Objective To observe the fundus characteristics of acquired immune deficiency syndrome （AIDS) with cytomegalovirus retinitis （CMVR）. Methods Twenty-seven AIDS patients （44 eyes）with CMVR were studied. All the patients had undergone the examinations of visual acuity, intraocular pressure, slit lamp microscope, indirect ophthalmoscope and color fundus photography. The fundus lesions were divided into active lesions and chronic lesions, and the active lesions were subdivided into central, peripheral and mixed types which involving both the posterior and peripheral fundus. Results Of 27 patients （44 eyes）, 19 patients（29 eyes）had active lesions. Five patients （six eyes, 13.6%） had central lesions （exudation， hemorrhage and vascular sheath in the posterior retina）, nine patients （15 eyes, 34.1%） had peripheral yellow and white granular lesions. Five patients （eight eyes, 18.2%） had mixed lesions. Chronic lesions were found in eight patients（15 eyes, 34.1%）, which showed pigment and scarring lesions along vascular branches. Conclusion The fundus lesions of AIDS with CMVR have distinct features.
Objective To observe ocular manifestations of acquired immunodeficiency syndrome（AIDS）.Methods Fourtytwo AIDS patients（66 eyes）with ocular complaints received examinations of visual acuity, slit-lamp microscope, ophthalmoscope and fundus fluorescence angiography (FFA). The results were retrospectively analyzed. Results There are five types of ocular findings, including cytomegalovirus (CMV) retinitis (37 eyes, 56.0%), retinal microvasculopathy of human immunodeficiency virus (21 eyes, 32.0%), optic nerve diseases (three eyes, 4.5%), retinal neuroepithelial layer detachment (two eyes, 3.0%) and uveitis (three eyes, 4.5%).Conclusions The common ocular manifestations showed progressive necrotic retinitis, retinal hemorrhage and retinal vasculitis and attenuated，cotton-wool spots in AIDS patients.
Objective To evaluate the clinical features, diagnosis, and outcome of the treatment of cytomegalovirus (CMV) retinitis, and the relationship between CMV retinitis and acquired immunodeficiency syndrome (AIDS). Methods A total of 95 eyes of 56 patients with cytomegalovirus retinitis and AIDS were studied. The fundus feature, visual acuity and CD4+ T-lymphocyte counts were analyzed and the follow-up periods ranged from 2 weeks to 18 months. Results Before the definitive diagnosis of CMV retinitis, the courses of AIDS were 4 to 26 months in all patients. In the initial examination, the granular form of CMV retinal lesion was noted in 55 eyes (57%) in which retinal lesion of 46 eyes was peripheral. The fulminant form of CMV retinitis of 25 eyes (26%) was found in the posterior pole and consisted of densely opaque retinal lesions with blotchy hemorrhage and vasculitis. The overlap between these two presentations was noted in 15 eyes. Papillitis was observed in 7 eyes of CMV retinitis in this series of patients. The visual acuity ranged from finger counting to 0.5. The patients with extensive CMV retinitis or CMV retinitis in the posterior pole got poorer vision. The CD4+ T-lymphocyte counts of 30 patients was 0-30 (mean, 15±9/μl), and the survival time ranged from 2 weeks to 18 months (mean, 6.4±3.3 months). The vision was improved and CD4+ T-lymphocyte counts was significantly higher in the group treated with ganciclovir, and progression of CMV retinitis occured and the vision decreased in the non-treated group. Conclusion CMV retinitis is the most common intraocular complication in patients with AIDS. Diagnosis of CMV retinitis is based on the characteristic of necrotizing retinitis which was typically associated with retinal hemorrhage and vasculitis. Ganciclovir is effective for the treatment of CMV retinitis. (Chin J Ocul Fundus Dis, 2002, 18: 89-91)
Objective To evaluate the effectiveness and safety of foscarnet and ganciclovir for cytomegalovirus retinitis associated with acquired immune deficiency syndrome (AIDS). Methods We searched MEDLINE (1966 to 2005.12), EMBASE (1974 to Dec.2005), The Cochrane Library (Issue 4,2005), CBM (1978 to Dec.2005), CMCC (1994 to Dec. 2005), CNKI (1994 to Dec. 2005) and VIP (1989 to Dec. 2005). We identified randomized controlled trials of foscarnet versus ganciclovir. Two independent reviewers collected and evaluated details of study populations, interventions, and outcomes using a data extraction form. We conducted meta-analysis of the homoeonomous data. Result Three studies involving 451 patients were included. Meta-analysis showed foscarnet was better than ganciclovir with the following outcomes: mortality (RR=0.84, 95%CI 0.70 to 1.00, P=0.05); male genital ulcers (RR=1.29, 95%CI 0.60 to 2.82, P=0.002). There were no significant differences in ocular symptoms, relapses and other side effects. Conclusion Foscarnet in the treatment of cytomegalovirus retinitis in AIDS patients may be more benefical than ganciclovir with regard to mortality and male genital ulcers, but the supporting evidence is not very b because there are only three trials.
ObjectiveTo analyze the sensitivity and specificity of polymerase chain reaction (PCR) tests in the detection of cytomegalovirus (CMV) in the diagnosis of patients with acquired immune deficiency syndrome (AIDS), using aqueous humor samples. Methods25 AIDS patients (including 21 men and 4 women) were studied. The age of the patients varied from 24 to 59 years, with an average of (39.2±9.3) years. The CD4+ T cell count was from 1 to 523 cells/μl, with a medium of 40 cells/μl. They were infected with human immunodeficiency virus(HIV)for a period from 15 days to 9 years with a median of 10 months. They were divided into three groups according to the fundus and treatment, including untreated cytomegalovirus retinitis (CMVR), treated CMVR and control group. There were 10 patients without anti-CMV treatment and 7 patients treated previously with foscarnet or ganciclovir whose eyes were diagnosed CMVR. Control group has 8 patients who had normal fundus or minor retinopathy excluded from CMVR. Approximately 100 μl of aqueous humor was obtained by anterior-chamber paracentesis and PCR was performed in all cases. ResultsThere were CMV DNA in 9 of 10 eyes with untreated CMVR (90.0% sensitivity). Of 7 specimens from eyes with treated CMVR, 3 were CMV PCR positive (42.9% sensitivity). All 8 samples of the control group were negative for CMV DNA, indicating the clinical specificity of our PCR was greater than 99.9% for CMVR. The anterior chamber paracentesis did not cause any complications in our patients except for a patient with subconjunctival hemorrhage. ConclusionsThe assay had an estimated sensitivity of 90.0% in detecting untreated CMVR and a sensitivity of 42.9% in detecting CMVR that had been treated. The specificity of this assay was greater than 99.9%.
Objective To observe the clinical characteristics and treatment of cytomegalovirus retinitis (CMVR) in leukemia patients. Methods This is a retrospective analysis. Seven leukemia patients (13 eyes) with CMVR were studied. All patients underwent examinations of visual acuity, slit lamp microscope, ophthalmoscope, color fundus photography, peripheral blood CD4+T cell count and serum/aqueous CMV-DNA test. All patients were treated with ganciclovir or zoledronic acid combined with intravitreal injection of ganciclovir. The follow-up period was 3-14 months. Results Six patients were treated with hematopoietic stem cell transplantation and 1 patient was with chronic leukemia. All patients were CMV-DNA positive for serum, and 18.5% (2/7) for aqueous humor. CMVR in leukemia patients showed mild anterior segment inflammation, ocular fundus with irregular yellowish-white retinal necrosis and radial hemorrhage (7 eyes). Some (2 eyes) also shoed gray and white granular retinal infiltrates. Intravenous ganciclovir/zoledronic acid combined with intravitreal injection of high concentration ganciclovir was an effective treatment, while systemic corticosteroids were effective in reducing vitreous opacity. Conclusions CMVR is characterized by progressive necrotic retinitis with hemorrhage and vasculitis. Intravenous ganciclovir/zoledronic acid combined with intravitreal injection of ganciclovir is effective in the treatment of CMVR with leukemia.
ObjectiveTo observe the image characteristics of OCT in patients of acquired immunodeficiency syndrome (AIDS) with cytomegalovirus retinitis (CMVR).MethodsThirty-nine eyes of 26 patients of AIDS with CMVR diagnosed in Department of ophthalmology of Beijing Ditan Hospital Capital Medical University from January 2015 to December 2017 were included in this study. All the patients were males, with the mean age of 33.12±9.87 years. All the patients underwent the OCT examination by Spectralis HRA+OCT. The locations of scanning were macular, optical papilla and posterior pole of retina with retinitis. Typical images were saved and analyzed.ResultsThe OCT pathological changes of CMVR included increase of retinal thickness and reflex of retina, indiscernible retinal layers, irregularity or absent external limiting membrane and/or ellipsoid zone, hyperreflective spots, vitreous cells. Among 39 eyes, there were 6 eyes with strong point-like reflection in the outer layer of retina around the lesion, 31 eyes (79.49%) with strong point-like reflection in the full layer of retina, 25 eyes (64.10%) with lesion involved macular area, 34 eyes (87.17%) with vitreous cells.ConclusionsOCT images of the eyes with AIDS with CMVR were characterized by lesions involving the whole retina. Absent ellipsoid zone or structural changes can be seen in the affected areas and peripheral areas of the lesion.
ObjectiveTo observe the safety and efficacy of regime that based on aqueous cytomegalovirus-DNA (CMV-DNA) load and IL-8 determination for therapeutic monitoring and local treatment cessation of cytomegalovirus retinitis (CMVR) patients after allogeneic hematopoietic stem cell transplantation (HSCT).MethodsA prospective case series study. A total of 14 CMVR patients (22 eyes) after allogeneic HSCT diagnosed in Ophthalmology Department of Peking University People's Hospital between January 2016 and December 2018 were involved in this study. All patients were CMV-DNA seronegative at baseline and were treated with intravitreous injection of ganciclovir (IVG, 3 mg in 0.05 ml) twice per week for 4 times in the induction stage and once a week in the maintenance stage. Aqueous humor sample was collected during the first time of IVG every week. CMV-DNA and the level of IL-8 were measured by real time quantitative PCR and ELISA, respectively. During follow-up, negative CMV-DNA (＜103/ml) or level of IL-8＜30 pg/ml in aqueous sample was set as local treatment cessation. Then patients were followed every 2 weeks for at least 6 months. BCVA, intraocular pressure and fundus examination were taken for each visit. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. BCVA and intraocular pressure at the baseline and the last follow-up were compared by the Student t matching test.ResultsOf the 14 CMVR patients (22 eyes) after allogeneic HSCT, 8 patients (16 eyes) were bilateral, 6 patients (6 eyes) were unilateral. At the baseline, the mean logMAR BCVA was 0.814±0.563, the intraocular pressure was 17.2±7.8 mmHg (1 mmHg=0.133 kPa), the mean aqueous CMV-DNA load was (3.43±4.96)×105/ml, the mean level of IL-8 was 518±541 pg/ml. At cessation of local treatment, the median number of intravitreal injections was 5 times. Nine eyes showed negative CMV-DNA in aqueous humor, of which, 7 eyes showed negative IL-8 in aqueous. CMV-DNA could still be detected in 13 eyes, while IL-8 was negative. Only one eye’s retinal lesion was completely quiet. Six months after local treatment cessation, the mean logMAR BCVA was 0.812±0.691, the intraocular pressure was 14.8±5.4 mmHg; which was not significantly different from baseline (t=-0.107, 1.517; P=0.916, 0.137). Recurrence of CMVR happened in only 1 eye because of systemic EB virus infection. Retinal lesions progressively improved and became completely quiet in all the remaining 20 eyes. In 22 eyes, iatrogenic vitreous hemorrhage occurred due to low platelet count during treatment (＜30×109/ml) in 4 eyes. When the treatment was terminated for 6 months, the fundus of hematoma absorption was clearly visible. At the time of CMVR diagnosis, there were 2 eyes (9%) with posterior subcapsular opacity, which may be caused by systemic glucocorticoid therapy after allogeneic HSCT.ConclusionAqueous CMV-DNA load and level of IL-8 could be used as quantitative variables for monitoring the therapeutic effect and determining time for local treatment cessation for CMVR after HSCT safely and efficiently.
ObjectiveTo 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.MethodsA 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.ResultsFulminant 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).ConclusionFor 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.
ObjectiveTo evaluate the efficacy and safety of reduced-dose intravitreal ganciclovir for the treatment of acquired immunodeficiency syndrome (AIDS) patients with cytomegalovirus retinitis (CMVR).MethodsA prospective observational cohort study observed 15 AIDS patients (28 eyes) who suffered from CMVR onset between January 2016 and December 2018 at Nanning Aier Eye Hospital. Among this 28 eyes, BCVA of 6 eyes (21.4%) were between moving hand to counting finger, 15 eyes (53.6%) were between 0.02 to 0.1 and 7 eyes were better than 0.1 (25.0%). All eyes received intravitreal injection 0.1 ml of ganciclovir at 4 mg/ml (contain ganciclovir 0.4 mg). The induction regimen was twice weekly for 2 weeks and a maintenance period of the same dose weekly. The mean number of injections was 7.1±1.7 times. For hospitalized patients who had no contraindicated received a 14-day twice daily intravenous ganciclovir (IVG) 5.0 mg/kg·d until complete resolution of CMVR. All patients were divided into intravitreal ganciclovir (IVTG) group and IVTG+IVG group according to different treatment plans, which were 5 cases with 8 eyes and 10 cases with 20 eyes, respectively. The follow-up was more than 6 months. BCVA, complete resolution or stable of the lesion and complications were observed.ResultsSix months later, 20 eyes (71.4%) had a obvious reduced or disappeared of the anterior chamber and vitreous inflammation, and the retinal lesions became stable or complete resolution. 24 eyes showed improvements of BCVA and 4 eyes showed stable. 2 eyes (7.1%) presented with BCVA ≤ counting finger, 7 eyes (25.0%) were 0.02 - 0.1 and 19 eyes were ≥ 0.1 (67.9%). Compared with before treatment, the ratio of BCVA that less than or equal to counting finger and between 0.02 to 0.1 decreased (21.4% vs 7.1% and 53.6% vs 25.0%, respectively), but the ratio of BCVA better than 0.1 increased (25.0% vs 67.9%). When IVTG+IVG group was compared with IVTG group, the average time-to-resolution of CMVR were 83.2±25.2 and 85.3±24.4 days respectively. There was no significant difference in resolution times (Z=0.17, P=0.87). The ratio of retinal lesions became stable or complete resolution were 75.0% (15 eyes) and 62.5% (5 eyes), there was no evident difference in time-to-resolution between the two groups (F=0.42, P=0.51). No recurrence was seen during the follow-up period. In cases of unilateral CMVR, there were no patients with a second eye involvement during the follow-up period. No endophthalmitis, vitreous hemorrhage, retinal detachment were found in our study.ConclusionReduced-dose intravitreal ganciclovir is a safe and effective treatment option for CMVR.