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Ischemic maculopathy in patients with acquired immunodeficiency syndrome

AMERICAN JOURNAL OF OPHTHALMOLOGY 2001年第5期132卷 727-733页

作者： Cunningham, ET Levinson, RD Jampol, LM Engstrom, RE Lewis, H Holland, GN Univ Calif San Francisco Francis I Proctor Fdn Pearl & Samuel J Kimura Ocular Immunol Lab San Francisco CA 94143 USA Univ Calif San Francisco Dept Ophthalmol San Francisco CA 94143 USA Northwestern Univ Sch Med Dept Ophthalmol Chicago IL 60611 USA Jules Stein Eye Inst Ocular Inflammatory Dis Ctr Los Angeles CA 90024 USA Univ Calif Los Angeles Sch Med Dept Ophthalmol Los Angeles CA 90024 USA Cleveland Clin Fdn Div Ophthalmol Cleveland OH 44195 USA

PURPOSE: To describe the characteristics of ischemic maculopathy in patients with human immunodeficiency virus (HIV) infection, as a means of understanding this uncommon disorder more fully. METHODS: This is a multicenter, retrospective review of clinical data available for five HIV,infected patients who were given the diagnosis of ischemic maculopathy. RESULTS: All cases had been diagnosed on the basis of fluorescein angiograms obtained after patients complained of vision loss. Four of the five patients had bilateral macular disease. Visual acuity at presentation in the nine affected eyes ranged from 20/20 to count fingers. Vision loss was gradual in both eyes of one patient and was abrupt in onset in seven eyes. Each of the seven eyes with abrupt vision loss had opacification of the superficial retina and/or intraretinal hemorrhages near the fovea. Fluorescein angiography revealed enlargement of the foveal avascular zone and mild staining of the juxtafoveal vessels in affected eyes. Six eyes had active or clinically inactive cytomegalovirus retinitis at presentation, and a seventh eye developed cytomegalovirus retinitis 2 weeks later. All patients were receiving anticytomegalovirus drugs when they developed visual symptoms. Visual acuity remained stable in five eyes, became worse in two eyes, and improved in two eyes;final visual acuity ranged from 20/25 to count fingers. CONCLUSIONS: Ischemic maculopathy may cause profound and permanent vision loss in HIV-infected individuals. Fluorescein angiography should be considered in all HIV-infected patients with unexplained loss of vision. The pathogenesis of ischemic maculopathy remains unknown. (C) 2001 by Elsevier Science Inc. All rights reserved.

关键词：获得性免疫缺陷综合征/并发症获得性免疫缺陷综合征/药物疗法抗病毒药/治疗应用 CD4淋巴细胞计数巨细胞病毒视网膜炎/药物疗法巨细胞病毒视网膜炎/病因学荧光素血管造影术缺血/诊断缺血/病因学视网膜疾病/病因学视网膜出血/病因学视网膜血管/病理学回顾性研究视觉障碍/病因学视敏度成年人女(雌)性人类男(雄)性

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The ganciclovir implant plus oral ganciclovir versus parenteral cidofovir for the treatment of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome: The ganciclovir cidofovir cytomegalovirus retinitis trial

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2001年第4期131卷 457-467页

作者： Jabs, DA Johns Hopkins Univ Sch Med Baltimore MD 21205 USA

PURPOSE: To compare the regimen of the ganciclovir implant plus oral ganciclovir to one of intravenous cidofovir for the treatment of cytomegalovirus retinitis. METHODS: Sixty-one patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis were randomized either to the regimen of the ganciclovir implant plus oral ganciclovir, 1 gm three times daily, or intravenous cidofovir, 5 mg/kg once weekly for two doses, followed by 5 mg/kg every other week. RESULTS: Mortality was similar between the two treatment groups. Mortality rates were 0.41 per person-year in patients assigned to the ganciclovir regimen and 0.49 per person-year in patients assigned to cidofovir (P = .59). Ocular outcomes were similar between the two groups. Retinitis progression occurred at a rate of 0.67 per person-year in the ganciclovir group and 0.71 per person-year in the cidofovir group (P = .72), A loss of visual acuity of 15 letters or more occurred at a rate of 0.78 per person-year in the ganciclovir group and 0.47 per person-year in the cidofovir group (P = .28). The rate of loss of visual field was 7 degrees per month in the ganciclovir group and 2 degrees per month in the cidofovir group (P = .048). Vitreous hemorrhage was more common in the ganciclovir implant group (0.13 per person year) than in the cidofovir group (no cases, P = .014), whereas uveitis appeared to be more common in the cidofovir group (0.35 per person-year) than in the ganciclovir group (0.09 per person-year, P = .066). Nephrotoxicity (serum creatinine 1.6 mg/dL or greater) occurred at a rate of 0.18 per person-year in the ganciclovir group and 0.48 per person-year in the cidofovir group (P = .10). CONCLUSIONS: Although the small number of patients in this study limits definitive interpretation, these data suggest that in the era of highly active antiretroviral therapy, the regimens of the ganciclovir implant plus oral ganciclovir and of intravenous cidofovir are similar for controlling cytomegalovirus re

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Visual and anatomic outcomes associated with posterior segment complications after ganciclovir implant procedures in patients with AIDS and cytomegalovirus retinitis

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AMERICAN JOURNAL OF OPHTHALMOLOGY 1999年第3期127卷 288-293页

作者： Lim, JI Wolitz, RA Dowling, AH Bloom, HR Irvine, AR Schwartz, DM Univ So Calif Doheny Eye Inst Dept Ophthalmol Los Angeles CA 90033 USA Permanente Med Grp Dept Ophthalmol San Francisco CA USA

(PURPOSE)-P-.: To determine anatomic and visual acuity outcomes of posterior segment complications after ganciclovir implant surgery. (METHODS)-M-.: We reviewed the medical records of 63 patients with acquired immunodeficiency syndrome who had active cytomegalovirus retinitis in 82 eyes and who underwent 110 consecutive ganciclovir implant procedures. Preoperative and postoperative visual acuity, type of postoperative complication, treatment, and lines of visual acuity change were determined. (RESULTS)-R-.: Thirty-eight eyes of 19 patients had bilateral ganciclovir implant procedures, and 25 eyes of 19 patients underwent two Or more ganciclovir implant procedures. Thirteen (12%) of 110 ganciclovir implant procedures developed posterior segment complications: rhegmatogenous retinal detachment in six, vitreous hemorrhage in four, endophthalmitis in two, and cystoid macular edema with epiretinal membrane in one. Treatment included pars plana vitrectomy with silicone oil in two cases and without silicone oil in three cases, scleral buckling in one, intravitreal antibiotic injection in two, and laser photocoagulation in two. Overall, median visual acuity was 20/25 preoperatively. Median follow-up was 6 months for all eyes and 7 months for eyes with complications. Postoperative median visual acuity was 20/25 for eyes without complications vs 20/40 at 1 month, 20/60 at 3 and 6 months, and 20/100 at 12 months in eyes with complications (P <.001). More eyes with than without complications lost 2 or more lines of visual acuity (P <.001). (CONCLUSION)-C-.: Postoperative complications occurred in 12% of the ganciclovir implant procedures and were associated with decreased visual acuity despite treatment, (C) 1999 by Elsevier Science Inc. All rights reserved.

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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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Fomivirsen for the treatment of cytomegalovirus retinitis

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2002年第4期133卷 552-556页

作者： Jabs, DA Griffiths, PD Johns Hopkins Univ Sch Med Dept Ophthalmol & Med Baltimore MD USA Johns Hopkins Univ Bloomberg Sch Publ Hlth Dept Epidemiol Baltimore MD USA Royal Free Hosp Dept Virol London NW3 2QG England UCL Sch Med London W1N 8AA England

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Comparison of intraocular to plasma HIV-1 viral burden in patients with cytomegalovirus retinitis

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AMERICAN JOURNAL OF OPHTHALMOLOGY 1999年第2期127卷 221-223页

作者： Ciulla, TA Schnizlein-Bick, CT Danis, RP Frank, MO Wheat, LJ Indiana Univ Sch Med Dept Ophthalmol Indianapolis IN 46202 USA Indiana Univ Sch Med Dept Internal Med Div Infect Dis Indianapolis IN 46202 USA

PURPOSE: To determine the relationship between plasma and intraocular human immunodeficiency virus-1 (HIV-1) viral loads in 12 consecutive patients undergoing ganciclovir implant surgery for cytomegalovirus (CMV) retinitis. METHODS: Aqueous and vitreous specimens were assayed for HIV-1 viral load by polymerase chain reaction analysis (Roche Amplicor HIV Monitor;Roche Diagnostics Systems, Inc, Branchburg, New Jersey). RESULTS: It was possible to quantitatively assay HIV-1 burden in intraocular fluids using polymerase chain reaction analysis. In general, patients with plasma viral loads less than 250,000 copies/ml had undetectable (<200 copies/ml) HIV-1 in their aqueous and vitreous. CONCLUSIONS: It is likely that intraocular viral levels have several determinants in addition to plasma viral loads, with which they only partially correlate. (Am J Ophthalmol 1999;127:221-223. (C) 1999 by Elsevier Science Inc. All rights reserved.).

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Treatment of recurrent cytomegalovirus retinitis with the ganciclovir implant

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AMERICAN JOURNAL OF OPHTHALMOLOGY 1999年第3期127卷 276-282页

作者： Roth, DB Feuer, WJ Blenke, AJ Davis, JL Univ Miami Bascom Palmer Eye Inst Miami FL 33136 USA

(PURPOSE)-P-.: To evaluate preoperative characteristics and outcome of the treatment of recurrent cytomegalovirus (CMV) retinitis with the ganciclovir implant. (METHODS)-M-.: Records of 54 patients with acquired immunodeficiency syndrome and active, previously treated CMV retinitis who received a ganciclovir implant in one (n = 31) or both (n = 23) eyes were reviewed. Entry criteria included prior insertion and removal of an indwelling catheter or failure to respond to tolerated doses of ganciclovir and foscarnet, Preoperative factors that might correlate with outcome were analyzed, including demographic factors, duration of human immunodeficiency virus disease and CMV retinitis, indications for surgery, prior anti-CMV treatment, and extent of retinitis, (RESULTS)-R-.: Forty-six patients completed 1 month of follow-up and were analyzed for outcome. Thirty-one (67.4%) had inactive retinitis at 1 month vs 15 (32.6%) with active retinitis, and they received a mean of 23.5 +/- 22.9 weeks of preoperative ganciclovir vs 58.0 +/- 52.0 weeks in patients with active retinitis (P =.003), Involvement of more than 25% of retinal area by CMV retinitis was also correlated with activity at 1 month (P <.001), Patients who received implants because of lack of venous access had a median time to progression of 8.0 +/- 3.0 months vs 2.0 +/- 1.2 months fur patients who had inadequate response or intolerance to intravenous medication (1> = .073), Patients with 6 months or less vs more than 6 months of preoperative ganciclovir treatment had progression at a median time of 8.0 + 1.7 months vs 2.0 a 0.3 months, respectively (P =.016). (CONCLUSION)-C-.: Longer duration of preoperative ganciclovir or larger area of CMV retinitis correlates with lower success of ganciclovir implant therapy for recurrent retinitis, (C) 1999 by Elsevier Science Inc. All rights reserved.

关键词：艾滋病相关机会致病菌感染/药物疗法抗病毒药/治疗应用巨细胞病毒视网膜炎/药物疗法药物植入物随访研究更昔洛韦/治疗应用复发治疗结果视敏度成年人女(雌)性人类男(雄)性

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Immune-recovery uveitis in patients with cytomegalovirus retinitis taking highly active antiretroviral therapy

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2000年第1期130卷 49-56页

作者： Robinson, MR Reed, G Csaky, KG Polis, MA Whitcup, SM NEI NIH Bethesda MD 20892 USA NIAID NIH Bethesda MD 20892 USA

PURPOSE: To investigate the clinical features associated with immune recovery in human immunodeficiency virus (HIV)-infected patients with cytomegalovirus retinitis who are taking highly active antiretroviral therapy. METHODS: Sixteen patients were evaluated prospectively at the National Eye Institute, Bethesda, Maryland. Evaluation included a medical history and a complete ophthalmologic examination. The examination included best corrected visual acuity score measured by means of logarithmic charts, slit-lamp biomicroscopy, dilated retinal examination, retinal photography, and fluorescein angiography. Immune-recovery uveitis was defined as the ocular inflammation associated with clinical immune the presence of moderate to severe macular edema on fluorescein angiography and vitreous haze (P less than or equal to .001). CONCLUSIONS: Immune-recovery uveitis is an important cause of visual morbidity in HIV-infected patients with cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Although immune recovery associated with highly active antiretroviral therapy has allowed some patients to discontinue specific anticytomegalovirus therapy, the rejuvenated immune response can be associated with sight-threatening inflammation. Published by Elsevier Science Inc.

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Oxacillin-resistant Staphylococcus aureus endophthalmitis after ganciclovir intraocular implant

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2000年第4期129卷 554-555页

作者： Williamson, JC Virata, SR Raasch, RH Kylstra, JA Univ N Carolina Hosp & Clin Dept Pharm Chapel Hill NC USA Univ N Carolina Hosp & Clin Dept Ophthalmol Chapel Hill NC USA

PURPOSE: To describe a patient who developed oxacillin-resistant Staphylococcus aureus endophthalmitis after insertion of a ganciclovir intraocular implant. METHOD: Case report. RESULTS: A 42-year-old man with acquired immunodeficiency syndrome (AIDS) and a history of cytomegalovirus retinitis was admitted with right-sided eye pain and decreased visual acuity 10 days after receiving a second ganciclovir intraocular implant in the right eye, A therapeutic vitrectomy, right eye, was performed on the day of admission. A vitreal tap produced frank pus and white, fluffy debris. Cultures of the vitreal fluid grew oxacillin-resistant S aureus, sensitive only to vancomycin, ri fampin, and trimethoprim/sulfamethoxazole. The patient was successfully treated with removal of both ganciclovir implants in the right eye and a 4-week course of vancomycin and rifampin, However, the infection left the patient blind in the infected eye. CONCLUSION: Bacterial endophthalmitis is an infrequent but serious complication of the ganciclovir intraocular implant. (Am J Ophthalmol 2000;129:554-555. (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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