Abstract
To investigate the role of intravitreal sustained release dexamethasone implant in AIDS associated macular edema.This hospital based retrospective interventional study (nonrandomized) was conducted in Malda Medical College, West Bengal, India from September 2017 to august 2019 where 18 eyes of 18 patients with HIV were included. After proper history taking and required investigations, intravitreal sustained release dexamethasone implant was injected to each patient in respective eye under topical anaesthesia with strict aseptic measures and utmost care. Institutional clearance and written informed consent from each patient were taken before the procedure. Best corrected visual acuity (BCVA) and intraocular pressure (IOP) measurement and central macular thickness (CMT) evaluation by spectral domain optical coherence tomography (SD-OCT) were performed at baseline and after 1 month, 3 months, 6 months of injection. The data obtained then were put for paired t test using SPSS software.All patients had shown improvement in terms of BCVA as well as reduction of central macular thickness (CMT). 12 patients had increased IOP at first visit for which topical anti glaucoma drugs were prescribed and on subsequent visits their IOP were under control. Intravitreal sustained release dexamethasone implant is a good option to tackle macular edema in HIV infected patients.
Highlights
Acquired immunodeficiency syndrome (AIDS) is characterized by severe compromise of immune system with a propensity of different opportunistic infections and neoplasms resulting in multisystem disorder.[1]
HAART therapy in AIDS infected patients results in significant improvement in immune system but immune recovery uveitis(IRU)may occur 3 with signs of severe inflammation culminating in macular edema producing moderate to severe visual impairment its clear
We have found that all the patients had shown improvement in Best corrected visual acuity (BCVA) as revealed by improvement by 2-3 lines in standard Snellen’s chart, reduction in central macular thickness (CMT) as shown by spectral domain optical coherence tomography (SD-OCT)
Summary
Acquired immunodeficiency syndrome (AIDS) is characterized by severe compromise of immune system with a propensity of different opportunistic infections and neoplasms resulting in multisystem disorder.[1]. HAART therapy in AIDS infected patients results in significant improvement in immune system but immune recovery uveitis(IRU)may occur 3 with signs of severe inflammation culminating in macular edema producing moderate to severe visual impairment its clear pathogenesis is still unknown. IRU with macular edema can be treated with valganciclovir 450 mg twice daily.[4] Periocular steroids can be used with varying success provided CD4+ cell count should be above 60/mm[3] because of fear of reactivation of viral retinitis. Steroids reduce inflammation thereby controlling macular edema by means of inhibiting neutrophil transmigration, cytokines as well as vascular endothelial factors release.[5] It can be given topically, systemically, or through intravitreal and periocular route.
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