人类免疫缺陷病毒感染及获得性免疫缺陷综合征患者眼部病变的诊断与治疗

目的 探讨人类免疫缺陷病毒(HIV)感染及获得性免疫缺陷综合征(AIDS)患者的眼部病变特点、临床症状及治疗原则.方法 回顾性系列病例研究.回顾性分析110例(220只眼)HIV感染和AIDS患者的临床资料,包括患者视力、眼前节、眼底检查和荧光素眼底血管造影及外周血CD_4~+T淋巴细胞检测结果,其中2例(4只眼)AIDS合并巨细胞病毒(CMV)性视网膜炎患者施行了更昔洛韦玻璃体腔注药治疗.患者年龄、HIV感染时间与HIV视网膜病变及CMV性视网膜炎的相关性采用Pearson相关分析法,性别与HIV视网膜病变及CMV性视网膜炎的相关性采用Pearson ChiSquare分析法,正常眼底组、HIV视网膜病变组、CMV性视网膜炎组间CD_4~+T淋巴细胞计数比较采用多个独立样本的秩和检验.结果 患者初诊视力为无光感者5只眼,光感至0.04者10只眼,0.05～0.2者14只眼,0.3～0.7者62只眼,0.8及以上者129只眼.110例(220只眼)HIV感染和AIDS患者中,有25只眼角膜后有灰白色细小或色素性沉着物.22只眼房水闪光(+)或(++).4只眼虹膜后粘连.28只眼晶状体混浊.34只眼确诊为HIV视网膜病变,眼底表现为棉絮斑、视网膜出血及微血管瘤.32只眼确诊为AIDS合并CMV性视网膜炎,26只眼的眼底表现为沿血管分布的浓厚黄白色病损区,其上片状出血,边缘有不规则黄白色颗粒.3只眼为眼底病变晚期,表现为视网膜萎缩、视网膜血管硬化和狭窄、视神经萎缩.3只眼合并视网膜脱离.正常眼底的HIV感染者及AIDS患者CD_4~+T淋巴细胞计数中位数为100.0个/mm~3,HIV视网膜病变患者CD_4~+T淋巴细胞计数中位数为41.0个/mm~3,CMV性视网膜炎患者CD_4~+T淋巴细胞计数中位数为18.0个/mm~3.CD_4~+T淋巴细胞计数比较,正常眼底组与HIV视网膜病变组相比,差异有统计学意义(x~2=4.848,P=0.028);正常眼底组与CMV性视网膜炎组相比,差异有统计学意义(x~2=15.696,P=0.000);HIV视网膜病变组与CMV性视网膜炎组相比,差异有统计学意义(x~2=4.860,P=0.027).2例(4只眼)CMV性视网膜炎患者行更昔洛韦(400 μg)玻璃体腔注药后,视力提高,眼底病变明显消退.结论 视网膜微血管病变是HIV感染及AIDS常见的眼部并发症,CMV性视网膜炎是AIDS晚期最严重的眼部并发症.高效抗逆转录病毒治疗可重建患者的免疫功能,更昔洛韦玻璃体腔注药可有效治疗CMV性视网膜炎并挽救患者视力.     

AIDS合并巨细胞病毒性视网膜炎的观察

目的 探讨获得性免疫缺陷综合征(AIDS)合并巨细胞病毒(CMV)性视网膜炎患者的眼底改变特点及眼底荧光血管造影特征.方法 已诊断为CMV性视网膜炎的AIDS患者共34例49只眼,进行常规视力、裂隙灯检查、眼底检查及荧光素眼底血管造影(FFA)检查,分析其眼底病变的临床特征.结果 29只眼视网膜上见大片融合性黄白色坏死灶,边界不清,伴视网膜出血及血管炎改变;FFA晚期病灶区域弥漫性荧光素渗漏.12只眼周边部视网膜颗粒状坏死灶,边界欠清,未见明显 视网膜出血、渗出及血管管壁改变;FFA显示病灶区域强荧光,晚期荧光素渗漏.4只眼视网膜前见大片灰白色增殖膜;4只眼继发视网膜脱离.结论 CMV性视网膜炎主要表现为进行性坏死性的视网膜炎,伴出血及血管炎.     

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.     

巨细胞病毒性视网膜炎与获得性免疫缺陷综合征

目的 探讨巨细胞病毒性视网膜炎与获得性免疫缺陷综合征的关系、临床表现及诊断、治疗。 方法 观察分析56例巨细胞病毒(cytomeglovirus,CMV)性视网膜炎合并获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者95只眼，对其眼底、视力、T辅助细胞的细胞受体4（CD4 ＋）计数及预后进行观察随访2周～18个月。 结果 56例患者在诊断为巨细胞病毒性视网膜炎之前AIDS病程为4～26个月。95只眼56例患者中，眼底病灶表现为颗粒型者55只眼，其中46只眼位于周边部；爆发型者25只眼，均位于后极部，视网膜坏死灶致密伴斑片状出血和血管炎；颗粒型与爆发型病灶混合存在者15只眼；其中7只眼合并有视神经乳头炎；患者就诊时视力为眼前数指至0.5，病变广泛者及病变位于后极部者视力下降尤为严重。30例患者CD4 ＋细胞计数为0～30 个/μl,平均(15±9) 个/μl。患者存活时间为3～18个月。接受更昔洛韦(ganciclovir)治疗组患者视力多数提高，CD4 ＋T细胞计数明显升高，未治疗组患者92%病变呈进行性发展，视力显著下降。 结论 CMV性视网膜炎是AIDS病的主要眼部并发症，临床上以坏死性视网膜炎伴出血及血管炎为特征，目前治疗主要用更昔洛韦。 (中华眼底病杂志, 2002, 18: 89-91)     

巨细胞病毒性视网膜炎MSL-109单克隆抗体药物治疗的疗效观察

目的探讨获得性免疫缺陷综合征(AIDS)眼部并发症巨细胞病毒(CMV)性视网膜炎MSL-109单克隆抗体药物治疗的效果。方法对72例患者(105只眼)CMV性视网膜炎行MSL-109单克隆抗体药物治疗,观察其眼底、视力、T辅助细胞的细胞受体4(CD4+)计数及预后。结果 72例患者在诊断为巨细胞病毒性视网膜炎之前AIDS病程为4～26个月。72例(105只眼)患者中,眼底病灶表现为颗粒型者58只眼,其中47只眼位于周边部;爆发型者29只眼,均位于后极部,视网膜坏死灶致密伴斑片状出血和血管炎;颗粒型与爆发型病灶混合存在者18只眼;其中8只眼合并有视神经乳头炎;患者就诊时视力为眼前数指至0.4,病变广泛者及病变位于后极部者视力下降尤为严重。34例患者CD4+细胞计数为0～30个/μl,平均(15土9)个/μl。患者存活时间为3～18个月。经过MSL-109单克隆抗体治疗组患者视力多数提高,CD4+T细胞计数明显升高,未治疗组患者92%病变呈进行性发展,视力显著下降。结论 CMV性视网膜炎是AIDS病的主要眼部并发症,临床上以坏死性视网膜炎伴出血及血管炎为特征,目前治疗主要采用MSL-109单克隆抗体。     

巨细胞病毒性视网膜炎

探讨免疫功能低下患者中巨细胞病毒性视网膜炎的临床表现、诊断及治疗。方法 :观察分析 6 1例巨细胞病毒 (cytomeglovirus ,CMV)性视网膜炎患者 10 4只眼 ,对其眼底、视力、T辅助细胞的细胞受体4(CD4 )计数及预后进行观察随访 2周～ 18个月。结果 :6 1例CMV视网膜炎中 ,5 6例为获得性免疫缺陷综合征 (acquiredimmunodeficiencysyndrome ,AIDS)患者 ,1例为应用免疫抑制剂的肾移植患者 ,1例为接受化疗的急性淋巴细胞性白血病患者 ,3例为白血病同时合并AIDS患者。 10 4眼 6 1例患者中 ,眼底病灶表现为颗粒型者 5 8眼 ,其中 46眼位于周边部 ;爆发型者 2 8眼 ,均位于后极部 ,视网膜坏死灶致密伴斑片状出血和血管炎 ;颗粒型与爆发型病灶混合存在者 18眼 ;其中 7眼合并有视神经乳头炎 ;患者就诊时视力为眼前指数至 0 5 ,病变广泛者及病变位于后极部者视力下降尤为严重。 30例患者CD4 细胞计数为 0～ 30个 /μl,平均 15± 9个 /μl。接受更喜洛韦治疗组患者视力多数提高 ,CD4 T细胞计数明显升高 ,未治疗组患者 93 %病变呈进行性发展 ,视力显著下降。结论 :CMV视网膜炎是免疫功能严重低下患者 ,尤其AIDS病的主要眼部并发症 ,临床上以坏死性视网膜炎伴出血及血管炎为特征 ,治疗目前主要用更昔洛韦。     

获得性免疫缺陷综合征并发巨细胞性视网膜炎4例

巨细胞性视网膜炎 (CMV )是获得性免疫缺陷综合征(AIDS)的晚期常见并发症。多数报道都是在确诊CMV性视网膜炎前已证实患有AIDS ,病程长短不一。我院自 2 0 0 1年 9月至 2 0 0 3年 3月期间 ,门诊接诊四例患者均因发现具有典型的CMV性视网膜炎的临床症状被疑为AIDS ,最终通过人类免疫缺陷病毒 (HIV)抗体检验阳性而确诊 ,现报告如下。例 1　男　 40岁　职员　以双眼视力下降 3个月 ,加重半个月为主诉就诊。患者消瘦 ,乏力 ,精神欠佳。双眼视力均为光感 ,眼前节无异常。眼底可见双视盘边界模糊、充血、视网膜静脉血管有白鞘 ,后极部视…     

获得性免疫缺陷综合征合并人类免疫缺陷病毒视网膜病变的眼底病变特征分析

目的 观察获得性免疫缺陷综合征(AIDS)合并人类免疫缺陷病毒(AIDS/HIV)视网膜病变的眼底病变特征.方法 AIDS/HIV视网膜病变患者52例80只眼纳入研究.其中,男性42例67只眼,女性10例13只眼,男女比例为4.2:1;年龄16～78岁,平均年龄(43±12)岁.所有患者均进行矫正视力、眼压、裂隙灯显微镜、散瞳间接检眼镜、眼底彩色照相检查及CD4+T淋巴细胞检测.眼底检查由具有丰富经验的眼底病医生完成.观察所有患者的眼底病变特征.17例患者24只眼随访时间2 d～2年,随访时间中位数125 d;其余35例患者56只眼因死亡或在外地未能复诊.观察随访患者的眼底病变发展情况.结果 52例患者80只眼中,双眼发病28例56只眼,占患眼的70.0％;单眼发病24例24只眼,占患眼的30.0％.眼底检查发现,52例患者80只眼中,眼底表现为棉绒斑46例72只眼,占患眼的90.0％,其多位于视盘旁颞上或颞下血管附近,少数可散布于全后极部血管旁;单纯视网膜出血6例8只眼,占患眼的10.0％,表现为后极部火焰状、点状出血或Roth斑.表现为棉绒斑的72只眼中,单纯棉绒斑57只眼;合并视网膜出血15只眼,其出血部位多位于棉绒斑旁.完成随访的17例24只眼中,随访时间小于2周病灶无明显变化3例3只眼;原有棉绒斑或出血1～3个月后在未经治疗的情况下消失11例18只眼,其中5只眼在后极部其他部位出现新棉绒斑或出血;起初表现为棉绒斑样病变,但在随访1～5个月后原病变发展为巨细胞病毒性视网膜炎3例3只眼.结论 AIDS/HIV视网膜病变的最常见眼底表现为棉绒斑.     

AIDS患者眼病损害的临床分析

目的了解AIDS患者眼部损害的临床特征。方法对2004年1月至2009年10月在我院眼科首诊为眼部病变、实验室检测血清人类免疫缺陷病毒(H IV)抗体阳性的患者24例进行临床分析,结果24例均有视力下降,其中18例H IV视网膜炎眼底表现为视网膜周边部血管闭塞,后极部视网膜微血管瘤、绵絮斑、斑片状出血。3例为巨细胞病毒性视网膜炎,眼底为视网膜广泛变白,边缘颗粒状,大片状出血、大量黄白色渗出。3例为全葡萄膜炎,表现为前段虹膜睫状体炎,瞳孔模样渗出,玻璃体内可见大量炎性颗粒,视网膜血管迂曲扩张,视盘境界不清。结论 AIDS患者的首发症状无特异性,首诊误诊率很高,在临床中应高度注意这类眼部病变的临床实验室检测,使这类患者得到早期发现、早期预防、早期治疗     

人类免疫缺陷病毒感染合并获得性免疫缺陷综合征眼部病变的眼底特征

目的 观察人类免疫缺陷病毒感染合并获得性免疫缺陷综合征(HIV/AIDS)的眼部病变眼底特征.方法 1041例HIV/AIDS患者纳入研究.其中,男性882例,占88.70％;女性159例,占11.30％;年龄12～73岁,平均年龄41岁.发现HIV感染时间为1个月～10年,平均HIV感染时间为12个月.传播方式为性传播475例,占45.63％;针头注射传播508例,占48.80％;输血传播44例,占4.25％;母婴传播14例,占1.34％.所有患者均进行视力、裂隙灯显微镜及眼底检查;发现眼底异常改变时行眼压、眼底照相及荧光素眼底血管造影(FFA)检查.观察不同眼部病变的眼底特征.结果 1041例HIV/AIDS患者中,发现眼部病变247例,占23.73％.其中,HIV视网膜微血管病变是最为常见的眼部病变,共132例,占眼部病变患者的53.44％;其次为巨细胞病毒性视网膜炎(CMVR),共70例,占眼部病变患者的28.34％.眼底检查发现,HIV视网膜微血管病变眼底表现为视网膜微动脉瘤,沿血管走行的灶状出血、棉绒斑;CMVR眼底表现为不规则干燥外观,颗粒状边沿,有的累积视神经.FFA检查发现,HIV视网膜微血管病变表现为出血斑呈遮蔽荧光,出血中心轻度强荧光,无荧光渗漏;CMVR表现为大片出血遮蔽荧光,血管荧光渗漏和(或)脉络膜透见荧光,视盘及病变区域荧光着染.结论 HIV/AIDS可发生多种眼部病变,以HIV视网膜微血管病变和CMVR最为常见.HIV视网膜微血管病变主要表现为灶状出血和(或)棉绒斑,CMVR主要表现为不规则干燥外观病变,有时合并大片出血.     

Treatment of CMV retinitis with intravitreal foscarnet

PURPOSE: To assess the tolerability and efficacy of intravitreal injections of foscarnet in cytomegalovirus (CMV) retinitis in acquired immunodeficiency syndrome (AIDS). METHODS: Patients with CMV retinitis resistant and/or intolerant to intravenous foscarnet and ganciclovir and resistant to intravitreal ganciclovir were included. The induction therapy consisted of intravitreal injections of 2,400 micrograms of foscarnet twice a week. The assessment was performed by clinical examination and photographies of the fundus. RESULTS: Three patients (four eyes) have been included. Three eyes were administered seven and one eye eight intravitreal injections. The tolerability was good, but the efficacy was mere: the retinal lesions became less edematous, but they still extended. CONCLUSION: In these four eyes with CMV retinitis resistant to intravitreal ganciclovir, intravitreal injections of foscarnet were well tolerated but did not stop the progression of the retinitis.     

获得性免疫缺陷综合征并发进行性外层视网膜坏死的临床分析

目的 探讨获得性免疫缺陷综合征（AIDS）并发进行性外层视网膜坏死（PORN）的全身情况、眼底特点、治疗方法及预后。设计 回顾性病例系列。研究对象 2015年4月-2019年11月北京佑安医院AIDS合并PORN患者6例（11眼）。方法 分析其最佳矫正视力（BCVA）、裂隙灯、眼底照相、相干光断层扫描（OCT）及房水中水痘带状疱疹病毒脱氧核糖核酸（VZV-DNA）含量，外周血CD4+T淋巴细胞计数和人免疫缺陷病毒（HIV）病毒载量。3 眼行更昔洛韦或膦甲酸钠玻璃体注射联合全身治疗。随诊3~26个月。主要指标 AIDS合并PORN的眼底变化、房水中VZV-DNA值、玻璃体注药前后眼底变化、外周血CD4+T淋巴细胞计数和HIV病毒载量。结果 患者均为男性，平均年龄（27.6±3.2）岁。11眼均表现为无痛性视力下降，9眼（81.8%）初诊BCVA均≤0.2。眼底表现为进行性周边环形视网膜坏死，多灶性边界清楚的黄白色坏死灶向心性进展，无或轻微玻璃体反应。6眼合并渗出性视网膜脱离。早期病变OCT仅累及视网膜外层，后期出现外层视网膜变薄。11眼房水VZV-DNA含量均阳性，外周血CD4+T淋巴细胞计数平均（10.8±2.5）个/μl， HIV病毒载量平均（246289±462.7）拷贝/ml。3眼更昔洛韦和（或）膦甲酸钠玻璃体注射联合全身抗病毒治疗周期72~123天，病灶控制，视力好转（1眼由光感到手动，1眼由指数到0.1，1眼保持0.5）。结论 PORN是AIDS患者严重的眼部机会性感染，病变累及视网膜外层，前房及玻璃体反应无或轻微，病情进展速度快，预后差。眼内液病毒核酸检测有助于诊断。（眼科， 2020， 29： 375-379）     

Retinographic and angiographic study of ocular lesions detected in AIDS

We examined 42 patients with the acquired immune deficiency syndrome: 11 of these had retinal lesions. In this study we reported five cases; all were examined within several weeks of admission to the Maggiore Hospital, and at various intervals thereafter. Ophthalmic evaluation included determination of visual acuity, slit-lamp examinations, direct ophthalmoscopy with the pupil dilated, fundus photography and fluorescein angiography. Peripheral blood mononuclear cells were isolated during gradient density centrifugation. Lymphocyte subsets were determined by immunofluorescence with monoclonal antibodies of the OKT series. All patients demonstrated a reduction of the ratio of T-helper to T-suppressor. Patient no. 1 was a 41 year-old hemophiliac man became ill (ARC) in June 1986; initially the patient had no ocular lesions. After five months developed bilateral retinal cotton wool spots. The patient's clinical conditions progressively worsened during the ensuing months and after fifteen months he felt a decreased vision in left eye: retinal examination disclosed a presumed CMV retinitis. Patient no. 2 was a 30 year-old intravenous drug-user man. At the time of the admission (AIDS) ophthalmologic evaluation revealed multiple cotton wool spots in both eyes. These changed of number and size during the following months. This patient was treated with ganciclovir (dihydroxy propoxymethyl guanine) because developed a CMV encephalopathy. We noted after this treatment a strong reduction of the cotton wool spots without an improvement of the general conditions and he died a month later. Patient no. 3 was a 26 year-old drug-user woman admitted for ARC. Ophthalmologic evaluation disclosed in right eye a presumed CMV retinitis with vascular sheathing and hemorrhages, and in left eye a little white retinal lesion (an initial retinitis) and cotton wool spots. The general and the retinal conditions rapidly worsened and she died three months later. Patient no. 4 was a 24 year-old women, intravenous drug-user, admitted for AIDS complicated by central nervous system infection by Toxoplasmic Gondii. Ocular examination revealed in right eye retinal cotton wool spots, and in left eye a white chorioretinal lesion with vitritis attributed to Toxoplasma Gondii. This retinochoroiditis improved after empiric therapy with sulfonamides and pyrimethamine. Patient no. 5 was a 37 year-old bisexual man admitted for AIDS. The findings on ophthalmologic examination were: CMV retinitis in right eye and retinal cotton wool spots in left eye. Treatment with ganciclovir resulted in an improvement of general symptoms.(ABSTRACT TRUNCATED AT 400 WORDS)     

首诊眼科与非首诊眼科的获得性免疫缺陷综合征合并巨细胞病毒视网膜炎的眼底特征对比分析

目的对比分析首诊眼科与非首诊眼科的获得性免疫缺陷综合征(AIDS)合并巨细胞病毒视网膜炎(CMVR)的眼底特征。方法回顾性系列病例研究。2004年7月至2017年9月在徐州医科大学附属徐州市立医院眼科确诊的AIDS合并CMVR患者22例41只眼纳入研究。因眼部症状来眼科就诊后发现AIDS者7例14只眼(FVO组),已知患有AIDS后发生眼底病变者15例27只眼(FVNO组)。所有患者行视力、眼压、裂隙灯显微镜、间接检眼镜检查;屈光间质清晰者21例39只眼均行眼底彩色照相检查,其中5例行FFA检查;5例行OCT和眼部B型超声检查。将CMVR分为暴发型及懒惰型。除2例4只眼外,其余20例37只眼均进行了高效抗逆转录病毒治疗。所有患者均接受静脉滴注更昔洛韦治疗。41只眼中,行玻璃体腔注入更昔洛韦治疗12只眼;因视网膜脱离行25G玻璃体切割联合硅油填充手术10只眼;因广泛视网膜脱离,患者放弃手术治疗7只眼;未接受任何眼科治疗12只眼。治疗后平均随访时间(23±39)个月。对比分析两组患者暴发型、懒惰型CMVR的发生率及各自眼底特征。两组患者初诊及末次随访时的视力差异以及CD4+T细胞计数比较采用t检验;两组患者病灶是否累及黄斑以及病灶波及范围比较采用χ^2检验。结果暴发型CMVR表现为沿大血管分布的浓密的黄白色坏死灶伴出血以及伴或不伴卫星灶;懒惰型CMVR表现为稀疏的黄白色颗粒状外观病灶伴少许出血。伴随体征包括霜样树枝样血管鞘、视网膜动脉闭塞及视盘水肿等。FVO组7例14只眼均为暴发型。其中,伴视网膜动脉闭塞2例2只眼;伴视盘水肿1例2只眼,为双眼发病者。FVNO组15例27只眼中,暴发型13例21只眼,懒惰型4例6只眼。暴发型患者中,伴霜样树枝样血管鞘4例6只眼,伴视网膜动脉闭塞10例12只眼,伴视盘水肿4例4只眼。FVO组与FVNO组初诊视力比较,差异无统计学意义(t=-1.534,P=0.133);末次随访视力比较,差异有统计学意义(t=-3.420,P=0.001);初诊时CD4^+T细胞计数比较,差异无统计学意义(t=-0.902,P=0.378)。FVO组病灶累及黄斑和病灶范围波及3~4个象限的患眼数高于FNVO组,差异均有统计学意义(χ^2=7.552、7.865,P=0.006、0.005)。结论AIDS合并CMVR首诊眼科者较非首诊眼科者眼底浓密的坏死病灶累及黄斑更多,病灶范围更广。     

High-dose (5000-microg) intravitreal ganciclovir combined with highly active antiretroviral therapy for cytomegalovirus retinitis in HIV-infected patients in Venezuela

PURPOSE: To describe the use of high doses of intravitreal ganciclovir combined with highly active antiretroviral therapy (HAART) for the treatment of cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-infected patients. METHODS: Thirteen HIV-infected patients (18 eyes) with active CMV retinitis (83.3% in zone 1 and 38.4% resistant) participated in this prospective interventional case series. Patients were treated with high dose intravitreal ganciclovir (5.0 mg/0.1 mL once a week) in combination with HAART therapy. Intravitreal injections were discontinued once CMV retinitis healed if there was a significant increase in CD4+ count (any increase of > or 50 cells/microL to levels over 100 cells/microL sustained for at least 3 months). Mean follow-up was 15.6 months. Main outcome measures included assessment of visual acuity and retinal inflammation (CMV retinitis activity). A matched historical control group of 20 eyes (15 patients) with CMV retinitis treated with systemic ganciclovir (intravenous [induction] and oral [maintenance]) was included. RESULTS: Complete regression of the retinitis was obtained with high doses of intravitreal ganciclovir in 88.8% of eyes (two patients died during follow-up) at a mean of 4.5 weeks (2 to 8 weeks). Visual acuity improved two or more lines in 61.1% of eyes. No ganciclovir retinal toxicity was identified. Three eyes presented CMV retinitis reactivation at a mean of 25.6 days after their last injection. Complications (33.3%) included retinal detachment (RD; 3 eyes), immune recovery uveitis (IRU; 2 eyes), and endophthalmitis (1 eye). In our control group complete regression of the retinitis was obtained in 100% of eyes at a mean of 4 weeks (3 to 7 weeks). However, 12 eyes (60%) presented with CMV retinitis relapse at a mean of 29 days (21 to 32 days) after initiating oral ganciclovir (maintenance). Complications included RD (7 eyes, 35%) and IRU (3 eyes, 15%). Severe neutropenia occurred in 2 patients (13%). CONCLUSIONS: High doses of intravitreal ganciclovir (5.0 mg) once a week in combination with HAART therapy is effective to control CMV retinitis, and may be discontinued after CMV retinitis has healed if immune reconstitution with a significant increase in CD4+ count has occurred.     

Effect of individualized therapy for AIDS patients with cytomegalovirus retinitis in intravitreal ganciclovir injections

The effect of intravitreal ganciclovir injection combined with intravenous infusion on acquired immune deficiency syndrome (AIDS) patients with cytomegalovirus retinitis (CMVR) was investigated. A total of 32 eyes in 23 AIDS patients diagnosed as CMVR from 2017 to 2018 were included in the retrospective study. All patients underwent induction therapy by using intravenous drip of the anti-cytomegalovirus (CMV) agent ganciclovir (5 mg/kg q12h) combined with intravitreal ganciclovir injection (3 mg/time, 2 times/wk). The visual acuity, fundus photographs, lesion location, and number of intravitreal injections were observed preoperatively and postoperatively. Totally 14 eyes were cured during induction therapy. The number of injections [4.13 (2 to 6)] in CMVR patients with peripherally fundus lesions were significantly lower than those with central lesions [4.89 (2 to 6)]. The individualized therapy of intravitreal ganciclovir injections for AIDS patients with CMVR can effectively reduce the numbers of intravitreal injections.     

Cytomegalovirus retinitis and ocular complications in AIDS patients in Togo

BACKGROUND: Cytomegalovirus retinitis seems to be an uncommon complication in African AIDS patients. This study was conducted in 200 patients in order to evaluate AIDS eye related complications with specific focus to cytomegalovirus retinitis. MATERIAL AND METHODS: During a period of 20 months, 200 patients (83 men and 117 women) presenting WHO AIDS case definition diagnosis were enrolled for a complete ocular examination comprising external, anterior segment and retinal fundus and fluorescein angiographic examination. RESULTS: For the whole, 200 patients underwent ocular examinations; of them 121 (60.5%) developed ocular complications.The most frequent complications were cotton wool spots (25.5%), cytomegalovirus (CMV) retinitis (21.5%), retinal hemorrhage (6%), papilloedema (3%), chorioretinal toxoplasmosis (3%), peripheral retinal vascularitis (2. 5%), herpes zoster ophthalmicus (2%). Among those with CMV retinitis, bilateral lesions were found in 30 cases, and unilateral ones in 13 cases. Poor vision was associated with the presence of CMV retinitis in 88% of cases.Death occurred in a mean range of 22 days after the "presumed" diagnosis of CMV retinitis. CONCLUSION: Cytomegalovirus retinitis represents the second ocular complication in AIDS patients in this study. Poor visual outcome was associated in 88% of cases. These results demonstrate that in some west African countries, CMV retinitis may be a common complication in AIDS patients.