Wright ME, Robinson MR, Smith S, Rock-Kress D, Csaky KG, Masur H, Polis MA; Conference on Retroviruses and Opportunistic Infections.
9th Conf Retrovir Oppor Infect Feb 24 28 2002 Wash State Conv Trade Cent Seattle Wash Conf Retrovir Oppor Infect 9th 2002 Seattle Wash. 2002 Feb 24-28; 9: abstract no. 610-W.
Critical Care Med. Dept., NIH
BACKGROUND: CMV retinitis is characterized by necrosis and the formation of atrophic scar tissue. While HAART may obviate the need for lifelong anti-CMV therapy, its long-term sequelae in persons with HIV infection and CMV retinitis includes immune recovery uveitis (IRU) which may be vision threatening. We report choroidal neovascularization in peripheral atrophic retina, a finding not previously described, in 3 patients with IRU.METHODS: In a 4-1/2-year observational prospective study of 16 HIV-infected persons on HAART with inactive CMV retinitis, complete eye examinations were performed after cessation of anti-CMV therapy. Patients with neovascularization on fluorescein angiography (FA) underwent high-speed indocyanine green angiography (ICG) and when possible, optical coherence tomography (OCT).RESULTS: After a mean of 46 months on study, 3 patients showed evidence of neovascularization: fibrovascular proliferation overlying atrophic retina with adjacent normal retina. FA showed areas of hyperfluorescence over the entire lesion (approximately 3-10 disc areas) and OCT indicated that the fibrovascular membranes were firmly attached to the underlying choroid. ICG demonstrated an afferent feeder vessel emanating from the choroid into the lesion. All 3 had IRU (low-grade vitritis and diffuse macular edema). 1 patient experienced recurrent vitreous hemorrhages with vision loss over a 2-year period. Slow growth of the membranes in the other 2 patients was also noted.CONCLUSIONS: Peripheral choroidal neovascularization is a late finding in patients with atrophic CMV scars and IRU. Management of asymptomatic neovascularized membranes is not known, but recognition is important because of the potential for vitreous hemorrhage and vision loss.
Publication Types:
Keywords:
- AIDS Vaccines
- Acquired Immunodeficiency Syndrome
- Anti-HIV Agents
- Antiretroviral Therapy, Highly Active
- Choroidal Neovascularization
- Cytomegalovirus
- Cytomegalovirus Retinitis
- Disease Progression
- Drug Therapy, Combination
- HIV
- HIV Infections
- HIV Protease Inhibitors
- HIV Seronegativity
- HIV Seropositivity
- Humans
- Prospective Studies
- diagnosis
- drug therapy
- immunology
- therapy
Other ID:
UI: 102263825
From Meeting Abstracts