AIDS合并巨细胞病毒性视网膜炎60例临床观察

目的:探讨获得性免疫缺陷综合征(AIDS)合并巨细胞病毒性视网膜炎(CMVR)的临床特征,及CMVR相关眼部免疫重建综合征(IRIS)的临床特点.方法:回顾性分析我院感染科2010-01/2015-12收治确诊为AIDS合并CMVR患者60例103眼,对其临床表现、眼底病变、CD4+T淋巴细胞计数及预后等进行观察.结果:初诊视力≤0.1者65眼(63.1％),＞0.1 ～ ＜0.3者26眼(25.2％),≥0.3者12眼(11.7％),眼底改变表现为沿血管分布的黄白色病灶,伴片状出血,较少累及玻璃体.患者60例103眼,其中37眼(35.9％)视网膜病变主要累及后极部,45眼(43.7％)主要累及周边部,21眼(20.4％)为混合型.60例患者中CD4+T淋巴细胞计数平均38.6±12.3个/μL,其中≤50个/μL 43例(71.7％),＞50 ～ ＜100个/μL8例(13.3％),≥100个/μL9例(15.0％).经高效抗逆转录病毒治疗(HARRT)及抗巨细胞病毒(CMV)治疗后,66眼视力提高,19眼视力不变,18眼视力下降.54例患者CD4+T淋巴细胞计数升高,治疗前后CD4+T细胞变化有统计学差异(P＜0.05).5例9眼为HARRT后IRIS的CMVR,经抗病毒治疗,病情得到控制.结论:CMVR为AIDS常见眼部并发症,当CD4+T淋巴细胞计数≤50个/μL时应常规进行眼科检查.IRIS的CMVR预后较差.     

首诊巨细胞病毒性视网膜炎的艾滋病患者二例

例1男,49岁。因左眼视力下降3个月于2005年10月到我科就诊。2个月前曾在当地医院诊断为左眼玻璃体积血;左视网膜血管炎,给予活血化淤及抗炎治疗,效果不理想。患者近半年常有低热,间断腹泻。否认糖尿病、高血压病史。检查:视力:右眼0.8,左眼0.01,均不能矫正。眼压:右眼15mm Hg(1     

获得性免疫缺陷综合征并发巨细胞病毒性视网膜炎的临床分析

目的探讨获得性免疫缺陷综合征(acquiredimmunodeficiencysyndrome,AIDS)并发巨细胞病毒(cytomegalovirus,CMV)性视网膜炎的眼底表现特点、全身症状及治疗预后。方法观察8例(15只眼)AIDS并发CMV性视网膜炎的临床表现,分析其眼底、视力、荧光素眼底血管造影及CD4+T淋巴细胞检测结果,并对其中2例(4只眼)行更昔洛韦玻璃体腔注药治疗。随访时间2～34个月,平均16个月。结果初诊视力≤0.2者10只眼(66.7%),其中无光感者2只眼,眼前光感者2只眼,0.04～0.20者6只眼;0.8和0.9者各1只眼(13.3%);≥1.0者3只眼(20.0%)。12只眼的眼底表现为视网膜血管炎特点,呈沿血管分布的浓厚黄白色病损,其上有片状出血,边缘为不规则的黄白色颗粒,可形象描述为“奶酪加番茄酱样视网膜炎”;玻璃体透明或反应轻微。2只眼的眼底呈晚期表现,视网膜萎缩呈灰色,视网膜血管硬化、狭窄,视网膜色素上皮萎缩,可透见脉络膜血管及视神经萎缩。1只眼视网膜脱离。8例患者的CD4+T淋巴细胞计数在0～36个/mm3之间,平均(15.0±12.9)个/mm3。4只眼玻璃体注药后视力均显著提高。眼底病变明显消退,出血吸收。结论CMV性视网膜炎是AIDS最常见、最严重的眼部并发症。眼底表现特点为进行性、坏死性视网膜炎伴出血,同时合并有视网膜血管炎。但玻璃体反应无或轻微。对原因不明的黄白色病损、视网膜出血及视网膜血管炎应行血清人类免疫缺陷病毒(humanimmunodeficiencyvirus,HIV)抗体检测。反之,HIV阳性者应常规进行眼底检查。(中华眼科杂志,2005,41:803806)     

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。     

获得性免疫缺陷综合征患者视网膜微血管病变与巨细胞病毒视网膜炎对比研究

目的　分析获得性免疫缺陷综合征（acquired immunodeficiency syndrome，AIDS）患者视网膜微血管病变与巨细胞病毒视网膜炎（cytomegalovirus retinitis，CMVR）的疾病特征。方法　回顾性病例分析。选取就诊于首都医科大学附属北京佑安医院眼科并经感染科专科医师确诊的AIDS患者145例，其中合并视网膜微血管病变者75例为微血管病变组，合并CMVR者70例为CMVR组。所有患者均进行AIDS相关病史询问，同时行血人类免疫缺陷病毒（HIV）载量和CD4+T细胞检测，并行最佳矫正视力、眼压、裂隙灯检查、散瞳眼底检查及彩色眼底照相等眼科检查。对全身情况允许的微血管病变组25例、CMVR组70例进行血液和房水CMV-DNA检测。结果　视网膜微血管病变组最佳矫正视力为0.91±0.16，13例(17.33%)患者已开始高效联合抗反转录病毒治疗（HAART），CD4+T细胞数为22（0～506）个·μL^-1，8例（10.67%）患者有眼前节反应；CMVR组患者最佳矫正视力为0.63±0.37，34例(48.57%)患者已开始HAART，CD4+T细胞数为13（1~48）个·μL^-1，23例(32.85%)患者有眼前节反应，上述指标两组相比差异均有统计学意义（均为P=0.000）。微血管病变组25例中房水CMV-DNA阳性0例，血液CMV-DNA阳性8例（32.00%）；CMVR组70例中房水CMV-DNA阳性60例（85.71%），血液CMV-DNA阳性33例（47.14%）；两组血液中CMV-DNA阳性率相比差异无统计学意义（P=0.227），但房水中阳性率两组相比差异有统计学意义（P=0.000）。结论　AIDS合并CMVR患者比AIDS合并视网膜微血管病变患者视力更差，CD4+T细胞计数更低，眼前节反应及房水CMV-DNA阳性率更高，且视网膜微血管病变患者未接受HAART的人数明显高于CMVR患者。     

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)     

全身应用免疫抑制剂引发巨细胞病毒性视网膜炎一例

巨细胞病毒（cytomegalovirus，CMV）性视网膜炎以“比萨饼样”眼底改变为特征，常提示患者全身免疫力低下，考虑人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染或获得性免疫缺陷综合征（acquired immunodeficiency syndrome，AIDS），全身应用免疫抑制剂及化疗药物所致。我们于2005年收治1例因长期全身应用免疫抑制剂引发CMV性视网膜炎的患者，现将其眼部表现及诊治经过分析报告如下。     

获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎初发期患者临床特征分析

目的:观察获得性免疫缺陷综合征（AIDS）合并巨细胞病毒（CMV）性视网膜炎（CMVR）初发期患者的临床表现。方法:回顾性病例系列研究。2017年7月至2019年11月于首都医科大学附属北京佑安医院眼科检查确诊的AIDS合并CMVR初发期患者21例22只眼纳入研究。其中,男性19例19只眼,女性2例3只眼;平均年龄（3...     

AIDS合并巨细胞病毒性视网膜炎的临床研究

目的 探讨获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者巨细胞病毒性视网膜炎预防、临床特点和治疗方法.方法 对获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎11例(13眼)进行临床分析.结果 11例(13眼)均有特征性视网膜病变及视力下降或眼前黑影;10例患者CD+4 T细胞计数＜50个/μl,均处于AIDS晚期,且合并有其他机会感染;5例CMV-PCR检测为阳性;8例CMV IgM检测中1例(+),7例(-).6例经更昔洛韦治疗后视力提高,但需要较长的疗程;3例死于多重机会感染.结论 巨细胞病毒性视网膜炎是获得性免疫缺陷综合征患者的常见机会感染,早发现和及时治疗对其治愈有重要意义,获得性免疫缺陷综合征患者应常规眼科检查和随访,尤其CD4+ T细胞计数＜50个/μl的患者.病原学检测在诊断中具有重要价值.(中国眼耳鼻喉科杂志,2006,6362～364)     

获得性免疫缺陷综合征并发巨细胞病毒性视网膜炎的药物治疗现状和进展

巨细胞病毒性视网膜炎是获得性免疫缺陷综合征晚期最常见、最严重的眼部机会性感染,是导致患者视力丧失的最主要原因.继更昔洛韦、膦甲酸在临床广泛应用后,缬更昔洛韦、西多福韦及福米韦生也已经获得美国药品与食品管理局批准,先后应用于眼科临床,取得了一定的治疗效果.目前,马立巴韦、MSL-109单克隆抗体、Cyclopropavir及BAY 38-4766 正在进行Ⅰ期、Ⅱ期或Ⅲ期临床试验,可望给临床治疗带来新的希望.     

[In Press] Comparative analysis of cytomegalovirus retinitis and microvascular retinopathy in patients with acquired immunodeficiency syndrome

AIM: To compare the clinical manifestation of cytomegalovirus (CMV) retinitis and microvascular retinopathy (MVR) in patients with acquired immunodeficiency syndrome (AIDS) in China. METHODS: A total of 93 consecutive patients with AIDS, including 41 cases of CMV retinitis and 52 cases of MVR were retrospectively reviewed. Highly active antiretroviral therapy (HAART) status was recorded. HIV and CMV immunoassay was also tested. CD4+ T-lymphocyte count and blood CMV-DNA test were performed in all patients. Aqueous humor CMV-DNA test was completed in 39 patients. Ophthalmological examinations including best corrected visual acuity (BCVA, by International standard vision chart), intraocular pressure (IOP), slit-lamp biomicroscopy, indirect ophthalmoscopy were performed. RESULTS:In MVR group, the anterior segment examination was normal in all patients with a mean BCVA of 0.93±0.13. Blood CMV-DNA was 0 (0, 269000) and 42 patients (80.77%) did not receive HAART. In CMV retinitis group, 13 patients (31.71%) had anterior segment abnormality. The mean BCVA was 0.64±0.35 and blood CMV-DNA was 3470 (0, 1450000). Ninety patients (46.34%) had not received HAART. MVR group and CMV retinitis group the positive rates of aqueous CMV-DNA were 0 and 50%, respectively. Two patients with MVR progressed to CMV retinitis during the follow- up period. CONCLUSION: In comparison of CMV, patients with MVR have relatively mild visual function impairment. Careful ophthalmological examination and close follow-up are mandatory, especially for patients who have systemic complications, positive CMV-DNA test and without received HAART.     

Fluocinolone Acetonide Implant (Retisert) for Chronic Cystoid Macular Edema in Two Patients with AIDS and a History of Cytomegalovirus Retinitis

Purpose: To report the authors’ experience using fluocinolone acetonide (Retisert) to treat cystoid macular edema (CME) resulting from immune recovery uveitis (IRU) in 2 acquired immunodeficiency syndrome (AIDS) patients with a history of cytomegalovirus (CMV) retinitis.

Design: Interventional case series.

Methods: Medical records were reviewed of 2 patients who received Retisert implantation in 3 eyes for IRU-associated inflammation and CME. Suppression of CMV disease was achieved with oral medication in one patient and with simultaneous implantation of a ganciclovir implant in the other patient.

Results: After Retisert implantation in 3 eyes in AIDS patients on HAART, improvement in CME was seen in 2 eyes. No CMV reactivation was detected during the several-month follow-up period.

Conclusions: Retisert may be an effective treatment for CME in AIDS patients with IRU reactivation and a history of CMV retinitis.     

Comparative analysis of cytomegalovirus retinitis and microvascular retinopathy in patients with acquired immunodeficiency syndrome

AIM: To compare the clinical manifestation of cytomegalovirus (CMV) retinitis and microvascular retinopathy (MVR) in patients with acquired immunodeficiency syndrome (AIDS) in China. METHODS: A total of 93 consecutive patients with AIDS, including 41 cases of CMV retinitis and 52 cases of MVR were retrospectively reviewed. Highly active antiretroviral therapy (HAART) status was recorded. HIV and CMV immunoassay were also tested. CD4+ T-lymphocyte count and blood CMV-DNA test were performed in all patients. Aqueous humor CMV-DNA test was completed in 39 patients. Ophthalmological examinations including best corrected visual acuity (BCVA, by International Standard Vision Chart), intraocular pressure (IOP), slit-lamp biomicroscopy, indirect ophthalmoscopy were performed. RESULTS: In MVR group, the anterior segment examination was normal in all patients with a mean BCVA of 0.93±0.13. Blood CMV-DNA was 0 (0, 269 000) and 42 patients (80.77%) did not receive HAART. In CMV retinitis group, 13 patients (31.71%) had anterior segment abnormality. The mean BCVA was 0.64±0.35 and blood CMV-DNA was 3470 (0, 1 450 000). Nineteen patients (46.34%) had not received HAART. MVR group and CMV retinitis group the positive rates of aqueous CMV-DNA were 0 and 50%, respectively. Two patients with MVR progressed to CMV retinitis during the follow-up period. CONCLUSION: In comparison of CMV, patients with MVR have relatively mild visual function impairment. Careful ophthalmological examination and close follow-up are mandatory, especially for patients who have systemic complications, positive CMV-DNA test and without received HAART.     

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.     

艾滋病合并巨细胞病毒性视网膜炎的误诊分析

目的分析艾滋病合并巨细胞病毒性视网膜炎的误诊病例,以减少误诊。设计回顾性病例系列。研究对象具有误诊史的艾滋病合并巨细胞病毒性视网膜炎的患者9例。方法回顾性分析在北京地坛医院确诊的具有误诊史的艾滋病合并巨细胞病毒性视网膜炎患者的眼部和全身情况。主要指标误诊眼疾病,误诊时间,合并全身疾病。结果艾滋病患者巨细胞病毒性视网膜炎误诊为其他眼病的患者9例（12眼）,其中误诊为Coats病者1例,视网膜中央静脉阻塞者1例,Eales病者1例,孔源性视网膜脱离者1例,视盘血管炎者2例（3眼）,葡萄膜炎者2例（4眼）,曾先后误诊为急性视网膜坏死、葡萄膜炎和玻璃体混浊者1例。发病一周内误诊者3例,1周~3个月内误诊者2例,3个月以上病程者误诊4例。9例误诊患者中5例不曾进行高效抗逆转录病毒治疗（HAART）的患者CMV-IgM检测阳性;5例患者合并有贫血,5例患者合并其他部位的感染,4例患者合并肝肾功能异常,9例患者的CD4均〈200个/μL,其中6例患者的CD4〈50个/μL。结论艾滋病合并巨细胞病毒性视网膜炎受到病程、艾滋病抗病毒治疗和我们对疾病的认识等多种因素的影响易出现误诊。对于临床诊断有困难的疾病应考虑到这种疾病的可能,其正确的诊断需要结合全身情况综合判断。     

Cytomegalovirus Retinitis and Immune Recovery Uveitis in AIDS Patients Treated with Highly Active Antiretroviral Therapy in Taiwanese

Purpose: To determine the characteristics of cytomegalovirus (CMV) retinitis and immune recovery uveitis (IRU) in the era of highly active antiretroviral therapy (HAART). Methods: We reviewed data from 47 of 79 consecutive patients with acquired immunodeficiency syndrome (AIDS) and CMV retinitis. Results: The incidence of CMV retinitis in AIDS patients has markedly decreased over the recent 10 years. The characteristics of CMV retinitis have changed. Development of IRU occurred in 24.4%. Conclusions: Symptomatic IRU develops in a significant number of patients with inactive CMV retinitis following successful HAART. Eyes with IRU respond favorably to antiinflammatory therapy without reactivation of retinitis.     

未经抗巨细胞病毒治疗时艾滋病合并巨细胞病毒性视网膜炎的临床特征及其预后

目的 了解未经抗巨细胞病毒治疗时获得性免疫缺陷综合征（艾滋病）合并巨细胞病毒性视网膜炎的临床特征及其预后。设计 回顾性病例系列。研究对象 11例未经抗巨细胞病毒治疗的艾滋病合并巨细胞病毒性视网膜炎患者。方法 所有患者查矫正视力、非接触眼压、裂隙灯显微镜检查、动态视野、散瞳间接检眼镜检查、眼底照相,并行CD4 T淋巴细胞检测。随访2个月~5年（平均26.2±23.8个月）,观察病程过程中各项指标的变化。主要指标 矫正视力、眼前后节情况。结果 11例（21眼）发病,其中14眼无光感,矫正视力＜0.05者2例（2眼）,0.05≤矫正视力＜0.3者1例（1眼）,矫正视力≥0.3者3例（4眼）;21眼中,5眼仅有不同程度的角膜后色素性KP,余16眼除角膜KP外,均有不同程度的白内障;21眼中13眼有不同程度虹膜前后粘连,2例（3眼）合并角膜白斑、角膜血管翳,影响外观。眼底能窥入者9眼,表现为不同程度眼底瘢痕性改变,合并视网膜脱离者2眼。结论 未经抗巨细胞病毒治疗的艾滋病合并巨细胞病毒性视网膜炎患者视力预后差,除眼底病变外,还可引起眼前节病变。     

2mg与3mg更昔洛韦玻璃体注射治疗AIDS患者巨细胞病毒性视网膜炎的效果比较

目的 比较玻璃体注射2 mg和3 mg更昔洛韦治疗获得性免疫缺陷综合征(AIDS)患者巨细胞病毒性视网膜炎(CMVR)的有效性和安全性.设计 前瞻性比较性病例系列.研究对象 2016-2020年北京地坛医院AIDS合并CMVR患者63例(86眼).方法 患者随机分为2 mg组(41眼)和3 mg组(45眼),在接受更昔...