Temporal trends in ocular manifestations of HIV/AIDS patients in the past 18 years in a tertiary hospital in China

Graefe's Archive for Clinical and Experimental Ophthalmology - To investigate the ocular manifestation changes in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS)...     

Changing patterns of ocular manifestations in HIV seropositive patients treated with HAART

PURPOSE: To report the changing patterns of ocular manifestations in human immunodeficiency virus (HIV) seropositive patients treated with highly active antiretroviral therapy (HAART). METHODS: The clinical charts of HIV seropositive patients, 735 examined from 1997 to 2003 and treated with HAART for at least 2 months (Group 1), and 838 untreated examined from 1988 to 1995 (Group 2), were reviewed to assess the frequency of ocular manifestations. RESULTS: HIV-related retinal microangiopathy and opportunistic retinal infections (cytomegalovirus retinitis and toxoplasmic retinochoroiditis) were significantly higher in Group 2 than 1 (p<0.0001), while in patients treated with HAART a statistically significant increase in the frequency of chalazion (p<0.0001), diabetic and hypertensive retinopathy (p<0.0001), lipid arc of the cornea (p<0.0001), cataract and glaucoma (p<0.0001), and uveitis (p=0.026) was observed. CONCLUSIONS: HAART therapy has induced a dramatic decrease in the incidence of HIV-related microangiopathy and opportunistic retinal infection and the occurrence of new lesions related both to the metabolic alterations induced by HAART and to immune reconstitution, such as uveitis.     

Fundus manifestations and HIV viral loads of AIDS patients before and after HAART

AIM: To investigate the fundus manifestations and human immunodeficiency virus (HIV) viral loads of acquired immune deficiency syndrome (AIDS) patients before and after highly active antiretroviral therapy (HAART). METHODS: This retrospective study included 21 AIDS patients (42 eyes) who presented to the Department of Ophthalmology, Peking Union Medical College Hospital, from 2007 to 2011. Among the patients, 16 showed a good response to HAART, 3 presented drug resistance and 2 were pre-HAART. All patients underwent comprehensive ophthalmic examinations. The HIV viral loads and the CD4+ T-cell counts were also determined. RESULTS: The best-corrected visual acuity (BCVA) of 38 eyes (19 patients) was improved, and cytomegalovirus retinitis (CMVR) in 5 eyes (3 patients) regressed after HAART. Furthermore, 16 patients treated with effective HAART had decreased plasma HIV viral loads (<78 copies/mL) and increased CD4+ T-cell counts (343±161 cells/μL, P<0.005), but the HIV viral load in tears was still detected at 2404 copies/mL. The CD4+ T-cell count was lower in the CMVR group than in the non-CMVR group (P=0.022), but the HIV viral load in the tears was not significantly different between the two groups (P=0.439). CONCLUSION: Most patients with AIDS show a good viral response with a decreased HIV viral load and an increased CD4+ T-cell count in plasma after HAART. However, the HIV viral load remain quite high in the tear samples. Based on our results, we suggest that AIDS patients undergo long-term HAART that should not be interrupted.     

Oculosporidiosis in a tertiary care hospital of western Orissa, India: a case series

The authors present a case series of 54 subjects of Rhinosporidium. They were reported in two years at a tertiary care hospital of Western Orissa. The clinically diagnosed cases by ophthalmologists were confirmed by histopathological samples following surgery. In our series, we noted Rhinosporidium seeberi organisms as the main causative agent. Males were affected three times more than females. Children less than 10 years of age comprised more than 50% of our series. In 91% of cases, the conjunctiva was the site of this infection. Total excision of fungal mass was carried out in all cases and two cases had recurrence between 9 and 12 months following intervention. Although this is an endemic area for such infestation, unilateral manifestation observed in all cases is interesting to note. Low recurrence rate in limited follow-up period could be due to early detection and standard management.     

Etiology and antibacterial susceptibility pattern of community-acquired bacterial ocular infections in a tertiary eye care hospital in south India

Aims:

To identify the etiology, incidence and prevalence of ocular bacterial infections, and to assess the in vitro susceptibility of these ocular bacterial isolates to commonly used antibiotics.

Materials and Methods:

Retrospective analysis of consecutive samples submitted for microbiological evaluation from patients who were clinically diagnosed with ocular infections and were treated at a tertiary eye care referral center in South India between January 2002 and December 2007.

Results:

A total of 4417 ocular samples was submitted for microbiological evaluation, of which 2599 (58.8%) had bacterial growth, 456 (10.3%) had fungal growth, 15 (0.34%) had acanthamoebic growth, 14 (0.32%) had mixed microbial growth and the remaining 1333 (30.2%) had negative growth. The rate of culture-positivity was found to be 88% (P < 0.001) in eyelids’ infection, 70% in conjunctival, 69% in lacrimal apparatus, 67.4% in corneal, 51.6% in intraocular tissues, 42.9% in orbital and 39.2% in scleral infections. The most common bacterial species isolated were Staphylococcus aureus (26.69%) followed by Streptococcus pneumoniae (22.14%). Sta. aureus was more prevalent more in eyelid infections (51.22%; P = 0.001) coagulase-negative staphylococci in endophthalmitis (53.1%; P = 0.001), Str. pneumoniae in lacrimal apparatus and corneal infections (64.19%; P = 0.001), Corynebacterium species in blepharitis and conjunctivitis (71%; P = 0.001), Pseudomonas aeruginosa in keratitis and dacryocystitis (66.5%; P = 0.001), Haemophilus species in dacryocystitis and conjunctivitis (66.7%; P = 0.001), Moraxella lacunata in blepharitis (54.17%; P = 0.001) and Moraxella catarrhalis in dacryocystitis (63.83%; P = 0.001). The largest number of gram-positive isolates was susceptible to moxifloxacin (98.7%) and vancomycin (97.9%), and gram-negative isolates to amikacin (93.5%) and gatifloxacin (92.7%).

Conclusions:

Gram-positive cocci were the most frequent bacteria isolated from ocular infections and were sensitive to moxifloxacin and vancomycin, while gram-negative isolates were more sensitive to amikacin and gatifloxacin.     

HIV/AIDS and ocular complications

The introduction of highly active antiretroviral therapy (HAART) has greatly changed the pattern and natural history of ocular diseases of HIV-infected patients, resulting from the immune recovery and reduction of opportunistic infections. However, ophthalmic complication continues to be concern in AIDS even in the HAART era, especially in developing areas, where absolute majority of HIV-positive patients live. Lack of test facilities and experience, poor conditions of hygiene, different microbiological environment, absence of effective treatment etc., characterize the ophthalmic manifestation of HIV-infected patients in developing countries from that in developed regions and thus pose a great challenge to the ophthalmic treatment in developing area. Not only varied from region to region, ocular complications are distinctive between adults and children. At the same time, the side effects due to the application of HAART pose their own risks of ocular comp- lication and should, therefore, be given more resear     

艾滋病和眼部并发症

采用高效抗逆转录病毒疗法(HAART)后,由于免疫功能恢复和机会性感染的减少,极大地改变了艾滋病毒(HIV)感染者眼部疾病的病程及病史。然而,即使在HAART时代,眼部并发症仍然是艾滋病的临床特征之一,在发展中国家中尤其如此,而绝大多数HIV阳性病患者生活在发展中国家或地区。由于缺乏检验设备和经验、卫生条件差、微生物环境不同及缺乏有效的治疗,生活在发展中国家和地区的HIV感染者眼部并发症的特征与发达地区的艾滋病患者大不相同。因此,治疗发展中国家和地区HIV感染者的眼部并发症,具有更大的挑战性。此外,成人和儿童艾滋病患者眼部并发症也是不同的。与此同时,HAART的副作用也给眼部并发症带来了新的危险因素。所以,相关的研究应给予更多的关注。     

获得性免疫缺陷综合征的眼部表现

自从1981年第一例获得性免疫缺陷综合征(AIDS)被诊断以来,全球感染人类免疫缺陷病毒(HIV)的病例数一直在持续增长。在中国HIV／AIDS正以惊人的速度蔓延,因此每一个医务工作者包括眼科医护人员必须加强对HIV／AIDS的了解。该文对HIV／AIDS的眼部表现进行一综合介绍,重点讨论HIV／AIDS眼后段的表现和治疗,包括HIV视网膜炎、机会性感染、罕见肿瘤和神经眼科表现;简略介绍了眼前段的临床表现、发展中国家HIV／AIDS眼部表现的特点及眼科临床实践中的预防要点。     

Ocular manifestations of HIV/AIDS

HIV/AIDS affects millions of people worldwide. In the early stages of epidemic, eyes were affected because the CD4 T-lymphocytes count of HIV-infected patients dropped rapidly. Today, with the advent of highly active antiretroviral therapy, HIV-positive individuals live longer with a better quality of life. However, because a cure has not been found, many patients with HIV will develop ocular complications at some point. Ophthalmologists play an important role in the care of these patients. We must be prepared to work as part of a multidisciplinary staff, helping to understand the causes and try to achieve the best management of disease in order to prevent blindness. Most HIV-related ocular manifestations are discussed in this article, with a review of studies within the past 2 years. We hope government authorities, pharmaceutical industries, researchers and people from all nations stand together with two goals--less suffering and definitive cure.     

Posterior segment manifestations of HIV/AIDS

The ocular posterior segment manifestations of AIDS may be divided into four categories: retinal vasculopathy, unusual malignancies, neuro-ophthalmologic abnormalities, and opportunistic infections. Microvasculopathy is the most common manifestation. Opportunistic infections, particularly cytomegalovirus retinitis and progressive outer retinal necrosis, are the most likely to result in visual loss due to infection or subsequent retinal detachment. Diagnosis and treatment are guided by the particular conditions and immune status of the patient.     

Ophthalmic manifestations of acute and chronic leukemias presenting to a tertiary care center in India

Context:Screening for ocular manifestations of leukemia, although not a routine practice, is important as they may antedate systemic disease or form an isolated focus of its relapse.Aims:This study evaluates the spectrum of ocular manifestations in acute and chronic leukemias presenting to a tertiary care center in India.Results:The study subjects (n = 96) comprised 61 males and 35 females whose age ranged from 18 months to 91 years (mean = 39.73, ±22.1). There were 79 adults and 17 children, 53 new and 43 existing patients, 68 acute and 28 chronic, 61 myeloid and 35 lymphoid patients. Ocular lesions were found in 42 patients (43.8%). The ocular manifestations of leukemia were significantly (P = 0.01467) more frequent in acute 35/68 (51.9%) than chronic 7/28 (25%) leukemias. Primary or direct leukemic infiltration was seen in 8 (8.3%) subjects while secondary or indirect involvement due to anemia, thrombocytopenia, hyperviscosity, total body irradiation, and immunosuppression were seen in 42 (43.8%) subjects. Ocular changes were present in 37/79 (46.8%) adults and 5/17 (29.4%) children (P = 0.09460). Twenty-eight males (28/61) 45.9% and 14/35 (40%) females had ocular manifestations (P = 0.2874). The ocular manifestations were significantly (P = 0.01158) more frequent in myeloid leukemias 32/61 (52.9%) than lymphoid leukemias 10/35 (28.6%).Conclusions:Leukemic ophthalmic lesions were found in 42/96 (43.8%) patients. Ocular involvement is more often seen in adults, acute and myeloid leukemias. All the primary leukemic manifestations were seen in males. A periodic ophthalmic examination should be mandatory for all leukemic patients, as ocular changes are often picked up in asymptomatic patients.AimTo study the spectrum of ocular manifestations in acute and chronic leukemias presenting to a tertiary center in India.     

Current profile of secondary glaucoma in a Northern India tertiary eye care hospital

Purpose: To study the current profile of secondary glaucoma in all age groups of patients presenting to a tertiary eye care hospital in Northern India

Materials and methods: In this retrospective study, files of 5725 patients who were newly diagnosed to have glaucoma in our tertiary eye care centre from January 2014 to December 2016 were reviewed. Detailed data were collected from patient’s records, including history, best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp biomicroscopy findings, gonioscopy, and fundus findings. Demographic data, aetiology, and management in all these patients were also noted.

Results: Out of 5820 patients who visited glaucoma outpatient department (OPD) in a tertiary eye care hospital during 1 January 2014 to 31 December 2016, 5725 patients were diagnosed to have glaucoma by the glaucoma specialists. Five thousand three hundred and six patients (92.68%) were diagnosed to have primary glaucoma and 419 patients (7.32%) were diagnosed to have secondary glaucoma. The leading causes of secondary glaucoma were found to be neovascular glaucoma (17.42%), trauma (14.80%), post-keratoplasty (13.60%), post-cataract surgery (13.13%), and lens-induced glaucoma (12.41%). Secondary glaucoma was found to be an important cause of visual morbidity with 71.17% eyes presenting with BCVA < 6/60, IOP > 30 mm Hg in 62% eyes and 72% with cup-to-disc ratio of ≥0.7:1.

Conclusion: Secondary glaucoma is an important cause of visual morbidity. Timely diagnosis and prompt management are essential to prevent irreversible visual loss due to secondary glaucoma.     

Cost analysis of pediatric cataract surgery in a tertiary eye care hospital in Western India

Purpose:To assess the cost of pediatric cataract surgery in a tertiary eye care hospital from a provider’s perspective.Methods:Retrospective review of direct costs incurred for pediatric cataract surgery for the financial year April 1, 2018, to March 31, 2019. The cost analysis was done by standard costing methods. The fixed cost included the cost of land, buildings, construction, maintenance, personnel, operation theater (OT), and Out patient department (OPD) equipment. The variable cost included the cost of consumables used during surgery. The indirect costs were not considered.Results:The per-patient fixed facility cost was INR 1.52 ($0.02), maintenance cost was INR 39.06 ($0.55), OPD equipment and consultation were INR 19.64 ($0.28), OT equipment was INR 467.95 ($6.61), the cost for personnel was INR 5,300.33 ($74.92), and the cost of consumables varied between INR 16,418 ($314.44) and INR 22,313 ($397.76), with the choice of intraocular lenses (IOL) being the main determining factor. The net average cost for a pediatric cataract surgery varied between INR 22,246.50 ($ 314.44) and INR 28,141.50 ($ 397.76).Conclusion:Pediatric cataract surgeries are cost-intensive. High-volume surgeries and an increase in the number of patients in OPD reduce the fixed facility cost. But there is an overall increase in human resource (HR) and consumable cost owing to economic and technological reforms. However, the impact of operating a child, thereby, increasing his/her blindness-free years probably outweighs the cost and justifies it. High patient inflow, increased number of surgeries, and bulk purchase of consumables help in decreasing the cost.     

Isolation and antimicrobial susceptibility pattern of Nocardia among people with culture-proven ocular infections attending a tertiary care eye hospital in Tamilnadu, South India

AIMS: To evaluate the epidemiology, microbiological features, as well as antibiotic susceptibility patterns of Nocardiafrom cases with ocular nocardial infections seen over a period of 8 years in a tertiary eye care hospital. METHODS: Microbiology records of 164 cases of culture-proven ocular nocardial infection diagnosed between March 1997 and February 2005 were reviewed retrospectively. The outcome data included isolation rate, predisposing factors, demography (age and sex), and category of infection, utility of conventional diagnostic methods, microbiological profile, and antibiogram-resistogram patterns. Results: A total of 164 (3.1%) Nocardiaspecies were identified among 5378 culture-proven cases. Ninety-six (58.5%) isolates were from corneal scrapings followed by vitreous biopsy (17.0%). Most (58.0%) of the cases were between 51 and 80 age groups. Male preponderance was obvious. All the 164 (100%) nocardial infections were identified by culture. Of 125 ocular specimens subjected to Gram's staining, nocaridal filaments were identified in 70 (56%) specimens. In addition to KOH mounting, modified AFB staining was also found to be helpful. Upon in vitrosusceptibility testing, 98.7 and 90.2% of nocardial isolates showed sensitivity towards amikacin and ciprofloxacin, respectively. Conclusions: Ocular nocardiosis is relatively rare among ocular infections. Amikacin and ciprofloxacin are highly effective in treating ocular nocardiasis. Prompt and accurate microbiological diagnosis and early administration of these antibiotics may have a positive effect on the ocular outcome as well as in controlling nocardial prevalence.     

Systemic and ocular comorbidity of cataract surgical patients in a western Sydney public hospital

BACKGROUND: This study aimed to assess the frequency of major systemic and ocular comorbidities among cataract surgical patients attending a large general public hospital. METHODS: Consecutive patients aged 60+ years who had undergone cataract surgery at Westmead Hospital from July 2001 to December 2002 were included. Preoperative information was obtained from patient medical records. RESULTS: A total of 773 cataract surgical procedures were performed during the 18-month period, including 668 (86.4%) aged 60+ years. Complete data were available for 653 eyes (97.8%); 62.2% were women. The mean age at surgery was 74.6 (+/- 7.2) years. Frequent systemic comorbidities included: angina (20.2%), previous myocardial infarct (15.0%), diabetes (27.5%) and hypertension (56.3%); 12.5% were current smokers. Major preoperative ocular comorbidities included age-related maculopathy (12.6%), diabetic retinopathy (9.0%) and glaucoma (10.6%). Preoperatively, 21.7% of this group had severe visual impairment (visual acuity [VA] <6/60), 30.6% had moderate impairment (VA <6/24 ->or=6/60) and 30.6% had mild impairment (VA <6/12 ->or=6/24); 28.5% had presenting VA >or=6/12. CONCLUSION: The data indicate a high frequency of comorbid systemic and ocular diseases among cataract surgical patients.