Journal List > J Korean Ophthalmol Soc > v.50(1) > 1008586

Chang, Se, and Hyeong: Visual Outcome of Cytomegalovirus Retinitis in Korean Patients With Acquired Immune Deficiency Syndrome

Abstract

Purpose

To investigate the clinical characteristics and visual outcome of cytomegalovirus retinitis in Korean patients with acquired immunodeficiency syndrome (AIDS) in the highly active antiretroviral therapy (HAART) era.

Methods

The medical records of 252 patients from Seoul National University Hospital who were diagnosed with AIDS between 2003 and 2006 were reviewed retrospectively. In addition, 15 patients (19 eyes) Having cytomegalovirus (CMV) retinitis with a minimum follow-up period of more than a year were included. Visual acuity, immune status, involved retinal area, and bilaterality were analyzed.

Results

All patients were treated with the HAART regimen and an anticytomegaloviral agent with the exception of two patients. In all patients, immune recovery developed and retinitis was inactivated. Moderate (≤ 0.4) and severe (≤ 0.1) visual loss developed in 10 (52%) eyes and 9 (47%) eyes, respectively. Retinal detachment and involvement of posterior pole accounted for more than 80% (8 out of 10) of moderate, and 88% (8 out of 9) of severe visual loss. Patients with bilateral retinitis were more likely to develop retinal detachment and visual loss. Delayed immune recovery was associated with moderate visual loss.

Conclusions

Posterior pole involvement and retinal detachment were the major cause of visual loss in CMV retinitis in AIDS patients. Bilateral involvement and delayed immune recovery were related to retinal detachment and a poor visual outcome.

References

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Figure 1.
Visual acuity change throughout follow-up periods in Korean AIDS patients having CMV retinitis. (T-test). Visual acuity.
jkos-50-92f1.tif
Table 1.
Demographic and clinical characteristics of patients
Patient-specific characteristics
Age at diagnosis of CMV retinitis 37.3±6.8 (30-53) years
Male:Female 14:1 (22:2)
Bilaterality 4/15 (26.6%) (4/22, 18.1%)
Follow-up period 36.2±25.7 (12-87) months
Duration from diagnosis of AIDS to diagnosis of CMV retinitis 23.5±37.1 (0-119) months
MSM exposure 6/12 (50%)
Nadir CD4 T cell count§ 22.9±23.2 /µl
CD4 T cell count at CMV retinitis diagnosis 59.0±54.6 (5-160) /µl
<50 /µl 9 (60%)
50-99 /µl 2 (13.3%)
≥100 /µl 4 (26.6%)
HIV viral load 277,000±294,000 (53-750,000) /ml

CMV=cytomegalovirus

HIV=human immunodeficiency virus

MSM=male sex with male

§ Least CD4 T cell count

Data of dropped patients is included

Table 2.
Causes of moderate and severe visual loss
Initial VA (N=19) Final VA (N=19)
≤20/50: 10 (52.6%) ≤20/200: 4 (21.0%) ≤20/50: 10 (52.6%) ≤20/200: 9 (47.3%)
Posterior pole involvement 50.0% (5) 100% (4) 40% (4) 44.4% (4)
Vitreous haze 50.0% (5)
Retinal detachment 40% (4) 44.4% (4)
Cataract 10% (1) 11.1% (1)
Epiretinal membrane 10% (1)
Table 3.
Clinical characteristics of CMV retinitis patients
No TM Sex Age CMV Tx∗∗ Initial VA∏∏ Final VA Reason‡‡‡ Zone (post) †††† Zone (ant) CD4 Immune recovery time
1 Bi M 40 N†† 1.0 0.8 2 2 138 0
2-1 M 36 G IV/IV‡‡ 0.15 NLP††† RD§§§ 2 3 26 417
2-2 M 36 G IV/IV 0.08 0.06 Macula∏∏∏ 1 2 26 417
3 He§ M 39 G IV 0.7 0.5 2 2 160 0
4 He M 51 G IV 0.1 LP Macula 1 2 26 36
5 Ho M 30 G IV/IV 0.9 0.4 ERM### 1 1 11 173
6-1 Ho M 32 G IV/IV/F§§ 0.4 0.08 RD 2 3 10 156
6-2 Ho M 32 G IV/IV/F 0.6 HM Macula 2 2 10 156
7-1 He M 44 G IV/IV 0.9 0.6 2 2 40 161
7-2 He M 44 G IV/IV 0.9 0.6 3 3 40 161
8 He M 53 G IV 0.2 0.9 2 3 134 0
9 M 31 G IV/IV LP## NLP Macula 1 3 70 126
10 He M 33 N 0.2 0.04 Cat‗‗‗‗ 1 3 7 95
11 Ho M 30 G IV/O 0.5 0.7 2 2 40 28
12 Ho M 33 G IV/IV HM‗‗‗ NLP RD 1 3 5 145
13-1 Ho M 39 G IV/IV 0.4 0.8 2 2 11 163
13-2 Ho M 39 G IV/IV 0.4 LP RD 2 3 11 163
14 M 37 G IV/IV 0.9 1.2 1 2 110 0
15 Tf F 30 G IV/IV 0.7 1.0 2 2 98 92

No=patient number

TM=transmission

Bi=bisexual

§ He=heterosexual

Ho=homosexual;

Tf=transfusion

‗‗ CMV Tx=cytomegalovirus treatment regimen

†† N=no treatment

‡‡ G=ganciclovir induction therapy (IV: intravenous) / maintenance therapy (IV=intravenous; O=oral)

§§ F=foscarnet for recurrent case.

∏∏ VA=visual acuity

## LP=light perception

‗‗‗ HM= hand motion

††† NLP=no light perception

‡‡‡ Reason for moderate or severe visual acuity loss

§§§ RD=retinal detachment

∏∏∏ Macula=macula involvement

### ERM=epiretinal membrane

‗‗‗‗ Cat=cataract

‡‡‡‡ Zone (ant=most anterior part; post=most posterior part).

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