History Of Cytomegalovirus Retinitis Research Articles

Fluocinolone intravitreal implant (Iluvien) for macular edema secondary to immune recovery uveitis in patient with acute myeloid leukemia

PurposeTo report the use of Fluocinolone intravitreal implant (Iluvien) for the treatment of persistent cystoid macular edema (CME) due to immune recovery uveitis syndrome in a patient with previous cytomegalovirus retinitis and acute myeloid leukemia.DesignCase report.MethodsThe clinical history of a patient who received an Iluvien implant in one eye for the treatment of cystoid macular edema due to immune recovery uveitis syndrome, previously treated with peribulbar Triamcinolone and intravitreal Dexamethasone injections, was reviewed.ResultsA 48-year-old woman presented with cystoid macular edema due to immune recovery uveitis syndrome. The patient had a history of cytomegalovirus retinitis 3.5 years prior, secondary to immunosuppressive treatment for an acute myeloid leukemia. Three periocular triamcinolone injections and two dexamethasone intravitreal implants were performed, but the edema recurred, so fluocinolone intravitreal implant was used, achieving a sustained control of the condition at one year of follow-up.ConclusionThe Fluocinolone intravitreal implant may be an effective treatment for persistent CME in patients with immune recovery uveitis syndrome.

Cataract Surgery Outcomes in Human Immunodeficiency Virus Positive Patients at a Tertiary Care Academic Medical Center in the United States

ABSTRACT Purpose: To compare cataract surgery complications and visual outcomes in patients with and without human immunodeficiency virus (HIV). Methods: A retrospective cohort study was conducted on eyes undergoing phacoemulsification cataract surgery at an academic eye center from 1/1/2014 to 8/31/18. Outcomes included best corrected distance visual acuity (CDVA), intraoperative complications, cystoid macular edema (CME), and persistent anterior uveitis (PAU). Binary outcomes were analyzed using logistic regressions with generalized estimating equations. Visual outcomes were analyzed using a linear mixed model. Results: 9756 eyes from 5988 patients were included in the analysis. Of these, 66 eyes from 39 patients were HIV positive (HIV+). HIV+ patients were significantly younger at the time of surgery than HIV negative patients (p < .0001). Among HIV+ patients with available lab data, the mean CD4 count was 697.3 (SD = 335.7), and 48.7% of subjects had an undetectable viral load. Five eyes from three HIV+ patients had a history of cytomegalovirus retinitis (CMVR). Positive HIV status was not associated with increased risk of intraoperative complications. Post-operative CDVA was better in the HIV negative group compared to the HIV+ group but not significantly different (about 20/24 vs. 20/28, p = .0829). Eyes from HIV+ patients were at increased risk of developing PAU after surgery (adjusted OR = 6.04, 95% CI: 2.42–15.1, p = .0001), as well as CME (adjusted OR = 3.25, 95% CI: 1.02–10.4, p = .0470). Conclusions: Eyes from HIV+ patients were at greater risk of developing PAU and clinically significant CME; however, HIV+ patients had similar CDVA after cataract surgery compared to HIV negative patients.

Fluocinolone Acetonide Implant (Retisert) for Chronic Cystoid Macular Edema in Two Patients with AIDS and a History of Cytomegalovirus Retinitis

Purpose: To report the authors’ experience using fluocinolone acetonide (Retisert) to treat cystoid macular edema (CME) resulting from immune recovery uveitis (IRU) in 2 acquired immunodeficiency syndrome (AIDS) patients with a history of cytomegalovirus (CMV) retinitis.Design: Interventional case series.Methods: Medical records were reviewed of 2 patients who received Retisert implantation in 3 eyes for IRU-associated inflammation and CME. Suppression of CMV disease was achieved with oral medication in one patient and with simultaneous implantation of a ganciclovir implant in the other patient.Results: After Retisert implantation in 3 eyes in AIDS patients on HAART, improvement in CME was seen in 2 eyes. No CMV reactivation was detected during the several-month follow-up period.Conclusions: Retisert may be an effective treatment for CME in AIDS patients with IRU reactivation and a history of CMV retinitis.

Dementia with features of Alzheimer's disease and HIV-associated dementia in an elderly man with AIDS

Dementia with features of Alzheimer's disease and HIV-associated dementia in an elderly man with AIDS

Objective Analysis of Retinal Function in HIV-positive Children Without Retinitis Using Optical Coherence Tomography

Purpose: To assess the retinal nerve fiber layer thickness in children with human immunodeficiency virus disease without cytomegalovirus retinitis or visual symptoms. Methods: Thirty-eight eyes of 19 human immunodeficiency virus-positive children (group A) with visual acuity of 20/20 or better, normal color vision testing and no ophthalmoscopically detectable disorders were prospectively examined. All subjects of group A had no history of cytomegalovirus retinitis and CD4 counts consistently above 100. Patients in group B (40 eyes of 21 patients) were human immunodeficiency virus-negative age-matched control subjects. Thickness of retinal nerve fiber layer along a 3.4-mm-diameter circle centered on the optic nerve head was evaluated using third-generation optical coherence tomography. CD8 T-lymphocyte count, presence of systemic infection, hemoglobin, hematocrit and serum β-microglobulin levels were also recorded. Results: The mean overall retinal nerve fiber layer thickness in groups A and B were 89.2 ± 24.01 μm and 102.82 ± 29.168 μm (SD) respectively. The difference was considered extremely significant (P < 0.0001). Group A had significantly thinner average nerve fiber layer in temporal, nasal, superior and inferior retinal areas. Conclusions: Significant retinal nerve fiber layer thinning occurs in human immunodeficiency virus-positive children with no visual impairment or ophthalmologic evidence or retinitis.

Genotypes of JC virus, DNA of cytomegalovirus, and proviral DNA of human immunodeficiency virus in eyes of acquired immunodeficiency syndrome patients

JC virus (JCV) is a human polyomavirus that exists in at least eight different genotypes as a result of coevolution with different human populations all over the world. Well adapted to its host, it usually persists in the kidneys and possibly the brain. If the host becomes immunodeficient, JCV can cause the fatal demyelinating disease progressive multifocal leukoencephalopathy (PML). There is increasing evidence that JCV is transactivated by cytomegalovirus (CMV) and the human immunodeficiency virus (HIV). Both CMV and HIV can infect the retina of acquired immunodeficiency syndrome (AIDS) patients, causing severe necrosis in the case of CMV retinitis or a mild HIV-associated vasculopathy, with bleeding and cotton wool spots. The authors therefore investigated by polymerase chain reaction (PCR) whether DNA of these three viruses was detectable in paraffin-embedded eyes of AIDS patients with a clinical history of CMV retinitis. From a total of 65 eyes, JCV was detected in 21 (32%). Thirty-six (55%) were positive for CMV and 6 (9%) for proviral DNA of HIV. JCV and CMV were found in 13 eyes, JCV and HIV in 3 eyes, CMV and HIV in 1 eye, and DNA from all three viruses in 1 eye. The JCV genotypes were types 1A, 2A, 2E, 3, and 4. In 21 eyes of patients without AIDS, only one sample was JCV positive. In conclusion, JCV DNA can be detected in ocular tissue of AIDS patients at a significantly higher level than in eyes of nonimmunosuppressed patients. Further investigations will help to decide if JCV contributes to the retinopathy caused by CMV and HIV.

Paradoxical activity of CMV retinitis in patients receiving highly active antiretroviral therapy.

To report two types of atypical behaviors of cytomegalovirus (CMV) retinitis in the highly active antiretroviral therapy (HAART) era, including active CMV retinitis in the presence of persistently high CD4 cell counts during HAART and CMV retinitis that has not reactivated despite persistently low CD4 cell counts. Prospective, longitudinal, observational study of a cohort of 116 patients with acquired immunodeficiency syndrome who had a history of CMV retinitis during the HAART era. Sixty (52%) of the 116 patients with acquired immunodeficiency syndrome and CMV retinitis were HAART responders. Subsequently, HAART failed for 9 of the 60 patients with low CD4 cell counts. Of these 9 patients, 5 developed reactivation of CMV retinitis, and 4 remained free of CMV retinitis despite CD4 cell counts of <50/microL and lack of anti-CMV therapy. Paradoxically, there was a patient with a documented median CD4 cell count of 204/microL for 19 months who had newly diagnosed active CMV retinitis. In the HAART era, CMV retinitis may remain quiescent despite extremely low CD4 cell counts, and rarely, CMV retinitis may become active in the setting of persistently high CD4 cell counts in a subset of HAART responders.

Human immunodeficiency virus-positive patients with posterior intracorneal precipitates

Purpose To describe an unusual and possibly new keratopathy in human immunodeficiency virus (HIV)-positive patients. Design Retrospective observational case series. Participants: Six HIV-positive patients at four centers. Methods A complete medical history was obtained and a thorough ophthalmic examination was performed on each of the patients. Results Each patient had bilaterally symmetrical keratopathy consisting of variably pigmented round and reticular posterior intracorneal precipitates at the level of Descemet’s membrane. The precipitates were diffuse, but larger and more prominent near the limbus and finer toward the central cornea. None of the eyes were inflamed, and all had normal vision. No patient had uveitis on presentation or any history of cytomegalovirus retinitis. Conclusion These patients have a unique posterior keratopathy, which requires further investigation.

Oxacillin-resistant Staphylococcus aureus endophthalmitis after ganciclovir intraocular implant

PURPOSE: To describe a patient who developed oxacillin-resistant Staphylococcus aureus endophthalmitis after insertion of a ganciclovir intraocular implant. METHOD: Case report. RESULTS: A 42-year-old man with acquired immunodeficiency syndrome (AIDS) and a history of cytomegalovirus retinitis was admitted with right-sided eye pain and decreased visual acuity 10 days after receiving a second ganciclovir intraocular implant in the right eye. A therapeutic vitrectomy, right eye, was performed on the day of admission. A vitreal tap produced frank pus and white, fluffy debris. Cultures of the vitreal fluid grew oxacillin-resistant S aureus, sensitive only to vancomycin, rifampin, and trimethoprim/sulfamethoxazole. The patient was successfully treated with removal of both ganciclovir implants in the right eye and a 4-week course of vancomycin and rifampin. However, the infection left the patient blind in the infected eye. CONCLUSION: Bacterial endophthalmitis is an infrequent but serious complication of the ganciclovir intraocular implant.

Cystoid macular edema in a patient with acquired immunodeficiency syndrome and past ocular history of cytomegalovirus retinitis after initiation of protease inhibitors.

To describe a patient with acquired immunodeficiency syndrome (AIDS) who presented with cystoid macular edema (CME) which was not associated with active cytomegalovirus (CMV) retinitis or AIDS-related microvasculopathy. A 32-year-old man with AIDS and a past ocular history of inactive CMV retinitis was placed on protease inhibitors when his CD4+ T lymphocyte counts dropped to 8 cells/mm3. Three months later, after his CD4+ T lymphocyte counts had increased to 196 cells/mm3 he complained of micropsia and metamorphopsia in his right eye of 1 week duration. The patient had a complete ocular examination including fluorescein angiography (FA). Visual acuity (VA) was 7/10 OD. Fundus examination revealed CME and inactive CMV retinitis, and FA demonstrated CME and a hot disc. Two transseptal injections of corticosteroids were administered 2 weeks apart in the right eye as treatment of the CME. The patient reported gradual visual improvement and 6 weeks later, his VA was 10/10(-2). CME had resolved clinically and angiographically. CME in our case is associated with inactive CMV retinitis and gradually increasing number of CD4+ T lymphocytes after initiation of treatment with protease inhibitors. It may be amenable to regional administration of corticosteroids without reactivation of retinitis.

Discontinuation of maintenance therapy for CMV retinitis in AIDS patients on highly active antiretroviral therapy

The use of highly active antiretroviral therapy (HAART) has dramatically modified the natural history of cytomegalovirus retinitis (CMVR) in AIDS patients. In this context, we discontinued maintenance therapy in eight AIDS patients with previous CMVR and a good and persistent immune and virological response to HAART (CD 4 = 75/mm 3 in all patients, viral load =30000 copies of RNA/ml in seven patients and negative CMV viremia in six patients whose viremia was evaluated). The median recurrence-free interval before maintenance discontinuation was 613 days (326-787). No recurrence was observed after a median follow-up of 248 days (183-368) without maintenance therapy. In conclusion, discontinuation of maintenance therapy for CMVR in AIDS patients with good immune response to HAART can be considered and appears to be safe with a careful follow-up.

Rifabutin-Associated Uveitis During Prophylaxis for Mycobacterium avium Complex Infection

We report a case of severe uveitis, mimicking endophthalmitis, in association with the use of rifabutin. Report of a Case. A 31-year-old white man with acquired immunodeficiency syndrome, a CD4 count of 0.003X109/L (3/μL), and a history of cytomegalovirus retinitis in the right eye for which he was receiving maintenance therapy, presented with a 2-day history of photophobia and eye pain bilaterally in May 1994. His visual acuity at that time was 20/160 OD and 20/100 OS. He had been receiving rifabutin, 300 mg every day, for several months. Results of the eye examination showed severe anterior and posterior segment inflammation mimicking endophthalmitis. The patient received intravitreal antibiotics and had a vitreous aspirate that showed no growth of organisms. His vision improved after several weeks. In late July 1994, he had another episode of posterior uveitis with counting fingers vision in the left eye. Because of recent reports of rifabutin-associated