ABSTRACT
A 25-year-old aesthetician was operating Q-switch pulse (SPECTRA) cosmetic laser machine of 1,064 nm wavelength, for the purpose of skin bleaching. The probe suddenly slipped over the plastic sheet that had been placed to avoid COVID-19 exposure after which she complained of sudden loss of vision. She was diagnosed as having vitreous hemorrhage in her right eye and was treated conservatively for one month. She then complained of central scotoma and was diagnosed to have developed a full-thickness macular hole, for which she was advised vitrectomy surgery. The purpose of this case report is to emphasize the importance of taking precautions during the COVID-19 era and while doing that making sure how to handle the machines so as not to inflict any accidental injury to the operating physician. Macular Holes following skin bleaching with Nd:YAG laser occurring in operating aesthetician is rare as compared to that occurring in the patients.
ABSTRACT
This study aimed to compare the clinical performance between a smartphone-based fundus photography device and a contact imaging device for retinopathy of prematurity (ROP) screening. All patients were first examined with binocular indirect ophthalmoscopy (BIO), which served as the reference standard. The patients were then assessed by two devices. Imaging quality, ability to judge the zone and stage of ROP, agreement with the BIO results, vital signs, and pain scores were compared between these two devices. In total, 142 eyes of 71 infants were included. For the smartphone-based fundus photography, image quality was graded excellent or acceptable in 91.4% of examinations, although it was still significantly inferior to that of the contact imaging device (p < 0.001). The smartphone-based fundus photography images had moderate agreement with the BIO results regarding the presence or absence of plus disease (Cohen's κ = 0.619), but evaluating the zone (p < 0.001) and stage (p < 0.001) of ROP was difficult. Systemic parameters, except for heart rate, were similar between the two imaging devices (all p > 0.05). In conclusion, although the smartphone-based fundus photography showed moderate agreement for determining the presence or absence of plus disease, it failed to identify the zone and stage of ROP.
ABSTRACT
The present study aimed to determine the efficacy and safety of pro re nata (PRN) intravitreal brolucizumab therapy for neovascular age-related macular degeneration (AMD) without a loading dose in the real-world setting. The PROBE study (Pro Re Nata Brolucizumab for Exudative AMD) is a retrospective, observational, multicentric study that included 27 treatment-naïve patients (27 eyes) with neovascular AMD who received PRN brolucizumab therapy with the treatment interval being at least 8 weeks, should the need for a second consecutive injection arise. The primary outcome measure was changed to best-corrected visual acuity (BCVA) over time. Secondary outcome measures included the determination of change in central subfield thickness (CST) and complications. The mean follow-up was 11.2 ± 1.2 months. The mean baseline and final BCVA were 57.4 ± 4.5 letters and 65.3 ± 3.12 letters, respectively (p = 0.014). The mean gain in letters at the end of follow-up was 7.8 ± 3.5 letters. There was a significant decrease in CST at the end of the follow-up period (p = 0.013). Patients received a mean of 2.2 ± 0.9 injections (in addition to the first mandatory injection) during the follow-up period. There were no adverse events noted. In conclusion, initial PRN brolucizumab for exudative AMD without a loading dose demonstrated significant visual improvement and no adverse events.
ABSTRACT
PURPOSE: To evaluate the efficacy and safety of intravitreal sirolimus in the management of noninfectious uveitis of the posterior segment (NIU-PS). DESIGN: Combined analysis of 2 phase 3, randomized, double-masked, multinational, 6-month studies. PARTICIPANTS: Adults with active NIU-PS (intermediate uveitis, posterior uveitis, or panuveitis; defined as vitreous haze [VH] ≥1.5+ on modified Standardization of Uveitis Nomenclature scale). METHODS: Patients were randomized 1:1:1 to receive intravitreal sirolimus 44 µg (n = 208), 440 µg (n = 208), or 880 µg (n = 177) on days 1, 60, and 120. Patients discontinued medications for NIU-PS except for systemic corticosteroids, which were tapered according to protocol. Enrollment in the 880-µg group was terminated after interim results found no significant difference in efficacy compared with the 440-µg dose. MAIN OUTCOME MEASURES: The primary efficacy end point was the percentage of patients with VH of 0 at month 5 in the study eye without the use of rescue therapy. Secondary efficacy end points included VH of 0 or 0.5+, corticosteroid-tapering success, and changes in best-corrected visual acuity (BCVA). Safety measures included ocular and nonocular adverse events. RESULTS: A total of 592 patients were randomized. Significantly higher proportions of patients treated with 440 µg compared with 44 µg intravitreal sirolimus achieved VH of 0 (21.2% vs. 13.5%; P = 0.038) and VH of 0 or 0.5+ (50.0% vs. 40.4%; P = 0.049) at month 5. Best-corrected visual acuity was stable (absolute change <5 ETDRS letters) or improved >5 letters in 80.1% and 80.2% of patients in the 440-µg and 44-µg groups, respectively. At month 5, corticosteroids were tapered successfully in 69.6% and 68.8% of patients in the 440-µg and 44-µg groups, and among these patients, VH of 0 or 0.5+ was achieved by 43.5% and 28.1% in the 440-µg and 44-µg groups. Both doses were generally well tolerated. Mean changes from baseline intraocular pressure (IOP) in the study eye at each analysis visit were minimal in all treatment groups. CONCLUSIONS: Intravitreal sirolimus 440 µg improved ocular inflammation, as measured by VH, compared with the 44-µg dose, with minimal impact on IOP, while preserving BCVA.
Subject(s)
Posterior Eye Segment/diagnostic imaging , Sirolimus/administration & dosage , Uveitis, Posterior/drug therapy , Aged , Dose-Response Relationship, Drug , Double-Blind Method , Female , Follow-Up Studies , Humans , Immunosuppressive Agents/administration & dosage , Intraocular Pressure/drug effects , Intravitreal Injections , Male , Tomography, Optical Coherence/methods , Uveitis, Posterior/diagnosisABSTRACT
PURPOSE: To study the outcomes of management of rhegmatogenous retinal detachment in eyes with chorioretinal colobomas. METHODS: A retrospective review of 119 patients (119 eyes) with chorioretinal colobomas who underwent surgical repair for rhegmatogenous retinal detachment was performed. Data were collected on the site of the retinal break, type of surgery, anatomical success, and complications. RESULTS: The most common location of the primary retinal break was the intercalary membrane in 58.8% of eyes. The most common surgical intervention was vitrectomy with endolaser and silicone oil tamponade (77.3% of eyes). Final anatomical success was achieved in 87.4% of eyes. Anatomical success was significantly higher in eyes that received long-acting tamponade (P = 0.006). Cryotherapy was significantly associated with failure of primary vitrectomy (P = 0.028). Placement of an encircling band did not affect anatomical outcomes (P = 0.75). Most of the eyes (60%) with recurrent retinal detachment after primary vitrectomy had a primary break within the normal retina. CONCLUSION: The optimal option for managing retinal detachment in eyes with chorioretinal colobomas is pars plana vitrectomy with long-acting tamponade (silicone oil or octafluoropropane) and retinopexy to the edge of the coloboma and the primary breaks. Cryotherapy is associated with poor anatomical outcomes. An encircling band does not seem to affect the final anatomical outcome.
Subject(s)
Choroid/abnormalities , Coloboma/surgery , Endotamponade/methods , Postoperative Complications , Retina/abnormalities , Retinal Detachment/surgery , Vitrectomy/methods , Coloboma/complications , Coloboma/diagnosis , Female , Follow-Up Studies , Humans , Male , Retinal Detachment/complications , Retinal Detachment/diagnosis , Retrospective Studies , Silicone Oils/administration & dosage , Visual Acuity , Young AdultABSTRACT
PURPOSE: To evaluate the efficacy and safety of intravitreal sirolimus in the treatment of noninfectious uveitis (NIU) of the posterior segment (i.e., posterior, intermediate, or panuveitis). DESIGN: Phase III, randomized, double-masked, active-controlled, 6-month study with intravitreal sirolimus. PARTICIPANTS: Adults with active NIU of the posterior segment (intermediate, posterior, or panuveitis), defined as a vitreous haze (VH) score >1+. Subjects discontinued NIU medications before baseline, except for systemic corticosteroids, which were allowed only for those already receiving them at baseline and were rapidly tapered after baseline per protocol. METHODS: Intravitreal sirolimus assigned 1:1:1 at doses of 44 (active control), 440, or 880 µg, administered on Days 1, 60, and 120. MAIN OUTCOME MEASURES: The primary efficacy outcome was the percentage of subjects with VH 0 response at Month 5 (study eye) without use of rescue therapy. Secondary outcomes at Month 5 were VH 0 or 0.5+ response rate, corticosteroid tapering success rate (i.e., tapering to a prednisone-equivalent dosage of ≤5 mg/day), and changes in best-corrected visual acuity (BCVA). Adverse events during the double-masked treatment period are presented. RESULTS: A total of 347 subjects were randomized. Higher proportions of subjects in the intravitreal sirolimus 440 µg (22.8%; P = 0.025) and 880 µg (16.4%; P = 0.182) groups met the primary end point than in the 44 µg group (10.3%). Likewise, higher proportions of subjects in the 440 µg (52.6%; P = 0.008) and 880 µg (43.1%; P = 0.228) groups achieved a VH score of 0 or 0.5+ than in the 44 µg group (35.0%). Mean BCVA was maintained throughout the study in each dose group, and the majority of subjects receiving corticosteroids at baseline successfully tapered off corticosteroids (44 µg [63.6%], 440 µg [76.9%], and 880 µg [66.7%]). Adverse events in the treatment and active control groups were similar in incidence, and all doses were well tolerated. CONCLUSIONS: Intravitreal sirolimus 440 µg demonstrated a significant improvement in ocular inflammation with preservation of BCVA in subjects with active NIU of the posterior segment.
Subject(s)
Posterior Eye Segment/pathology , Retina/pathology , Sirolimus/administration & dosage , Uveitis/drug therapy , Visual Acuity , Adolescent , Adult , Aged , Aged, 80 and over , Dose-Response Relationship, Drug , Double-Blind Method , Female , Follow-Up Studies , Humans , Immunosuppressive Agents/administration & dosage , Intravitreal Injections , Male , Middle Aged , Retrospective Studies , Time Factors , Tomography, Optical Coherence , Treatment Outcome , Uveitis/diagnosis , Young AdultABSTRACT
BACKGROUND/AIMS: To compare the functional and anatomic outcomes of pars plana vitrectomy (PPV) with juxtapapillary laser photocoagulation (JLP) versus vitrectomy without JLP in optic disc pit maculopathy. METHODS: This was a multicentre, retrospective study of 46 consecutive patients with optic disc pit maculopathy presenting at tertiary eye centres between 1992 and 2012. Indications for surgery included distorted or decreased vision. Surgical intervention included PPV, posterior vitreous detachment, with or without gas tamponade. Twenty-four patients received laser photocoagulation at the temporal edge of the optic disc pit (group A) and 22 patients had no laser (group B). Postoperative best-corrected visual acuity (BCVA) and optical coherence tomography findings were the main outcome measures. RESULTS: Mean follow-up was 44â months (range 12-98â months). BCVA in group A improved significantly from 0.7 logMAR (20/100) preoperatively to 0.5 logMAR (20/60) postoperatively (p=0.017). In group B, BCVA improved from 0.7 logMAR (20/100) preoperatively to 0.4 logMAR (20/40) postoperatively (p=0.014). The difference in final BCVA between groups was not statistically significant (p=0.693). The mean central macular thickness (CMT) in group A improved significantly from 750â µm preoperatively to 309â µm at last follow-up (p<0.0001). The mean CMT in group B improved from 616â µm preoperatively to 291â µm at last follow-up (p=0.028). The difference in final CMT between groups was not statistically significant (p=0.747). CONCLUSIONS: PPV with JLP for optic disc pit maculopathy had similar functional and anatomic outcomes compared with vitrectomy without JLP.
Subject(s)
Eye Abnormalities/surgery , Laser Coagulation , Optic Disk/abnormalities , Retinal Diseases/surgery , Vitrectomy , Adolescent , Adult , Aged , Child , Eye Abnormalities/pathology , Female , Follow-Up Studies , Humans , Intraoperative Complications , Male , Middle Aged , Postoperative Complications , Retinal Diseases/pathology , Retrospective Studies , Subretinal Fluid , Tomography, Optical Coherence , Visual AcuityABSTRACT
We treated 26 eyes of 25 young patients having a mean age of 30 years with intravitreal vascular endothelial growth factor (VEGF) inhibitor for choroidal new vessel (CNV) formation overlying choroidal osteoma over a mean follow-up of 26 months. Mean number of injections was 2.4 at 6 months, 3.2 at 12 months, and 5.5 at 24 months. CNV was subfoveal in 14 eyes, juxtafoveal in 5, extrafoveal in 5, and peripapillary in 2. By paired comparison, mean decrease from baseline was 119.7 microns at 6 months (n = 15; P = 0.001), 105.3 microns at 1 year (n = 10; P = 0.03), and 157.6 microns at 2 years (n = 7; P = 0.08). BCVA improved by 3.3 lines at 6 months after therapy (n = 26; P < 0.001), 2.8 lines (n = 20; P = 0.01) at 1 year, and 3.1 lines (n = 13; P = 0.049) at 2 years. We conclude that intravitreal anti-VEGF injections improve vision in majority of eyes with CNV from choroidal osteoma.
ABSTRACT
Myasthenia gravis is an important indication for the long-term prescription of corticosteroids. We present a patient with myasthenia gravis who had worsening of symptoms associated with the use of alendronate. A 24-year-old patient with myasthenia gravis had been administered oral systemic corticosteroid (deflazacort 40 mg/day) for 3 years in order to control his myasthenic symptoms. One year earlier, his lumbar spine bone mineral density was decreased. He was started on oral calcium/vitamin D3 and alendronate (70-mg tablets once a week) for osteoporosis. He reported an exacerbation of muscle weakness and extreme fatigue on days when he took alendronate. He could not work on these days and has to be on leave. Alendronate was stopped, and he was started on intravenous ibandronate injections given every 3 months. He did not experience muscle weakness and fatigue with ibandronate therapy. Alendronate should be used with caution in patients with myasthenia gravis who have corticosteroid-induced osteoporosis.
Subject(s)
Alendronate/adverse effects , Bone Density Conservation Agents/adverse effects , Myasthenia Gravis/chemically induced , Osteoporosis/drug therapy , Alendronate/therapeutic use , Bone Density Conservation Agents/therapeutic use , Diphosphonates/therapeutic use , Glucocorticoids/adverse effects , Glucocorticoids/therapeutic use , Humans , Ibandronic Acid , Male , Myasthenia Gravis/drug therapy , Osteoporosis/chemically induced , Young AdultABSTRACT
The authors report a case of degenerated intravitreal cysticercus cyst presenting as endogenous endophthalmitis, which has hitherto been unreported. A young adult presented with symptoms of chronic bilateral ocular inflammation, and was treated topically for endogenous endophthalmitis in the left eye. On dilated fundus examination the right eye was found to have a cystic structure in the inferior vitreous cavity. The cyst was removed by a three-port vitrectomy. On submitting the vitreous sample to histopathology it was confirmed to be degenerated cysticerus cyst with chronic inflammation.
Subject(s)
Cysticercosis/pathology , Cysts/diagnosis , Diagnostic Errors , Endophthalmitis/pathology , Uveitis/diagnosis , Adolescent , Animals , Cysticercosis/drug therapy , Cysticercosis/surgery , Cysticercus/isolation & purification , Cysts/pathology , Cysts/surgery , Fundus Oculi , Humans , Male , Treatment Outcome , Uveitis/pathology , Uveitis/surgery , Vitrectomy , Vitreous Body/pathology , Vitreous Body/surgeryABSTRACT
PURPOSE: To characterize the concentration-time profile of triamcinolone acetonide (TA) in human aqueous after a single, 20-mg, intravitreal injection. DESIGN: Case series. PARTICIPANTS: Seven patients and 10 eyes that received intravitreal injection of the decanted 20 mg of TA. METHODS: Fifty microliters of aqueous were sampled from each intravitreally TA-injected eye at postinjection monthly interval and the samples were subjected to liquid chromatography coupled with tandem mass spectrometric detection for TA. MAIN OUTCOME MEASURES: The TA concentration in the aqueous. RESULTS: The TA was cleared from the aqueous in a monoexponential manner with a half-life of 29.6 days and clearance coefficient of 0.0234 (1/day). The extrapolated maximum TA concentration in aqueous was about 3312 ng/ml and the area under the curve was 74,017 day x ng/ml. CONCLUSIONS: The TA concentration in human aqueous could stay above therapeutic concentration for 150 days (5 half-lives with remaining TA concentration of 104 ng/ml) after a 20-mg intravitreal injection, suggesting an even longer therapeutic concentration of TA in vitreous.
Subject(s)
Aqueous Humor/metabolism , Glucocorticoids/pharmacokinetics , Triamcinolone Acetonide/pharmacokinetics , Adult , Biological Availability , Chromatography, High Pressure Liquid , Female , Glucocorticoids/chemistry , Half-Life , Humans , Injections , Male , Middle Aged , Tandem Mass Spectrometry , Triamcinolone Acetonide/chemistry , Vitreous BodyABSTRACT
PURPOSE: To assess the long-term role of bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) in inflammatory ocular neovascularization. DESIGN: Retrospective multicenter consecutive case series of inflammatory ocular neovascularization. METHODS: settings: Multicenter institutional and private practices. STUDY POPULATION: Patients with inflammatory ocular neovascularization in one or both eyes of varying etiologies who failed standard therapy. intervention: Intravitreal injection of bevacizumab. MAIN OUTCOME MEASURES: Improvement of best-corrected visual acuity (BCVA) expressed as logarithm of minimal angle of resolution (logMAR), and decrease in central foveal thickness as measured by optical coherence tomography at 6, 12, 18, and 24 months of follow-up. RESULTS: Mean logMAR BCVA (central foveal thickness) following intravitreal bevacizumab was as follows: baseline, 0.65 (6/27 or 20/90) (338 microm; 99 eyes of 96 patients); 6 months, 0.42 (6/16 or 20/53) (239 microm; 2.0 injections; 81 eyes); 12 months, 0.39 (6/15 or 20/49) (241 microm; 2.3 injections; 95 eyes); 18 months, 0.40 (6/15 or 20/50) (261 microm; 3.0 injections; 46 eyes); and 24 months, 0.34 (6/13 or 20/44) (265 microm; 3.6 injections; 27 eyes). Paired comparisons revealed significant visual improvement at 6 months of 2.4 lines (P = .000), at 12 months of 2.5 lines (P = .000), at 18 months of 2.5 lines (P = .001), and at 24 months of 2.2 lines (P = .013). Paired comparisons revealed significant central foveal flattening at 6 months of 78 microm (P = .000), at 12 months of 85 microm (P = .000), at 18 months of 90 microm (P = .003), and at 24 months of 77 microm (P = .022). Three eyes developed submacular fibrosis and 1 eye submacular hemorrhage. CONCLUSION: Intravitreal bevacizumab led in the long-term to significant mean visual improvement of > or =2.2 lines and significant foveal flattening in a wide variety of inflammatory ocular diseases without major complications.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal/therapeutic use , Choroidal Neovascularization/drug therapy , Choroiditis/drug therapy , Uveitis/drug therapy , Visual Acuity/physiology , Adult , Angiogenesis Inhibitors/adverse effects , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized , Bevacizumab , Choroidal Neovascularization/physiopathology , Choroiditis/physiopathology , Female , Fluorescein Angiography , Follow-Up Studies , Humans , Injections , Male , Retrospective Studies , Tomography, Optical Coherence , Treatment Outcome , Uveitis/physiopathology , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Vitreous BodyABSTRACT
Ocular manifestations can occur in up to 50% of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients and posterior segment involvement is the most common presentation. The posterior segment manifestations of AIDS can be divided into four categories: retinal vasculopathy, opportunistic infections, unusual malignancies and neuro-ophthalmologic abnormalities. Retinal microvasculopathy and cytomegalovirus (CMV) retinitis are the most common manifestations, even in the era of highly active anti-retroviral therapy (HAART). Highly active anti-retroviral therapy has been shown to cause regression of CMV retinitis, reduce the incidence of CMV-related retinal detachments, and prolong patient survival. Immune recovery uveitis is a new cause of vision loss in patients on HAART. Diagnosis and treatment are guided by the particular conditions and immune status of the patient.
Subject(s)
AIDS-Related Opportunistic Infections , Uveitis, Posterior , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/virology , Anti-Retroviral Agents/therapeutic use , HIV , Humans , India/epidemiology , Morbidity/trends , Prognosis , Uveitis, Posterior/drug therapy , Uveitis, Posterior/epidemiology , Uveitis, Posterior/virologyABSTRACT
PURPOSE: To assess the role of bevacizumab in inflammatory ocular neovascularization. DESIGN: Retrospective, multicenter, consecutive case series of inflammatory ocular neovascularization. METHODS: Patients with inflammatory ocular neovascularization of varying causes for whom standard therapy failed were treated with intravitreal injection of bevacizumab. Main outcome measures included improvement of best-corrected visual acuity (BCVA) expressed in logarithm of minimum angle of resolution units, response of inflammatory ocular neovascularization by funduscopy and angiography, and decrease in central foveal thickness as measured by optical coherence tomography at the three-month follow-up. RESULTS: At the three-month follow-up, 84 eyes of 79 patients had been treated with a mean of 1.3 injections (range, one to three). Thirty-four eyes showed juxtafoveal choroidal neovascularization (CNV), 34 eyes showed subfoveal CNV, eight eyes showed peripapillary CNV, and 11 eyes showed neovascularization of the disc (NVD) or neovascularization elsewhere (NVE). BCVA improved 2.4 lines from 0.68 (6/28 or 20/94) to 0.44 (6/17 or 20/55) (P < .001). BCVA improved by one to three lines in 34.5% of the eyes, by four to six lines in 16.7% of the eyes, and by more than six lines in 14.2% of the eyes. Function was unchanged in 23.8% of the eyes. BCVA worsened in 10.7% (zero to three lines in 7.1%, more than four lines in 3.6%). Central foveal thickness decreased from baseline 346 to 252 microm (P < .001). For CNV, 32 eyes (43.2%) had complete regression after the injection, 27 (36.5%) had partial regression, five (6.8%) had no response, and 10 eyes (13.5%) were not evaluated by the contributors. For NVD or NVE, seven eyes (63.6%) had complete regression of new vessels and four eyes (36.4%) had partial regression after the injection. CONCLUSIONS: Intravitreal bevacizumab led to short-term significant visual improvement and regression of inflammatory ocular neovascularization in a wide variety of inflammatory ocular diseases.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal/therapeutic use , Choroidal Neovascularization/drug therapy , Retinal Neovascularization/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Antibodies, Monoclonal, Humanized , Bevacizumab , Child , Choroidal Neovascularization/etiology , Choroidal Neovascularization/physiopathology , Eye Diseases/complications , Female , Follow-Up Studies , Humans , Injections , Male , Middle Aged , Optic Disk/blood supply , Retinal Neovascularization/etiology , Retinal Neovascularization/physiopathology , Retrospective Studies , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology , Vitreous BodyABSTRACT
Human immunovirus infection in India is rapidly increasing. Ocular lesions due to highly active antiretroviral therapy have been well recognized. Acquired immunodeficiency syndrome can affect all parts of the eye. However, posterior segment lesions are the most common and of these, Human immunodeficiency virus retinopathy and cytomegalovirus retinitis predominate. Often clinical examination can establish the diagnosis of many ocular lesions in acquired immunodeficiency syndrome; therefore, ophthalmologists need to be aware of the more common ones. Various drugs in different routes can used to treat cytomegalovirus retinitis. Highly active antiretroviral therapy has remarkably reduced systemic and ocular morbidity among acquired immunodeficiency syndrome patients. To facilitate care of these patients aseptic precautions for ophthalmic care personnel are now well established and therefore ophthalmologist should not hesitate to provide ophthalmic care to acquired immunodeficiency syndrome patients.
Subject(s)
Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/therapy , Eye Infections/diagnosis , Eye Infections/therapy , HIV-1 , Acquired Immunodeficiency Syndrome/pathology , Diagnosis, Differential , Eye Infections/pathology , HumansABSTRACT
PURPOSE: To study the various changes in the course of cytomegalovirus (CMV) retinitis following combination antiretroviral treatment. METHODS: Combination antiretroviral treatment was given to 12 patients with active CMV retinitis following which all anti-CMV medications were discontinued once the CD4 cell counts were > 100/mm3 for 3 months. RESULTS: The median CD4 cell count increased from 36.5/mm3 (range, 3-74/mm3) at baseline to 175.5/mm3 (range, 97-410/mm3) at 3 months. No patient had reactivation of CMV retinitis or developed extraocular CMV infection during median follow-up of 16.7 months. In one patient with peripheral active CMV retinitis, the retinitis resolved completely and remained so throughout the follow-up period without specific anti-CMV treatment. Five (41.7%) patients had immune recovery vitritis. CONCLUSION: Patients receiving combination antiretroviral treatment following treatment for CMV retinitis have better control of CMV retinitis but immune recovery vitritis is a common sequelae. Reactivation of CMV retinitis is common in patients who discontinue combination antiretroviral treatment.