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Immune recovery uveitis in patients with AIDS and cytomegalovirus retinitis after highly active antiretroviral therapy

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2000年第5期129卷 634-639页

作者： Nguyen, QD Kempen, JH Bolton, SG Dunn, JP Jabs, DA Johns Hopkins Univ Sch Med Dept Ophthalmol Baltimore MD USA Johns Hopkins Univ Sch Med Dept Med Baltimore MD USA

PURPOSE: To estimate the incidence and describe the characteristics of immune recovery uveitis in patients with:acquired immunodeficiency syndrome (AIDS) and cytomegalovirus retinitis treated with highly active antiretroviral therapy. METHODS: The records of all patients with AIDS and cytomegalovirus retinitis from 1995 to 1998 seen at the AIDS Ophthalmology Service of the Johns Hopkins Medical Institutions were reviewed, Eighty two patients with cytomegalovirus retinitis treated with highly active antiretroviral therapy were identified. Thirty-three patients (40.2%) were classified as responders to highly active antiretroviral therapy, defined as an increase in CD4+ T-cell count by 50 cells/mu L, or more to a level of 100 cells/mu L, or more. RESULTS:Immune recovery uveitis occurred in six patients, Among the 33 patients with an immunologic response to highly active antiretroviral therapy, the incidence rate of immune recovery uveitis was 0.109/person-year. Ocular complications associated with immune recovery uveitis included cystoid macular edema (four:patients), epiretinal membranes (two patients), and optic disk neovascularization (one patient). CONCLUSIONS: Immune recovery uveitis was uncommon in our population but may have vision-impairing complications. (C) 2000 by Elsevier Science Inc, All rights reserved.

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Immune recovery uveitis

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2000年第1期130卷 103-106页

作者： Kuppermann, BD Holland, GN Univ Calif Los Angeles Jules Stein Eye Inst Ocular Inflammatory Dis Ctr Los Angeles CA 90095 USA Univ Calif Los Angeles Sch Med Dept Ophthalmol Los Angeles CA 90095 USA Univ Calif Irvine Sch Med Irvine CA 92717 USA

%In March 1998, the American Journal of Ophthalmology featured a cluster of publications[1, 2 and 3] that focused on the emerging problem of intraocular inflammation in patients with human immunodeficiency virus disease. Included was one of the early descriptions of "immune recovery uveitis," a condition in which heightened intraocular inflammatory reactions, attributable to the improved immune function associated with new potent antiretroviral therapies, occurs in some patients with preexisting cytomegalovirus retinitis. [3 and 4] Now, 2 years later, immune recovery uveitis is believed to be the leading cause of severe, new vision loss in patients with cytomegalovirus retinitis related to the acquired immunodeficiency syndrome. [5] Nevertheless, the disorder remains poorly understood. A recently published study^6 and two additional articles^7,8 in this issue of the journal address some of the questions that have arisen about immune recovery uveitis, and highlight many of the problems that remain to be solved.

关键词：抗逆转录病毒治疗高效抗病毒药/治疗应用 CD4淋巴细胞计数 CD4阳性T淋巴细胞/生理学巨细胞病毒视网膜炎/并发症巨细胞病毒视网膜炎/药物疗法巨细胞病毒视网膜炎/免疫学巨细胞病毒视网膜炎/病毒学眼疾病/病因学免疫系统/生理学葡萄膜炎/并发症葡萄膜炎/药物疗法葡萄膜炎/免疫学葡萄膜炎/病毒学人类

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Frosted branch angiitis in a child with HIV infection

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2001年第3期131卷 394-396页

作者： Fine, HF Smith, JA Murante, BL Nussenblatt, RB Robinson, MR NEI Clin Res Training Program NIH Bethesda MD 20892 USA NEI Immunol Lab NIH Bethesda MD 20892 USA Univ Rochester Strong Mem Hosp Childrens Hosp Strong Dept Pediat Infect Dis Rochester NY 14642 USA NEI Off Clin Director NIH Bethesda MD 20892 USA

PURPOSE: In adults with human immunodeficiency virus (HIV) infection, frosted branch angiitis is commonly associated with cytomegalovirus retinitis and responds to anti-cytomegalovirus therapy. We describe the first pediatric case of HIV-associated frosted branch angiitis. METHODS: Case report. RESULTS: A 7-year-old HIV-infected male with frosted branch angiitis was refractory to induction doses of intravenous ganciclovir and foscarnet over a 2-month period. Although cytomegalovirus antigenemia resolved, the angiitis only improved after subsequent treatment with systemic corticosteroids, CONCLUSION: Frosted branch angiitis in this patient was not attributed to cytomegalovirus. The pathogenesis of HIV-associated frosted branch angiitis may differ between children and adults. (Am J Ophthalmol 2001;131:394-396, (C) 2001 by Elsevier Science Inc. All rights reserved.).

关键词：抗病毒药/治疗应用巨细胞病毒视网膜炎/并发症巨细胞病毒视网膜炎/诊断巨细胞病毒视网膜炎/药物疗法膦甲酸/治疗应用更昔洛韦/治疗应用糖皮质激素类/治疗应用 HIV感染/并发症 HIV感染/诊断 HIV感染/药物疗法视网膜疾病/诊断视网膜疾病/药物疗法视网膜疾病/病因学视网膜血管/药物作用视网膜血管/病理学血管炎/诊断血管炎/药物疗法血管炎/病因学儿童人类男(雄)性

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First operation anatomic success and other predictors of postoperative vision after complex retinal detachment repair with vitrectomy and silicone oil tamponade

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2000年第6期130卷 745-750页

作者： Scott, IU Flynn, HW Lai, MY Chang, S Azen, SP Univ Miami Sch Med Bascom Palmer Eye Inst Dept Ophthalmol Miami FL 33136 USA Univ So Calif Keck Sch Med Dept Prevent Med Stat Consultat & Res Ctr Los Angeles CA USA Columbia Univ Dept Ophthalmol Edward S Harkness Eye Inst New York NY 10027 USA

PURPOSE: To evaluate the role of first operation anatomic success compared with success after reoperation and preoperative characteristics in achieving ambulatory vision (greater than or equal to4/200) and good vision (greater than or equal to 20/100) after repair of complex retinal detachment with vitrectomy and silicons oil tamponade. METHODS: A prospective, observational, multicenter study of patients who underwent vitrectomy with silicone oil for retinal detachments associated with cytomegalovirus necrotizing retinitis or a non-cytomegalovirus necrotizing retinitis etiology, including proliferative diabetic retinopathy, giant retinal tear, proliferative vitreoretinopathy, and ocular trauma. RESULTS: A higher rate of ambulatory vision was achieved in the first operation anatomic success cases, compared with the reoperation cases, for eyes with cytomegalovirus necrotizing retinitis (72% vs 50%, P < 0.01) and eyes without cytomegalovirus necrotizing retinitis (51% vs 38%, P = 0.04), For eyes with cytomegalovirus necrotizing retinitis, preoperative ambulatory vision (RR = 2.3, P < 0.0001) and reoperation (RR = 0.4, P = 0.05) were independent predictors of postoperative ambulatory vision, For eyes without cytomegalovirus necrotizing retinitis, preoperative ambulatory vision (RR 4.0, p < 0.0001) and retinal detachment etiology (P = 0.02) were prognostic factors. Compared to eyes with trauma, eyes with giant retinal tear, proliferative vitreoretinopathy and proliferative diabetic retinopathy were 2.8 (P < 0.003), 2.2 (P = 0.01) and 1.6 (P = 0.17) times as likely to achieve postoperative ambulatory vision, respectively. Within the giant retinal tear group, a higher rate of ambulatory vision was achieved in the first operation anatomic success cases compared with the reoperation cases (66% vs 31%, P = 0.03). Although not statistically significant, similar out comes occurred in the proliferative diabetic retinopathy (48% vs 25%) and proliferative vitreoretinopathy groups

关键词：巨细胞病毒视网膜炎/并发症随访研究前瞻性研究再手术视网膜脱离/病因学视网膜脱离/外科学视网膜坏死综合征急性/并发症硅油类/投药和剂量治疗结果视敏度玻璃体切除术成年人女(雌)性人类男(雄)性中年人

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Migration of silicone oil into the brain: A complication of intraocular silicone oil for retinal tamponade

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2000年第5期129卷 685-688页

作者： Eller, AW Friberg, TR Mah, F Univ Pittsburgh Dept Ophthalmol Pittsburgh PA 15260 USA

PURPOSE: To report a case in which intravitreal silicone oil-migrated along the intracranial portion of the optic nerve and into the lateral ventricles of the brain after the repair of a retinal detachment secondary to cytomegalo virus retinitis. METHODS: A 42-year old man with acquired immunodeficiency syndrome (AIDS) developed a rhegmatogenous retinal detachment in his left eye secondary to a cytomegalovirus infection of the retina. The detachment was repaired using 5000 cs intraocular silicone oil for a long-term tamponade. Subsequently, the affected eye developed glaucoma, which was poorly controlled. Fifteen:months after the retinal surgery, he developed a peripheral neuropathy that was thought to be AIDS related. Computed tomography and magnetic resonance imaging of the head were performed to investigate the neuropathy RESULTS: The patient was found to have a foreign substance within his lateral ventricles that shifted with position and was identical with respect to its imaging properties to the remaining intraocular silicone oil. Additional material was found along the intracranial portion of his optic nerve. CONCLUSION: Under certain circumstances, intraocular silicone oil may migrate out of the eye, along the intracranial portion of the optic nerve, and into the lateral ventricles of the brain. (C) 2000 by Elsevier Science Inc. All rights reserved.

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Long-term posterior and anterior segment complications of immune recovery uveitis associated with cytomegalovirus retinitis

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2000年第1期130卷 57-64页

作者： Karavellas, MP Song, M MacDonald, JC Freeman, WR Univ Calif San Diego Dept Ophthalmol Shiley Eye Ctr La Jolla CA 92093 USA

PURPOSE: To identify and describe long-term posterior and anterior segment complications of immune recovery uveitis in patients with inactive cytomegalovirus retinitis who are undergoing highly active antiretroviral therapy-mediated recovery of immune function. METHODS: A prospective cohort study at a university medical center. Twenty-nine eyes of 21 patients with immune recovery uveitis and inactive cytomegalovirus retinitis were followed for 14.5 to 116 weeks (median, 43 weeks) after diagnosis of immune recovery uveitis, RESULTS: Nine eyes of nine patients developed visually important complications involving the posterior segment, anterior segment, or a combination of both. Posterior segment complications included severe proliferative vitreoretinopathy in three eyes and spontaneous vitreous hemorrhage from avulsion of a blood vessel secondary to tory syndrome that may result in complications months to years after the onset of inflammation. (C) 2000 by Elsevier Science Inc. All rights reserved.

关键词：眼前半段/病理学抗逆转录病毒治疗高效抗病毒药/治疗应用 CD4淋巴细胞计数 CD4阳性T淋巴细胞/生理学白内障/病因学白内障/病理学队列研究巨细胞病毒视网膜炎/并发症巨细胞病毒视网膜炎/药物疗法巨细胞病毒视网膜炎/免疫学巨细胞病毒视网膜炎/病毒学免疫系统/生理学虹膜炎/病因学虹膜炎/病理学虹膜炎/外科学前瞻性研究复发时间因素葡萄膜炎/并发症葡萄膜炎/药物疗法葡萄膜炎/免疫学葡萄膜炎/病毒学视敏度玻璃体视网膜病增生性/病因学玻璃体视网膜病增生性/病理学玻璃体视网膜病增生性/外科学玻璃体出血/病因学玻璃体出血/病理学玻璃体出血/外科学成年人人类男(雄)性

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Current and novel agents for the treatment of cytomegalovirus retinitis.

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Drugs in R&D 1999年第5期2卷 289-297页

作者： Akerele, T. Lightman, S. Department of Clinical Ophthalmology Institute of Ophthalmology London United Kingdom

The incidence of cytomegalovirus (CMV) retinitis appears to be declining with improved treatment protocols for HIV and prophylaxis protocols for other high risk patients. Despite this, CMV retinitis remains a major cause of visual loss in patients who are severely immunocompromised. Treatment options are evolving in the light of viral resistance, new methods of drug delivery, new drugs, and the increased potential for improvement of immune function that modern antiretroviral therapy provides. In this article, we review the changing options available for the management of CMV retinitis and discuss possible therapeutic agents for the future.

关键词：抗病毒药/治疗应用巨细胞病毒/药物作用巨细胞病毒视网膜炎/并发症巨细胞病毒视网膜炎/药物疗法抗药性微生物药物临床试用/治疗应用 HIV感染/并发症器官移植/副作用动物人类

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