获得性免疫缺陷综合征眼底病变特征分析

目的 观察获得性免疫缺陷综合征(AIDS)患者眼底病变特征.方法 经临床和实验室血清学检查确诊为AIDS并在眼科就诊发现有眼底病变的42例患者的66只眼纳入研究.所有患者均进行常规视力、裂隙灯显微镜、直接检眼镜检查及荧光素眼底血管造影(FFA)检查,对其眼底病变的临床特征进行回顾性分析.结果 66只眼中,巨细胞病毒性视网膜炎37只眼,占56.0%.眼底见视网膜上大片融合性黄白色颗粒状视网膜坏死灶,边界不清,伴视网膜出血,血管狭窄、阻塞和白鞘.人类免疫缺陷病毒微血管病变21只眼,占32.0%.眼底见视网膜棉绒斑、斑点状出血或微血管瘤.视神经病变3只眼,占4.5%.眼底见不同程度的视盘水肿、视神经炎或视神经萎缩.其他眼底病变5只眼,占7.5%.眼底表现为神经上皮脱离2只眼,占3.0%;葡萄膜炎3只眼,占4.5%.结论 进行性坏死性视网膜炎,视网膜出血,血管闭塞白鞘,棉绒斑是AIDS患者常见的眼底表现.     

与获得性免疫缺陷综合征相关的卡波济肉瘤在眼部的临床表现

目的 提高对获得性免疫缺陷综合征(AIDS)患者眼部卡波济肉瘤(KS)的认识及诊断处理能力。方法 回顾系列病例研究。回顾分析10例AIDS并发KS患者的眼部临床表现及其治疗随访结果。结果 10例患者均为汉族男性;年龄21~71岁,平均(38.60±15.66)岁;病程10 d~7个月,平均(2.68±2.41)个月。CD4 ⁺T淋巴细胞2~348 个/μL,平均(62.30±105.86)个/μL。临床表现:眼睑合并结膜KS4 例、结膜KS 4例、眼睑KS 2例。眼睑KS表现为紫黑色局部结节,质韧,边界不清,无移动性,无压痛;结膜KS呈暗红色,片状。仅1例为单纯眼部KS,余9例均为全身多发性KS,累及皮肤、口腔、淋巴结、肺、肝、心包等。治疗:1例单纯眼部睑结膜KS未合并其他部位肿瘤患者行手术切除,高效抗逆转录病毒治疗(HAART),未行化学治疗(简称化疗),观察1年未复发;余9例均给予HAART和多柔比星脂质体或紫杉醇化疗。2例治疗过程中全身衰竭死亡,8例患者随访8~19个月,平均(12.50±4.28)个月,眼部病变6例完全缓解,2例部分缓解。结论 随着HIV/AIDS感染日益增多,汉族人种AIDS患者KS发病逐渐增多,且多为多器官累及。HAART合并化疗可提高患者眼部病变缓解率。     

与获得性免疫缺陷综合征相关的卡波济肉瘤在眼部的临床表现

目的提高对获得性免疫缺陷综合征(AIDS)患者眼部卡波济肉瘤(KS)的认识及诊断处理能力。方法回顾系列病例研究。回顾分析10例AIDS并发KS患者的眼部临床表现及其治疗随访结果。结果10例患者均为汉族男性;年龄21~71岁,平均(38.60±15.66)岁;病程10 d^7个月,平均(2.68±2.41)个月。CD4^+T淋巴细胞2~348个/μL,平均(62.30±105.86)个/μL。临床表现:眼睑合并结膜KS4例、结膜KS 4例、眼睑KS 2例。眼睑KS表现为紫黑色局部结节,质韧,边界不清,无移动性,无压痛;结膜KS呈暗红色,片状。仅1例为单纯眼部KS,余9例均为全身多发性KS,累及皮肤、口腔、淋巴结、肺、肝、心包等。治疗:1例单纯眼部睑结膜KS未合并其他部位肿瘤患者行手术切除,高效抗逆转录病毒治疗(HAART),未行化学治疗(简称化疗),观察1年未复发;余9例均给予HAART和多柔比星脂质体或紫杉醇化疗。2例治疗过程中全身衰竭死亡,8例患者随访8~19个月,平均(12.50±4.28)个月,眼部病变6例完全缓解,2例部分缓解。结论随着HIV/AIDS感染日益增多,汉族人种AIDS患者KS发病逐渐增多,且多为多器官累及。HAART合并化疗可提高患者眼部病变缓解率。     

Ophthalmic manifestations of acquired immunodeficiency syndrome. A study of thirty-four patients

Ophthalmic manifestations were studied in 34 patients suffering from AIDS. Ophthalmic disorders were found in 20 of these (58%), the most frequent being a cotton-wool-type spot (94.7%). Three patients showed an ophthalmic state compatible with choroid ischemia and atrophy of the pigmented epithelium of the retina. Three patients had necrotizing retinitis probably of viral etiology (cytomegalovirus). Other disorders observed were intraretinal hemorrhages, Roth's spots, microaneurysms, periphlebitis and ocular infiltration by Kaposi's sarcoma.     

Posterior segment manifestations of human immunodeficiency virus/acquired immune deficiency syndrome

Ocular manifestations can occur in up to 50% of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients and posterior segment involvement is the most common presentation. The posterior segment manifestations of AIDS can be divided into four categories: retinal vasculopathy, opportunistic infections, unusual malignancies and neuro-ophthalmologic abnormalities. Retinal microvasculopathy and cytomegalovirus (CMV) retinitis are the most common manifestations, even in the era of highly active anti-retroviral therapy (HAART). Highly active anti-retroviral therapy has been shown to cause regression of CMV retinitis, reduce the incidence of CMV-related retinal detachments, and prolong patient survival. Immune recovery uveitis is a new cause of vision loss in patients on HAART. Diagnosis and treatment are guided by the particular conditions and immune status of the patient.     

Anterior segment manifestations of human immunodeficiency virus/acquired immune deficiency syndrome

Ocular complications are known to occur as a result of human immunodeficiency virus (HIV) disease. They can be severe leading to ocular morbidity and visual handicap. Cytomegalovirus (CMV) retinitis is the commonest ocular opportunistic infection seen in acquired immune deficiency syndrome (AIDS). Though posterior segment lesions can be more vision-threatening, there are varied anterior segment manifestations which can also lead to ocular morbidity and more so can affect the quality of life of a HIV-positive person. Effective antiretroviral therapy and improved prophylaxis and treatment of opportunistic infections have led to an increase in the survival of an individual afflicted with AIDS. This in turn has led to an increase in the prevalence of anterior segment and adnexal disorders. Common lesions include relatively benign conditions such as blepharitis and dry eye, to infections such as herpes zoster ophthalmicus and molluscum contagiosum and malignancies such as squamous cell carcinoma and Kaposi's sarcoma. With the advent of highly active antiretroviral therapy, a new phenomenon known as immune recovery uveitis which presents with increased inflammation, has been noted to be on the rise. Several drugs used in the management of AIDS such as nevirapine or indinavir can themselves lead to severe inflammation in the anterior segment and adnexa of the eye. This article is a comprehensive update of the important anterior segment and adnexal manifestations in HIV-positive patients with special reference to their prevalence in the Indian population.     

Slowed saccades in the acquired immunodeficiency syndrome

We recorded eye movements using infrared oculography in ten patients with the acquired immunodeficiency syndrome (AIDS) and ten control subjects of similar age. Peak saccadic velocity for the AIDS group was significantly lower than that of the control group for both adducting and abducting saccades (P less than .001). Saccadic duration for the AIDS group was significantly greater than that of the controls for both adducting and abducting saccades (P less than .02 for adduction and P less than .01 for abduction). There was no difference in saccadic latencies between the two groups. We add slowed saccades to the ocular motility manifestations of AIDS. Our study indicated that analysis of ocular motility may be of value in providing early detection of neurologic dysfunction, and may also be an important quantitative measure of the responsiveness of patients to different types of potential therapies.     

Ophthalmic involvement in acquired immunodeficiency syndrome

Forty patients with acquired immunodeficiency syndrome (AIDS) were examined for ocular abnormalities. Twenty of these patients died and the eyes were obtained for culture and histopathologic examination. These patients have multiple opportunistic infections and neoplasms as the result of a severe depression of cellular immunity. Fifty percent of all patients with AIDS and 75% of the autopsy group have ocular signs attributable to AIDS. Ocular findings were confined to four major categories: cytomegalovirus retinitis (10 patients), retinal cotton wool spots (11 patients), conjunctival Kaposi's sarcoma (2 patients) and neuro-ophthalmic motility abnormalities (3 patients). Cytomegalovirus retinitis was a significant cause of visual loss. Seven of 40 autopsy eyes had hand motion or worse visual acuity prior to the patients' death because of CMV retinitis. This necrotic retinitis showed minimal inflammation and progressed to involve the entire retina in three to six months, resulting in a gliotic retinal membrane. Therapy with antiviral agents was not effective. Recognizing the ocular signs of AIDS may facilitate the diagnosis. The ophthalmologist also has a major role in the observation of progression or regression of these ocular manifestations, and can assist in the evaluation of therapy in patients with AIDS.     

Neuropathology of the retina in acquired immunodeficiency syndrome

The pathogenesis of HIV-mediated neurodegeneration is unknown. Presently, work is focused on two main hypotheses: direct (caused by HIV or component proteins) versus indirect (monocyte-mediated) neurotoxicity. In HIV-induced retinal disease, the high incidence of opportunistic infections and the low HIV viral burden found in most clinical specimens present challenges in defining the roles played by potential factors. Future studies will see the resolution of these controversies by showing the mechanism of HIV-induced neuronal damage and its relationship to retinal disease.     

Ocular manifestations of acquired immune deficiency syndrome

The ocular complications of acquired immune deficiency syndrome (AIDS) include: (1) a noninfectious microangiopathy, most often seen in the retina, consisting of cotton-wool spots with or without intraretinal hemorrhages and other microvascular abnormalities; (2) opportunistic ocular infections, primarily cytomegalovirus (CMV) retinitis; (3) conjunctival, eyelid, or orbital involvement by those neoplasms seen in patients with AIDS (i.e., Kaposi's sarcoma and lymphoma); and (4) neuro-ophthalmic lesions. In a series of 200 AIDS patients evaluated clinically, AIDS retinopathy was present in 66.5%. Sixty-four percent had cotton-wool spots, and 12% had intraretinal hemorrhages. Cytomegalovirus retinitis was diagnosed in 28% of AIDS patients. Neuro-ophthalmic lesions were found in 8% of all AIDS patients and were present in 33% of those patients with cryptococcal meningitis. Acquired immune deficiency syndrome retinopathy was present in 40% of 35 patients with the AIDS-related complex (ARC) and in 1.3% of 232 patients with asymptomatic human immunodeficiency virus (HIV) infection, evaluated photographically. These results suggest that the prevalence of AIDS retinopathy increases with increasing severity of HIV infection, and that CMV retinitis presents a significant vision-threatening problem in AIDS patients.     

Internuclear ophthalmoplegia in acquired immunodeficiency syndrome

We describe the case of a patient with acquired immunodeficiency syndrome (AIDS) who had internuclear ophthalmoplegia (INO) and subsequent rapid neurologic deterioration. To our knowledge, this is the first report of a patient with AIDS and INO.     

Ocular pathology in acquired immunodeficiency syndrome

The gross and microscopic ocular findings were prospectively studied in 38 human immunodeficiency virus (HIV)-seropositive subjects undergoing postmortem examination. Pathologic lesions were detected in 27 patients (71%), including cytomegalovirus retinitis in 7, cytoid bodies in 6, cryptococcosis in 6, and choroidal histoplasmosis, mycobacteriosis, choroidal lymphoma, optic nerve demyelination, and microglial nodule formation in the optic nerve in 1 patient each. Of the abnormal ocular findings, 67% were detected only microscopically. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article.     

Ocular tuberculosis in acquired immunodeficiency syndrome

PURPOSE: To present the clinical, histopathological, and molecular biologic findings in fifteen cases of ocular tuberculosis (TB) in patients with acquired immune deficiency syndrome (AIDS). DESIGN: Retrospective, observational, noncomparative case series of HIV-infected patients with ophthalmic complaints and/or with advanced disease (CD4+ cell count < 200), seen between the years 1993 to 2005 at tertiary care ophthalmic and AIDS care hospitals. METHODS: Each patient underwent a complete ophthalmic examination and relevant laboratory and radiologic investigations and was treated accordingly. The study was carried out in this cohort to describe the ocular manifestations of TB. The main outcome measures were to describe the clinical course histopathologic and molecular biologic features of ocular lesions attributable to tuberculosis in AIDS patients in our center. RESULTS: Ocular TB was seen in 15 (1.95%) out of 766 consecutive cases of HIV/AIDS. Nineteen eyes of 15 patients were affected. Four cases (26.66%) had bilateral presentation. Presentations of ocular TB included choroidal granulomas in 10 eyes (52.63%), subretinal abscess in seven eyes (36.84%), worsening to panophthalmitis in three eyes, conjunctival tuberculosis, and panophthalmitis each in one eye (5.26%). All cases had evidence of pulmonary tuberculosis. Coexistent central nervous system (CNS) tuberculosis was seen in two cases and one case had abdominal tuberculosis. CD4+ cell counts were done in 14 patients; the count ranged from 14 to 560 cells/microl--mean 160.85 cells/microl. CONCLUSIONS: Ocular TB in AIDS is relatively rare and can occur even at CD4+ cell counts greater than 200 cells/microl. It can have varied presentations with severe sight-threatening complications.     

Neuro-ophthalmic findings in acquired immunodeficiency syndrome

We reviewed the neuro-ophthalmic findings in 177 subjects with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex who underwent an eye examination in one center from January 1984 to May 1989. The findings included ocular motor nerve palsies (five cases), papilledema (two cases), cytomegalovirus optic neuritis (two cases), cortical blindness (one case), conjugate gaze palsy (one case), and altitudinal visual field defect (one case). These findings were attributed to central nervous system toxoplasmosis (four cases) or lymphoma (one case), cryptococcal meningitis (two cases), systemic cytomegalovirus infections (two cases), and herpes simplex encephalitis (one case). Of 177 patients, 61 patients were tested for syphilis. Twenty-six patients had positive rapid plasma reagin titers, and 28 had positive fluorescent treponemal antibody-absorbed tests. Human immunodeficiency virus-infected individuals need to be screened routinely for syphilis.     

Ocular findings in the acquired immunodeficiency syndrome.

A patient with acquired immunodeficiency syndrome is described. Both retinae were severely affected. Vision was reduced to light perception with projection incerta in the right eye and finger counting at 1.5 m in the left eye. Eye involvement is common in this syndrome, appearing at an early stage of the disease. The fundal appearance could thus be of help in diagnosis.