ABSTRACT
Cytomegalovirus retinitis is the most frequent ocular opportunistic infection in AIDS patients. Untreated, it is always a progressive and destructive disease of the retina that results in blindness. Specific treatment is therefore mandatory to halt the progression of the retinal lesions. The authors report their experience in the treatment of CMV retinitis with foscarnet in 25 AIDS patients; the drug is an analog of pyrophosphate, virostatic against all herpes-class viruses including CMV. Foscarnet was successful in halting the progression of CMV retinitis during induction treatment (180 mg/kg/day) by either a TID (three times a day) or a BID (twice a day) regimen, and in healing retinal lesions during maintenance (90 mg/kg/day) in 14 out of 19 patients. Five patients had a relapse of retinitis during maintenance. In these patients a brief course of intravitreal foscarnet, in association with the lowest dosage of the drug administered systematically (90 mg/kg/day), was effective in healing the retinal lesions. The main systemic side effects, such as renal impairment and electrolytic disturbances, were observed only during the induction treatment, and only in one case was it necessary to stop the therapy.
Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Antiviral Agents/therapeutic use , Cytomegalovirus Retinitis/drug therapy , Foscarnet/therapeutic use , AIDS-Related Opportunistic Infections/pathology , AIDS-Related Opportunistic Infections/virology , Adult , Antiviral Agents/administration & dosage , Cytomegalovirus/genetics , Cytomegalovirus Retinitis/pathology , Cytomegalovirus Retinitis/virology , DNA, Viral/analysis , Disease Progression , Drug Administration Routes , Female , Foscarnet/administration & dosage , HIV , Humans , Male , Middle Aged , Polymerase Chain Reaction , Prospective StudiesABSTRACT
Cytomegalovirus retinitis is the most frequent ocular opportunistic infection in AIDS patients. In selected cases intravitreal injections of foscarnet may be the sole therapeutic possibility. The retinal toxicity of the drug, however, has not yet been thoroughly investigated. Our present study in the rabbit eye concerns the retinal toxicity of 2, 4, and 6 intravitreal injections of 3.6 mg of foscarnet, using ophthalmoscopy, histology and electrophysiology to evaluate retinal damage. The results show that foscarnet may be employed intravitreally without substantial damage to the retina, but only in short courses of injections when no other therapeutic possibility may be utilized.
Subject(s)
Foscarnet/toxicity , Retina/drug effects , Animals , Drug Administration Schedule , Electroretinography/drug effects , Female , Foscarnet/administration & dosage , Fundus Oculi , Male , Ophthalmoscopy , Rabbits , Retina/pathology , Retina/physiopathology , Retinitis/chemically induced , Retinitis/pathology , Retinitis/physiopathology , Vitreous BodyABSTRACT
The clinical picture of an acute frosted periphlebitis has been reported in a limited number of otherwise healthy patients, and in one case of human immunodeficiency virus (HIV) infection. The disease is usually bilateral and highly sensitive to steroids. The case of a 26-year-old, HIV-seropositive woman who developed unilateral diffuse perivenous sheathing in the course of recurrent cytomegalovirus retinitis is reported. The appearance of the retinovasculitis was identical to that described as an acute frosted periphlebitis, and the disease proved to be highly sensitive to a combined treatment of steroids and ganciclovir. The clinical findings in this case support the possibility that the appearance of an acute frosted periphlebitis can occur in response to several different stimuli, including cytomegalovirus.
Subject(s)
Cytomegalovirus Infections/complications , Eye Infections, Viral/complications , Phlebitis/etiology , Retinal Diseases/etiology , Retinitis/complications , AIDS-Related Opportunistic Infections/complications , Acute Disease , Adult , Female , Fluorescein Angiography , Fundus Oculi , Ganciclovir/therapeutic use , HIV Seropositivity , Humans , Phlebitis/drug therapy , Prednisolone/therapeutic use , Retinal Diseases/drug therapy , Retinitis/drug therapyABSTRACT
We examined 60 patients affected by idiopathic recurrent anterior uveitis and studied the relevance of stressful life events and psychological distress in relation to relapses of the disease. The results were statistically insignificant when compared to the control groups. We found that neither life events nor psychological distress played a contributory role in this disease.
