AIDS／HIV感染合并视网膜脱离

目的探讨获得性免疫缺陷综合征（AIDS）／艾滋病病毒（HIV）感染合并视网膜脱离（RD）的临床特点、药物及手术治疗。方法回顾11例（16眼）AIDS／HIV感染患者RD的实验室检查和临床诊治资料，分析其病因、与细胞免疫的关系、RD发生的高危因素、治疗方法及治疗效果的影响因素。6例（6眼）做了玻璃体视网膜手术。结果13眼孔源性RD由病毒性视网膜炎及可疑病毒性视网膜炎引起，2眼RD由梅毒性葡萄膜炎引起，1眼为原发性孔源性视网膜脱离；发病时，6例CDfT淋巴细胞计数低于100个／μL，3例CD4T淋巴细胞计数高于200个／μL；未手术跟视力无改变，手术眼术后视力有不同程度提高，病程短及单纯性孔源性网脱眼术后矫正视力好于病程长及感染性视网膜炎导致的网脱眼。结论病毒性视网膜炎是CD4^＋T淋巴细胞计数较低的AIDS患者发生孔源性RD的主要病因，原发性孔源性RD及非病毒感染葡萄膜视网膜炎是CD4^＋T淋巴细胞计数较高的AIDS／HIV感染患者RD的主要病因。CD4^＋T淋巴细胞计数较低是RD的高危因素；玻璃体视网膜手术是视网膜解剖复位、改善视力的首选治疗方法。RD的病因、病程及病情严重程度是影响手术后视力的因素。

Retinal detachment in patients with acquired immunodeficiency syndrome

Objective To explore the clinical characteristics and treatment of retinal detachment (RD)in acquired immunodeficiency syndrome(AIDS)/HIV infection patients.Methods The clinical and laboratory data of 11 AIDS/HIV infected patients(16 eyes)with RD were reviewed.The etiology、risk factors and treatment of RD were analyzed retrospectively and 6 cases ( 6 eyes)in which underwent vitreoretinal surgery.Results 13 eyes were caused by vires retinitis and suspected virus retinitis,2 eyes by syphilitic chorioretinitis,one eye by primary rhegmatogenous retinal detachment.The CD4+T lymphocyte count in 6 patients were less than 100 cell/μL and more than 200 cell/μL in 3 patients when RD occured;The visual acuity of eyes that unaccepted surgery unchanged,increased in operated eyes.The corrected visual acuity of rhegmatogenous RD with shorter duration was better than that with longer duration or infectious retinitis.Conclusion The main reason of RD in AIDS/HIV infection patients with lower CD4+T lymphocyte count was virus retinitis.That with higher CD4+T lymphocyte count was primary rhegmatogenous RD and non-virus retinal infection.Low CD4+T lymphocyte Was a risk factor.Surgery was the first choice for retinal anatomical reattachment and visual acuity improvement.The etiology、duration and the severity of RD affected the visional acuity of operated eyes.