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Cytomegalovirus (CMV) is the most common intraocular opportunistic infection in profoundly immunocompromised patients with AIDS. It is characterized by an acute, progressive, necrotizing retinitis in patients with a CD4 count of <50 cells/μL. Although the incidence of CMV retinitis has declined because of the introduction of antiretroviral therapy...
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Abstract
Introduction: CMVR is the most common opportunistic ocular infection in severely
immunocompromised individuals. Herein, we report three immune deficient patients with
CMVR.
First case: A 15-year old girl with the diagnosis of HIV infection and diffuse large
B-cell lymphomaadmittedto hospital with the complaint of blurred vision on her left...
Citations
... CME that results from immune recovery uveitis contributes to a major cause of visual loss in HIV-infected patients on highly active antiretroviral therapy. [3] A presentation of cytomegalovirus retinitis is associated with UME along with ERMs. In immune recovery uveitis, there is production of interleukin-12 (IL-12), and this causes more severe edema than observed in other types of uveitis. ...
Cystoid macular edema is a complication of uveitis which can lead to severe visual impairment if left untreated. Uveitic macular edema occurs when the balance between the water entering the eye and pumped out of the eye is altered thus losing equilibrium in the physiologic function of the retina. Edema has a negative impact on visual recovery in patients with uveitis and may continue to exist despite control of uveitis. This delayed resolution of edema observed clinically and by imaging is most frequent following intermediate uveitis, birdshot retinochoroidopathy, sarcoid uveitis, panuveitis, and iridocyclitis associated with human leukocyte antigen B27. Literature about management of uveitic macular edema is limited, and no consensus has been reached with regard to management protocol. Several treatment options exist including corticosteroids, nonsteroidal anti-inflammatory drugs, immunomodulatory agents, implants, and surgery. These therapies can be administered through various routes such as oral, topical, periocular, or intravitreal injections. A response to treatment is seen as decrease in macular thickness and improvement in visual acuity.
... . CME is a complication that can result from this inflammation and is emerging as a major cause of visual loss in human immunodeficiency virus-(HIV-) infected patients. The main symptoms are decreased vision, metamorphopsia, and floaters [48,49]. In the study by Kempen et al. eyes with IRU had a 20-fold higher risk of CME [26]. ...
IRU is the most common form of immune reconstitution inflammatory syndrome in HIV-infected patients with cytomegalovirus retinitis who are receiving highly active antiretroviral therapy (HAART). Among patients with CMV in the HAART era, immune recovery may be associated with a greater number of inflammatory complications, including macular edema and epiretinal membrane formation. Given the range of ocular manifestations of HIV, routine ocular examinations and screening for visual loss are recommended in patients with CD4 counts <50 cells/μL. With the increasing longevity of these patients due to the use of HAART, treatment of IRU may become an issue in the future. The aim of this paper is to review the current literature concerning immune recovery uveitis. The definition, epidemiology, pathophysiology, clinical findings, complications, diagnosis, and treatment are presented.
