Cytomegalovirus retinitis in HIV-infected patients with and without highly active antiretroviral therapy.

PURPOSE: To assess the impact of highly active antiretroviral therapy on the epidemiology of cytomegalovirus retinitis in patients infected with the human immunodeficiency virus (HIV). METHODS: In a study performed in a single center for infectious diseases, we compared the data collected in 1995 (without highly active antiretroviral therapy) with 1997 data (with highly active antiretroviral therapy). RESULTS: In a comparison of 1997 with 1995 data, the mean CD4+ cell count of patients with cytomegalovirus (CMV) retinitis was higher (169 +/- 150 CD4/microl vs 15 +/- 47 CD4/microl) (P = .05), and the relapses of CMV retinitis were less frequent (17% vs 36%) (P = .02). Newly diagnosed CMV retinitis decreased from 6.1% (59 of 952 patients) in 1995 to 1.2% (nine of 726 patients) in 1997 (P < .0001). In 1997, patients with newly diagnosed or relapsing CMV retinitis had a lower mean CD4+ (37 +/- 42) cell count than patients with no relapsing CMV retinitis (197 +/- 160) (P = .01). CONCLUSION: The incidence and recurrences of CMV retinitis decreased from 1995 to 1997, probably as a result of restored immunity while the patients were undergoing highly active antiretroviral therapy; however, the increasing frequency of HIV resistance to highly active antiretroviral therapy justifies close ocular follow-up.

Silicone oil removal combined with macular pucker dissection: a retrospective review of 14 cases.

PURPOSE: Silicone oil must be removed from the eye to avoid late complications after the surgical management of proliferative vitreoretinopathy (PVR). Macular pucker, frequently observed after retinal detachment surgery, is responsible for visual impairment. The safety of a procedure combining epimacular membrane peeling and silicone oil removal was retrospectively evaluated. METHODS: Fourteen eyes that had previously undergone vitrectomy and silicone oil tamponade for rhegmatogenous retinal detachment with severe PVR, penetrating or blunt trauma, and intraocular foreign bodies were included. Silicone oil tamponade was maintained for a mean period of 30 weeks (range, 12-108 weeks). The removal of silicone oil was combined with the peeling of an epimacular membrane. RESULTS: Mean follow-up after silicone oil removal was 86 weeks (range, 13-234 weeks). The final retinal reattachment rate was 78%. Macular pucker recurred in one eye after a 24-month period. Best-corrected visual acuity improved two lines or more in eight eyes (57%) and reached 20/200 or better in eight eyes (57%) at last follow-up. CONCLUSION: Macular pucker dissection and silicone oil removal can be safely combined. This single procedure can obviate the need for further surgery in eyes that have already undergone multiple operations and allows good visual recovery.