Comparative analysis for the fundus characteristics of acquired immune deficiency syndrome with cytomegalovirus retinitis between first-visit and non-first-visit in ophthalmology_Chinese Journal of Ocular Fundus Diseases

Authors：

 Li Suyan , Qiao Lei , Feng Ruifang , Liu Sha , Zhang Zhengpei , Ji Sujuan , Liu Haiyang

Department of Ophthalmology,The Affiliated Municipal Hospital of Xuzhou Medical University, Eye Institute of Xuzhou, Xuzhou 221002, China;

Corresponding author：

Li Suyan, Email: lisuyan1226@126.com

Keywords：

Acquired immunodeficiency syndrome/complications; Cytomegalovirus retinitis; First-visit in ophthalmology; Fundus features

DOI：

10.3760/cma.j.issn.1005-1015.2020.02.007

Video：

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Objective To comparatively analyze for the fundus characteristics of acquired immune deficiency syndrome (AIDS) with cytomegalovirus retinitis (CMVR) between first-visit and non-first-visit in ophthalmology.Methods A retrospective study was performed for 22 patients (41 eyes) diagnosed as CMVR with AIDS by ophthalmology in the Affiliated Municipal Hospital of Xuzhou Medical University from July 2004 to September 2017. The patients were divided into two groups: one with the first-visit in ophthalmology (FVO) and the other with the first-visit in non-ophthalmology (FVNO). All patients underwent visual acuity, intraocular pressure, slit lamp microscope and indirect ophthalmoscope examinations. Thirty-nine eyes of 21 patients with clear refractive media were examined by color fundus photography, of which 5 patients were examined by FFA. Five patients examined by OCT and B-mode ultrasound. The CMVR were characterized as fulminant type or indolent type. All the 22 patients (41 eyes) except 2 patients (4 eyes) accepted highly active antiroviral therapy, and all patients were treated with ganciclovir intravenously. Nine patients (12 eyes) received intravitreal injection of ganciclovir, 7 patients (10 eyes) underwent vitrectomy because of retinal detachment, 6 patients (7 eyes) gave up surgery because of extensive retinal detachment, and the other 12 eyes did not undergo any eye surgery. All patients were followed for 6-58 months (average 23±39 months). The incidences and fundus characteristics of the patients with fulminant or indolent CMVR were compared and analyzed. Between the two groups, the difference of visual acuity and CD4⁺T cell count at the first vist and the last follow-up were analyzed by a t-test, and the macular involvement and spread of the two groups were compared by a chi-square test.Results Fulminant CMVR showed dense yellow-white necrotic lesions along the great vessels with or without satellite lesions, while indolent CMVR showed sparse yellow-white granular lesions with a little bleeding. The concomitant signs included frost-like dendritic vascular sheath, retinal artery occlusion and optic disc edema. Fourteen eyes of 7 patients in FVO group were fulminant, including 2 patients (2 eyes) with retinal artery occlusion and 1 patient (two eyes) with optic disc edema. In FVNO group, there were 27 eyes of 15 patients, including 21 eyes of 13 cases identified as fulminant type and 6 eyes of 4 patients as indolent type. In the fulminant type, there were 4 patients (6 eyes) with frost-like dendritic vascular sheath, 10 patients (12 eyes) with retinal artery occlusion and 4 patients (4 eyes) with optic disc edema. There was no significant difference in initial visual acuity (t=－1.534, P=0.133), but there was a significant difference in visual acuity at the last follow-up (t=－3.420, P=0.001). There was no significant difference in CD4⁺ T cells between the two groups at the first visit (t=－0.902, P=0.378). The proportions of macular involvement and 3-4 quadrant involvement in FVO group were significantly higher than those in FVNO group (χ²=7.552, 7.865; P=0.006, 0.005).Conclusion For AIDS patients with CMVR, the first-visit in ophthalmology showed more dense necrotic lesions involving macular and a wider range of lesions than the first-visit in non-ophthalmology.

Citation： Li Suyan, Qiao Lei, Feng Ruifang, Liu Sha, Zhang Zhengpei, Ji Sujuan, Liu Haiyang. Comparative analysis for the fundus characteristics of acquired immune deficiency syndrome with cytomegalovirus retinitis between first-visit and non-first-visit in ophthalmology. Chinese Journal of Ocular Fundus Diseases, 2020, 36(2): 121-126. doi: 10.3760/cma.j.issn.1005-1015.2020.02.007 Copy

1.	马楠, 叶俊杰, 李东辉, 等. 免疫重建炎症综合征的眼部病变[J]. 中华眼科杂志, 2014, 50(8): 593-597. DOI: 10.3760/cma.j.issn.0412-4081.2014.08.009.Ma N, Ye JJ, Li DH, et al. Ocular lesions in immune reconstruction inflammatory syndrome[J]. Chin J Ophthalmol, 2014, 50(8): 593-597. DOI: 10.3760/cma.j.issn.0412-4081.2014.08.009.
2.	Sterne JA, Hernan MA, Ledergerber B, et al. Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study[J]. Lancet, 2005, 366(9483): 378-384. DOI: 10.1016/S0140-6736(05)67022-5.
3.	Huang G, Jiang Q, Li M, et al. Retrospective study of cytomegalovirus retinitis complicated with acquired immunodeficiency syndrome[J]. Int J Clin Exp Med, 2015, 8(6): 9537-9542.
4.	Wong JX, Wong EP, Teoh SC. Outcomes of cytomegalovirus retinitis-related retinal detachment surgery in acquired immunodeficiency syndrome patients in an Asian population[J/OL]. BMC Ophthalmol, 2014, 14: 150[2014-11-27]. https://link.springer.com/article/10.1186/1471-2415-14-150. DOI: 10.1186/1471-2415-14-150.
5.	李丹, 孙挥宇, 毛菲菲, 等. 获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎71例临床分析[J]. 眼科, 2015, 24(3): 206-209. DOI: 10.13281/j.cnki.issn.1004-4469.2015.03.016.Li D, Sun HY, Mao FF, et al. Clinical analysis of 71 cases of acquired immunodeficiency syndrome complicated with cytomegalovirus retinitis[J]. Eye, 2015, 24(3): 206-209. DOI: 10.13281/j.cnki.issn.1004-4469.2015.03.016.
6.	杨娅玲, 江睿, 何太雯, 等. 获得性免疫缺陷综合征合并巨细胞病毒视网膜炎80例患者的临床特点[J]. 中华眼科杂志, 2014, 50(3): 197-202. DOI: 10.3760/cma.j.issn.0412-4081.2014.03.009.Yang YL, Jiang R, He TW, et al. Clinical characteristics of 80 patients with acquired immunodeficiency syndrome complicated with cytomegalovirus retinitis[J]. Chin J Ophthalmol, 2014, 50(3): 197-202. DOI: 10.3760/cma.j.issn.0412-4081.2014.03.009.
7.	Thorne JE, Jabs DA, Kempen JH, et al. Causes of visual acuity loss among patients with AIDS and cytomegalovirus retinitis in the era of highly active antiretroviral therapy[J]. Ophthalmology, 2006, 113(8): 1441-1445. DOI: 10.1016/j.ophtha.2006.03.022.
8.	杨培增. 巨细胞病毒及其所致葡萄膜炎[M]//杨培增. 临床葡萄炎. 北京: 人民卫生出版社, 2004: 584-593.Yang PZ. Cytomegalovirus and uveitis caused by cytomegalovirus[M]//Yang PZ. Clinical uvities. Beijing: People’s Publishing House, 2004: 584-593.
9.	Shapira Y, Mimouni M, Vishnevskia-Dai V. Cytomegaloviurs retinitis in HIV-negative patients-associated conditions, clinical presentation, diagnostic methods and treatment strategy[J]. Acta Ophthalmol, 2018, 96(7): 761-767. DOI: 10.1111/aos.13553.
10.	Tripathy K, Mittal K, Venkatesh P, et al. Treatment of unilateral zone 1 cytomegalovirus retinitis in acute lymphoblastic leukemia with oral valganciclovir and intravitreal ganciclovir[J]. Oman J Ophthalmol, 2017, 10(3): 250-252. DOI: 10.4103/ojo.OJO_190_2016.
11.	Jabs DA. Cytomegalovirus retinitis and the acquired immunodeficiency syndrome-bench to bedside: LXVII Edward Jackson Memorial Lecture[J]. Am J Ophthalmol, 2011, 151(2): 198-216. DOI: 10.1016/j.ajo.2010.10.018.
12.	Shah JM, Leo SW, Lee TL, et al. A cytomegalovirus retinitis screening program: evaluation of enrollment criteria for HIV patients in Singapore[J]. Ocul Immunol Inflamm, 2015, 23(5): 362-370. DOI: 10.3109/09273948.2014.902472.
13.	Erice A, Tierney C, Hirsch M, et al. Cytomegalovirus (CMV) and human immunodeficiency virus (HIV) burden, CMV end organ disease, and survival in subjects with advanced HIV infection (AIDS Clinical Trials Group Protocol 360)[J]. Clin Infect Dis, 2003, 37(4): 567-578. DOI: 10.1086/375843.
14.	李甦雁, 张正培, 季苏娟, 等. 获得性免疫缺陷综合征合并巨细胞病毒视网膜炎一例[J]. 中华眼科杂志, 2005, 41(10): 953-954. DOI: 10.3760/j:issn:0412-4081.2005.10.022.Li SY, Zang ZP, Ji SJ, et al. Acquired immunodeficiency syndrome complicated with cytomegaloviruss retinitis: a case report[J]. Chin J Ophthalmol, 2005, 41(10): 953-954. DOI: 10.3760/j:issn:0412-4081.2005.10.022.
15.	孙挥宇, 李丹, 毛菲菲, 等. 获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎的特殊眼底病变特征[J]. 中华眼底病杂志, 2014, 30(3): 309-311. DOI: 10.3760/cma.j.issn.1005-1015.2014.03.020.Sun HY, Li D, Mao FF, et al. Characteristics of special fundus lesions in acquired immunodeficiency syndrome complicated with cytomegalovirus retinitis[J]. Chin J Ocul Fundus Dis, 2014, 30(3): 309-311. DOI: 10.3760/cma.j.issn.1005-1015.2014.03.020.
16.	Mao F, Wu J, Sun H, et al. Forsted branch angiitis in an AIDS patient with cytomegalovirus retinitis[J]. Int J Infect Dis, 2016, 52: 9-11. DOI: 10.1016/j.ijid.2016.09.003.
17.	Agarwal M. Shrivastav A, Waris A. Tubercular retinal vasculitis mimicking frosted branch angiitis: a case report[J/OL]. J Ophthalmic Infect, 2018, 8(1): 3[2018-01-22]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777968/. DOI: 10.1186/s12348-018-0145-8.
18.	Kumawat B, Tripathy K, Venkatesh P, et al. Central retinal vein occlusion-like appearance: a precursor stage in evolution of frosted branch angiitis[J]. J Ophthalmic Vis Res, 2017, 12(4): 440-442. DOI: 10.4103/jovr.jovr_84_15.
19.	Wood EH, Wong RW. Bilateral frosted branch angiitis as the presenting sign of antiphonspholipid antibody syndrome[J/OL]. J Ophthalmic Inflamm Infect, 2016, 6(1): 20[2016-06-10]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4901211/. DOI: 10.1186/s12348-016-0089-9.
20.	Leeamornsiri S, Choopong P, Tesavibul N. Frosted branch angiitis as a result of immune recovery uveitis in a patient with cytomegalovirus retinitis[J/OL]. J Ophthalmic Inflamm Infect, 2013, 3(1): 52[2013-06-22]. https://link.springer.com/article/10.1186%2F1869-5760-3-52. DOI: 10.1186/1869-5760-3-52.
21.	Yeo TH, Yeo TK, Wong EP, et al. Immune recovery uveitis in HIV patients with cytomegalovirus retinitis in the era of HAART therapy-a 5-year study from Singapore[J/OL]. J Ophthalmic Inflamm Infect, 2016, 6(1): 41[2016-11-07]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5099291/. DOI: 10.1186/s12348-016-0110-3.
22.	王文吉. 常见眼内病毒感染性病变[J]. 中国眼耳鼻喉科杂志, 2016, 16(1): 3-6. DOI: 10.14166/j.issn.1671-2420.2016.01.002.Wang WJ. Changes of common intraocular virus infection[J]. Chin J Ophthalmol and Otorhinolaryngol, 2016, 16(1): 3-6. DOI: 10.14166/j.issn.1671-2420.2016.01.002.
23.	周曼, 高巧云, 徐格致, 等. 急性视网膜坏死综合征的临床分析[J]. 中华眼底病杂志, 2009, 25(6): 454-457. DOI: 10.3760/cma.j.issn.1015-1005.2009.06.13.Zhou M, Gao QY, Xu GZ, et al. Clinical analysis of acute retinal necrosis syndrome[J]. Chin J Ocul Fundus Dis, 2009, 25(6): 454-457. DOI: 10.3760/cma.j.issn.1015-1005.2009.06.13.
24.	Shantha JG, Weissman HM, Debiec MR, et al. Advances in the management of acute retinal necrosis[J]. Int Ophthalmol Clin, 2015, 55(3): 1-13. DOI: 10.1097/IIO.0000000000000077.

1. 马楠, 叶俊杰, 李东辉, 等. 免疫重建炎症综合征的眼部病变[J]. 中华眼科杂志, 2014, 50(8): 593-597. DOI: 10.3760/cma.j.issn.0412-4081.2014.08.009.Ma N, Ye JJ, Li DH, et al. Ocular lesions in immune reconstruction inflammatory syndrome[J]. Chin J Ophthalmol, 2014, 50(8): 593-597. DOI: 10.3760/cma.j.issn.0412-4081.2014.08.009.
2. Sterne JA, Hernan MA, Ledergerber B, et al. Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study[J]. Lancet, 2005, 366(9483): 378-384. DOI: 10.1016/S0140-6736(05)67022-5.
3. Huang G, Jiang Q, Li M, et al. Retrospective study of cytomegalovirus retinitis complicated with acquired immunodeficiency syndrome[J]. Int J Clin Exp Med, 2015, 8(6): 9537-9542.
4. Wong JX, Wong EP, Teoh SC. Outcomes of cytomegalovirus retinitis-related retinal detachment surgery in acquired immunodeficiency syndrome patients in an Asian population[J/OL]. BMC Ophthalmol, 2014, 14: 150[2014-11-27]. https://link.springer.com/article/10.1186/1471-2415-14-150. DOI: 10.1186/1471-2415-14-150.
5. 李丹, 孙挥宇, 毛菲菲, 等. 获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎71例临床分析[J]. 眼科, 2015, 24(3): 206-209. DOI: 10.13281/j.cnki.issn.1004-4469.2015.03.016.Li D, Sun HY, Mao FF, et al. Clinical analysis of 71 cases of acquired immunodeficiency syndrome complicated with cytomegalovirus retinitis[J]. Eye, 2015, 24(3): 206-209. DOI: 10.13281/j.cnki.issn.1004-4469.2015.03.016.
6. 杨娅玲, 江睿, 何太雯, 等. 获得性免疫缺陷综合征合并巨细胞病毒视网膜炎80例患者的临床特点[J]. 中华眼科杂志, 2014, 50(3): 197-202. DOI: 10.3760/cma.j.issn.0412-4081.2014.03.009.Yang YL, Jiang R, He TW, et al. Clinical characteristics of 80 patients with acquired immunodeficiency syndrome complicated with cytomegalovirus retinitis[J]. Chin J Ophthalmol, 2014, 50(3): 197-202. DOI: 10.3760/cma.j.issn.0412-4081.2014.03.009.
7. Thorne JE, Jabs DA, Kempen JH, et al. Causes of visual acuity loss among patients with AIDS and cytomegalovirus retinitis in the era of highly active antiretroviral therapy[J]. Ophthalmology, 2006, 113(8): 1441-1445. DOI: 10.1016/j.ophtha.2006.03.022.
8. 杨培增. 巨细胞病毒及其所致葡萄膜炎[M]//杨培增. 临床葡萄炎. 北京: 人民卫生出版社, 2004: 584-593.Yang PZ. Cytomegalovirus and uveitis caused by cytomegalovirus[M]//Yang PZ. Clinical uvities. Beijing: People’s Publishing House, 2004: 584-593.
9. Shapira Y, Mimouni M, Vishnevskia-Dai V. Cytomegaloviurs retinitis in HIV-negative patients-associated conditions, clinical presentation, diagnostic methods and treatment strategy[J]. Acta Ophthalmol, 2018, 96(7): 761-767. DOI: 10.1111/aos.13553.
10. Tripathy K, Mittal K, Venkatesh P, et al. Treatment of unilateral zone 1 cytomegalovirus retinitis in acute lymphoblastic leukemia with oral valganciclovir and intravitreal ganciclovir[J]. Oman J Ophthalmol, 2017, 10(3): 250-252. DOI: 10.4103/ojo.OJO_190_2016.
11. Jabs DA. Cytomegalovirus retinitis and the acquired immunodeficiency syndrome-bench to bedside: LXVII Edward Jackson Memorial Lecture[J]. Am J Ophthalmol, 2011, 151(2): 198-216. DOI: 10.1016/j.ajo.2010.10.018.
12. Shah JM, Leo SW, Lee TL, et al. A cytomegalovirus retinitis screening program: evaluation of enrollment criteria for HIV patients in Singapore[J]. Ocul Immunol Inflamm, 2015, 23(5): 362-370. DOI: 10.3109/09273948.2014.902472.
13. Erice A, Tierney C, Hirsch M, et al. Cytomegalovirus (CMV) and human immunodeficiency virus (HIV) burden, CMV end organ disease, and survival in subjects with advanced HIV infection (AIDS Clinical Trials Group Protocol 360)[J]. Clin Infect Dis, 2003, 37(4): 567-578. DOI: 10.1086/375843.
14. 李甦雁, 张正培, 季苏娟, 等. 获得性免疫缺陷综合征合并巨细胞病毒视网膜炎一例[J]. 中华眼科杂志, 2005, 41(10): 953-954. DOI: 10.3760/j:issn:0412-4081.2005.10.022.Li SY, Zang ZP, Ji SJ, et al. Acquired immunodeficiency syndrome complicated with cytomegaloviruss retinitis: a case report[J]. Chin J Ophthalmol, 2005, 41(10): 953-954. DOI: 10.3760/j:issn:0412-4081.2005.10.022.
15. 孙挥宇, 李丹, 毛菲菲, 等. 获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎的特殊眼底病变特征[J]. 中华眼底病杂志, 2014, 30(3): 309-311. DOI: 10.3760/cma.j.issn.1005-1015.2014.03.020.Sun HY, Li D, Mao FF, et al. Characteristics of special fundus lesions in acquired immunodeficiency syndrome complicated with cytomegalovirus retinitis[J]. Chin J Ocul Fundus Dis, 2014, 30(3): 309-311. DOI: 10.3760/cma.j.issn.1005-1015.2014.03.020.
16. Mao F, Wu J, Sun H, et al. Forsted branch angiitis in an AIDS patient with cytomegalovirus retinitis[J]. Int J Infect Dis, 2016, 52: 9-11. DOI: 10.1016/j.ijid.2016.09.003.
17. Agarwal M. Shrivastav A, Waris A. Tubercular retinal vasculitis mimicking frosted branch angiitis: a case report[J/OL]. J Ophthalmic Infect, 2018, 8(1): 3[2018-01-22]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777968/. DOI: 10.1186/s12348-018-0145-8.
18. Kumawat B, Tripathy K, Venkatesh P, et al. Central retinal vein occlusion-like appearance: a precursor stage in evolution of frosted branch angiitis[J]. J Ophthalmic Vis Res, 2017, 12(4): 440-442. DOI: 10.4103/jovr.jovr_84_15.
19. Wood EH, Wong RW. Bilateral frosted branch angiitis as the presenting sign of antiphonspholipid antibody syndrome[J/OL]. J Ophthalmic Inflamm Infect, 2016, 6(1): 20[2016-06-10]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4901211/. DOI: 10.1186/s12348-016-0089-9.
20. Leeamornsiri S, Choopong P, Tesavibul N. Frosted branch angiitis as a result of immune recovery uveitis in a patient with cytomegalovirus retinitis[J/OL]. J Ophthalmic Inflamm Infect, 2013, 3(1): 52[2013-06-22]. https://link.springer.com/article/10.1186%2F1869-5760-3-52. DOI: 10.1186/1869-5760-3-52.
21. Yeo TH, Yeo TK, Wong EP, et al. Immune recovery uveitis in HIV patients with cytomegalovirus retinitis in the era of HAART therapy-a 5-year study from Singapore[J/OL]. J Ophthalmic Inflamm Infect, 2016, 6(1): 41[2016-11-07]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5099291/. DOI: 10.1186/s12348-016-0110-3.
22. 王文吉. 常见眼内病毒感染性病变[J]. 中国眼耳鼻喉科杂志, 2016, 16(1): 3-6. DOI: 10.14166/j.issn.1671-2420.2016.01.002.Wang WJ. Changes of common intraocular virus infection[J]. Chin J Ophthalmol and Otorhinolaryngol, 2016, 16(1): 3-6. DOI: 10.14166/j.issn.1671-2420.2016.01.002.
23. 周曼, 高巧云, 徐格致, 等. 急性视网膜坏死综合征的临床分析[J]. 中华眼底病杂志, 2009, 25(6): 454-457. DOI: 10.3760/cma.j.issn.1015-1005.2009.06.13.Zhou M, Gao QY, Xu GZ, et al. Clinical analysis of acute retinal necrosis syndrome[J]. Chin J Ocul Fundus Dis, 2009, 25(6): 454-457. DOI: 10.3760/cma.j.issn.1015-1005.2009.06.13.
24. Shantha JG, Weissman HM, Debiec MR, et al. Advances in the management of acute retinal necrosis[J]. Int Ophthalmol Clin, 2015, 55(3): 1-13. DOI: 10.1097/IIO.0000000000000077.

Chinese Journal of Ocular Fundus Diseases

Comparative analysis for the fundus characteristics of acquired immune deficiency syndrome with cytomegalovirus retinitis between first-visit and non-first-visit in ophthalmology

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