Posterior segment manifestations in human immunodeficiency virus/acquired immunodeficiency syndrome patients in rural population of central india

Background: Ocular manifestations of HIV infections are common in the developing countries with lacking data in rural areas. The aim of study was to assess the prevalence of ophthalmic manifestations among HIV infected individuals in rural population and to find the relationship between CD4 count and ocular manifestations among these individuals.Methods: Authors have included 400 HIV patients of age more than 15 years that were registered in ART center of our institute. Ocular examination was done with slit lamp biomicroscope and indirect ophthalmoscope. Blood sample was sent for CD4 count analysis.Results: The mean age of patients ware 31.9±9.3 years, the ocular manifestations were more commonly found in the age group 25-35 years. 51 % were males and 49% were females. Most common mode of transmission was heterosexual contact (51%).55 % patients had CD4 count >150 cell/cumm. Cotton wool spots (36%) and intra-retinal haemorrhages (32%) was most common posterior segment findings followed by ocular toxoplasmosis (13%), CMV retinitis (10%), acute retinal necrosis (3 %).Conclusions: The prevalence of ocular manifestations in HIV patients is high and is a burden for our society, authors recommend screening of all the HIV patients to detect any vision threatening ocular lesions at the earliest.

Progressive Localized Retinal Nerve Fiber Layer Defect Following Cotton Wool Spots and a Dot Hemorrhage

We report two cases of progressive localized retinal nerve fiber layer (RNFL) defect following cotton wool spots and a dot hemorrhage, 63-year-old woman with RNFL defect in inferior temporal retina of the right eye and 43-year-old man with RNFL defect in superior temporal retina of the right eye. Case 1 showed a dot hemorrhage adjacent to RNFL defect in the right eye and a new slit-like localized RNFL defect in the left eye 5 months later. The visual field in the left eye demonstrated corresponding field defect 9 months later. Case 2 showed a slit-like RNFL defect starting from cotton wool spots in the right eye and corresponding visual field defect. Cotton wool spots and dot hemorrhages represented ischemic damages at the nerve fiber layer. Two noticeable cases showed the progression of RNFL defect caused by repetitive localized microvascular ischemic events, resulting in visual field loss.