Improved Visual Results After Surgical Repair of Cytomegalovirus-Related Retinal Detachments

Lim, Joshua; Enger, Cheryl; Haller, József; Campochiaro, Peter A.; Meredith, Travis A.; Bustros, Serge de; Dunn, Jack; Jabs, DA

doi:10.1097/00006982-199515040-00033

Cited by 6 publications

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“…Retinal detachments occurred at the rate of 0.33/EY 5,86. Although surgical repair of the detachments could be accomplished by vitreoretinal surgery with silicone oil, visual recovery after detachment was limited by the refractive problems with silicone oil and the subsequent development of cataract 86,113,114. In the Johns Hopkins CMV Retinitis Cohort Study, nearly all patients undergoing surgical repair of CMV retinitis-related retinal detachments subsequently experienced cataract formation, and the median time from retinal surgery to cataract formation was 1.8 months.…”

Section: Visual Outcomes Of Cytomegalovirus Retinitismentioning

confidence: 99%

Cytomegalovirus Retinitis and the Acquired Immunodeficiency Syndrome—Bench to Bedside: LXVII Edward Jackson Memorial Lecture

Jabs

2011

American Journal of Ophthalmology

111

101

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Purpose-To update information on cytomegalovirus (CMV) retinitis in patients with the acquired immune deficiency syndrome (AIDS) and to integrate information on its pathogenesis and clinical outcomes. Design-Literature review.Methods-Selected articles from the medical literature, particularly large epidemiologic studies, including the Johns Hopkins Cytomegalovirus Retinitis Cohort Study, the Longitudinal Study of the Ocular Complications of AIDS, and the Cytomegalovirus Retinitis and Viral Resistance Study, were reviewed. Clinical information is discussed in light of knowledge on CMV, its pathogenesis, and its interactions with human immunodeficiency virus (HIV).Results-Cytomegalovirus uses several mechanisms to evade the immune system and establish latent infection in immunologically normal hosts. With immune deficiency, such as late-stage AIDS, CMV reactivates, is disseminated to the eye, and establishes a productive infection, resulting in retinal necrosis. HIV and CMV potentiate each other: CMV accelerates HIV disease, and CMV retinitis is associated with increased mortality. Randomized clinical trials have demonstrated the efficacy of treatments for CMV retinitis. Systemically-administered treatment for CMV retinitis decreases AIDS mortality. Highly active antiretroviral therapy (HAART), effectively suppresses HIV replication, resulting in immune recovery, which, if sufficient, controls retinitis without anti-CMV therapy. Resistant CMV, detected in the blood, correlates with resistant virus in the eye and is associated with worse clinical outcomes, including mortality. Host factors, including host genetics and access to care, play a role in the development of CMV retinitis. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-ClinicalOff label use of drugs: Discussion of intravitreal injection of antiviral drugs ganciclovir, foscarnet, and cidofovir. NIH Public Access Author ManuscriptAm J Ophthalmol. Author manuscript; available in PMC 2012 February 1.Published in final edited form as: Am J Ophthalmol. 2011 February ; 151(2): 198-216.e1. doi:10.1016/j.ajo.2010.018. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Epidemiology of Cytomegalovirus RetinitisPrior to the advent of the acquired immune deficiency syndrome (AIDS), cytomegalovirus (CMV) retinitis (Figure 1) was a rare disease seen primarily among transplant patients, but also among those with congenital CMV infection and other forms of immune compromise. 1 -4 It was estimated to affect ~1% of patients undergoing renal transplant and ~0.5% of those undergoing bone marr...

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Section: Visual Outcomes Of Cytomegalovirus Retinitismentioning

confidence: 99%

Cytomegalovirus Retinitis and the Acquired Immunodeficiency Syndrome—Bench to Bedside: LXVII Edward Jackson Memorial Lecture

Jabs

2011

American Journal of Ophthalmology

111

101

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“…7,8 Pars plana vitrectomy with silicone oil tamponade and endolaser is usually the treatment of choice for complicated RD associated with CMV retinitis. [9][10][11] Spectral domain-optical coherence tomography (SD-OCT), a new generation of OCT technology, currently offers more rapid and superior quality imaging of retinal pathology. [12][13][14] We wished to determine the vitreoretinal relationship in CMV retinitis and used SD-OCT to image CMV retinitis scars, bordering areas of nonaffected retina, and the overlying vitreous in human immunodeficiency virus-positive patients with a history of CMV retinitis.…”

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Vitreoretinal Interface Abnormalities in Healed Cytomegalovirus Retinitis

Brar

Kozák

Freeman

et al. 2010

Retina

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“…With the improvement of microsurgical techniques, silicone oil has been successfully used in the management of complicated retinal detachments associated with proliferative vitreoretinopathy, giant retinal tears, proliferative diabetic retinopathy, severe trauma, and cytomegalovirus related retinal detachments. [1][2][3][4][5] It provides prolonged intraocular tamponade and because of its optical clarity, it allows for adequate postoperative assessment.…”

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confidence: 99%

Visual loss following removal of intraocular silicone oil

Cazabon

Groenewald²,

Pearce³

et al. 2005

British Journal of Ophthalmology

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Aim: To investigate the cause of visual loss following removal of intraocular silicone oil in patients who underwent vitrectomies for retinal detachment or giant retinal tear. Methods: The clinical records of three cases with visual loss following removal of silicone oil were reviewed. Investigations carried out included fundus fluorescein angiogram, optical coherence tomography, and electrophysiological studies. Results: Visual acuities dropped from 6/9 to 6/36 in two cases and 6/24 to 3/24 in the third. None of the three cases had macula detachment at any stage. Fundus fluorescein angiogram and optical coherence tomography were normal in all cases. Pattern electroretinogram showed reduced amplitudes of the P50 and N95 components. Multifocal electroretinogram indicated a selective damage to the central part of the macula. Conclusions:The results suggest that the abnormality arises predominantly in the central part of the macula, especially the outer and middle layers. However, the exact mechanism still remains obscure.S ilicone oil has a well established role in vitreoretinal surgery. With the improvement of microsurgical techniques, silicone oil has been successfully used in the management of complicated retinal detachments associated with proliferative vitreoretinopathy, giant retinal tears, proliferative diabetic retinopathy, severe trauma, and cytomegalovirus related retinal detachments.

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Improved Visual Results After Surgical Repair of Cytomegalovirus-Related Retinal Detachments

Cited by 6 publications

References 0 publications

Cytomegalovirus Retinitis and the Acquired Immunodeficiency Syndrome—Bench to Bedside: LXVII Edward Jackson Memorial Lecture

Cytomegalovirus Retinitis and the Acquired Immunodeficiency Syndrome—Bench to Bedside: LXVII Edward Jackson Memorial Lecture

Vitreoretinal Interface Abnormalities in Healed Cytomegalovirus Retinitis

Visual loss following removal of intraocular silicone oil

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