Unilateral ischemic maculopathy associated with cytomegalovirus retinitis in patients with AIDS: Optical coherence tomography findings

Abstract

To describe the clinical and optical coherence tomography (OCT) characteristics of ischemic maculopathy in two patients with acquired immunodeficiency syndrome (AIDS). Two patients with AIDS and cytomegalovirus (CMV) retinitis developed ischemic maculopathy. Both patients presented with central visual loss and active granular CMV retinitis. The presence of opacification of the superficial retina in the macular area and intraretinal edema suggested the diagnosis. Fluorescein angiography changes were similar in the two cases with enlargement of the foveal avascular zone and late staining of juxtafoveal vessels. OCT changes were suggestive of retinal ischemia: Increased reflectivity from the inner retinal layer and decreased backscattering from the retinal photoreceptors due to fluid and retinal edema. Ischemic maculopathy may cause a severe and permanent decrease in vision in AIDS patients. Fluorescein angiography and OCT should be considered in any patient with AIDS and unexplained visual loss. The mechanism of ischemic maculopathy may be multifactorial.

A comparative study on retinal thickness of the macular region among AIDS patients with normal ocular fundus, HIV-related microvascular retinopathy patients, and cytomegalovirus retinitis patients

“…OCT characteristics of patients in the CMVR group: In the present study, the thickness of various macular regions in the CMVR group generally increased, and the reflection of the entorretina increased. [10] This is consistent with the study results reported by Japanese scholar Yashiro et al, [11] but is contradictory to the study results reported by Pathai [12] and Plummer. [13] Plummer et al used a Heidelberg retina tomograph to measure the thickness of the nerve fiber layer in 38 HIV positive patients with or without CMVR and 24 HIV negative controls, and found that the thickness of the nerve fiber layer of HIV positive patients was smaller than that of the controls, regardless of CMVR.…”

Extralesional microvascular and structural macular abnormalities in cytomegalovirus retinitis

“…Following hematogenous spread of the virus, involvement of pericytes and vascular endothelial cells of the inner blood retinal barrier has been suggested as a critical step of CMV infecting the retina in in vitro , ex vivo and post-mortem studies 5 – 7 . Clinically, occlusive retinal vasculitis is evident and association of CMVR with several ischemic retinal vascular diseases was also reported 8 – 10 . These pieces of evidence suggest that there could be a global dysfunction of the inner blood retinal barrier or retinal capillary plexus in eyes affected with CMVR.…”

Ischemic Maculopathy: Anoccult Cause of an Irreversible Visual Loss

“…Ischaemic maculopathy can occur in retinal arterial or venous occlusion, retinal arteritis, retinopathy of prematurity (ROP), ocular ischemic syndrome, talc retinopathy, proliferative or non-proliferative diabetic retinopathy, pars planitis, Sarcoidosis, cytomegalovirus retinitis caused by AIDS, familial exudative vitreoretinopathy, Eales' disease involving the macula [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Additionally, it has been reported that it can be developed following intravitreal antivascular endothelial growth factor injection [21,22].…”