improvement in visual acuity (Figs 5 and 6). Vision in the left eye was maintained at 6/5 with stable zone 3 disease and no CMO. COMMENTThe picture of CMV retinitis is changing with the advent of eVective retroviral therapy. CMVR has recently been diagnosed in patients with relatively high CD4+ counts (197-270/µl) following the initiation of HAART.6 A syndrome of macular serous exudation 7 has recently been described, ...

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“…In such cases of papillary or peri papillary retinitis, where a macula exudate decreases vision, antiviral treatment improved vision in 96% ( fig. 7b) [42], The currently recommended ganciclovir therapy consists of an intravenous induction therapy of 2-3 weeks at 5 mg/kg per day. Foscamet intravenous induction therapy consists of 2-3 week at 90 mg/kg daily.…”

Section: Opportunistic Infections Of the Posterior Segment Of The Eyementioning

confidence: 99%

Opportunistic Infections of the Eye in Immunocompromised Patients

Guembel

Ohrloff²

1997

Ophthalmologica

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All opportunistic infections of the eye have their origin in the suppression of the immune system of the host. The immunosuppression can be acquired through the human immune deficiency virus or as a result of immunosuppressive therapy in solid-organ transplant recipients with a maintenance therapy of cyclosporin and prednisone or during chemotherapy in patients with myelo-proliferative disorders. Generally, in less than 2% could severe opportunistic infections of the eye, like cytomegalovirus (CMV) or herpes virus infection, be found in transplant and cancer patients with chemotherapy. About 35–70% of patients with AIDS exhibit ocular manifestations of disease, so the most notable opportunistic infection with an incidence of 35% would be CMV retinitis. Less frequent are progressive outer retinal necrosis syndrome, Kaposi’s sarcoma and optic neuropathies. This paper reviews recent advances in the diagnosis and special local therapies of the worst opportunistic infections in immunocompromised hosts.

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Macular Serous Exudation in Patients With Acquired Immunodeficiency Syndrome and Cytomegalovirus Retinitis

Cited by 30 publications

References 19 publications

Immune Recovery Uveitis in a CMV Retinitis Patient Without Hiv Infection

Immune Recovery Uveitis in a CMV Retinitis Patient Without Hiv Infection

Cystoid macular oedema in patients with AIDS and cytomegalovirus retinitis on highly active antiretroviral therapy

Opportunistic Infections of the Eye in Immunocompromised Patients

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