Br J Ophthalmol 1999;83:47-49 ( January )
Cystoid macular oedema and cytomegalovirus retinitis in patients
with HIV disease treated with highly active antiretroviral therapy
Nathalie Cassoux,a
Livia Lumbroso,a
Bahram Bodaghi,a
Lydie Zazoun,a
Christine Katlama,b
Phuc LeHoanga
a Department of
Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France, b Department of Infectious
Diseases, Pitié-Salpêtrière Hospital, Paris, France
Correspondence to: Professor P LeHoang, Service d'Ophtalmologie, Hôpital
Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651 Paris
Cedex 13, France.
Accepted for publication 29 July 1998
BACKGROUND
Although
cystoid macular oedema (CMO) is a rare cause of visual loss in AIDS
related cytomegalovirus (CMV) retinitis, nine cases are reported of CMO
occurring in HIV infected patients with a prior diagnosis of CMV who
were receiving highly active antiretroviral therapy (HAART).
METHODSMedical and
ophthalmological records of nine AIDS patients with inactive CMV
retinitis were retrospectively analysed. Ophthalmic examination data,
laboratory findings, and the systemic antiviral treatment were studied.
Ophthalmic examination included visual acuity, anterior chamber flare
measured with the laser flare cell meter (LCFM), vitreous haze
quantification according to the Nussenblatt grading system, and
fluorescein angiography.
RESULTSNine HIV
infected patients, eight men and one woman, mean age 39 years (range
29-53 years) presented with inactive CMV retinitis and CMO. On
fluorescein angiography, CMO was present only in eyes (14 eyes) with
signs of previous CMV retinitis. CMV retinitis was inactive in all of
them. Visual acuity ranged from 20/200 to 20/30. In 10 eyes with CMV
retinitis, anterior chamber flare measured with the LCFM ranged from
18.5 to 82 photons/ms (mean 35.42 ph/ms). A significant vitreous
inflammation (1.5+) was observed in eight eyes. All patients had been
treated with anti-CMV drugs for a mean period of 18 months (range
12-36 months). All nine patients received HAART with a combination of
two nucleotide analogue reverse transcriptase inhibitors and one
protease inhibitor for a mean period of 14 months (range 9-18 months).
The HIV viral load was below detectable levels (<200 copies/ml) in
eight patients and low (3215 copies/ml) in one. At the time of CMO, the
median CD4+ lymphocyte count was 232 cells × 106/l (range
99-639).
CONCLUSIONIn AIDS
patients, the usual absence of intraocular inflammation in eyes
affected by CMV retinitis has been tentatively explained by the
profound cellular immunodeficiency. In these patients, treated with
HAART, CD4+ counts were increased for several months (mean 14 months).
In their eyes, CMV retinitis was associated with significant ocular
inflammation and CMO. These findings could be related to the
restoration of immune competence after HAART as recently shown.
Keywords:
cystoid macular oedema;
cytomegalovirus retinitis;
HIV;
highly active antiretroviral therapy;
HAART
© 1999 by British Journal of Ophthalmology
