Ocular Disorders Associated with a new Severe Acquired Cellular Immunodeficiency Syndrome

Holland, Gary N.; Gottlieb, Michael; Yee, Robert D.; Schanker, Howard M.; Pettit, Thomas H.

doi:10.1016/0002-9394(82)90127-1

Cited by 192 publications

(46 citation statements)

References 29 publications

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“…CMV retinitis has become more commonly recognized as a complication of chronic CMV infection in immunosuppressed hosts, including those with the acquired immunodeficiency syndrome (AIDS) (5). Patients with CMV retinitis are good candidates for antivfral trials for several reasons.…”

Section: Antiviral Therapy Of Systemic Cytomegalovirus (Cmv)mentioning

confidence: 99%

Alpha-interferon administration in cytomegalovirus retinitis

Chou¹,

Dylewski²,

Gaynon³

et al. 1984

Antimicrob Agents Chemother

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Four patients, including three with the acquired immunodeficiency syndrome (AIDS), were treated with high-dose, buffy coat-derived alpha-interferon for progressive cytomegalovirus retinitis. Two of these patients had decreased viruria during therapy and the other two had increased viruria. There was evidence of progression of disease despite therapy in all patients, although the retinitis eventually became quiescent in the patient without AIDS. The severe immunosuppression encountered in AIDS patients complicates the management of cytomegalovirus and other opportunistic infections. CMV retinitis has become more commonly recognized as a complication of chronic CMV infection in immunosuppressed hosts, including those with the acquired immunodeficiency syndrome (AIDS) (5). Patients with CMV retinitis are good candidates for antivfral trials for several reasons. The disease tends to evolve less rapidly than some other CMV syndromes, thus allowing time for virological confirmation of the diagnosis before initiating therapy and time for a therapeutic effect to have an impact on the disease process. Because the eye lesions are characteristic and easily followed by objective criteria such as fundus photographs, clinical response may be readily assessed. Also, the risk of permanent visual loss and the lack of proven effective therapy has stimulated the use'of experimental antivirals in an effort to preserve vision.We report here our experience in the treatment of four patients with'CMV retinitis, using high-dose human leukocyte interferon. Three of the patients had AIDS. We monitored response clinically and virologically, using traditional tissue culture methods as well as the recently developed DNA hybridization assay for rapid measurement of viruria (3). diarrhea, perianal herpes simplex infection, and leukopenia. Two months before referral, visual loss in the left eye was noted, and a diagnosis of CMV retinitis was made. Viral culture of the urine showed CMV. Because of progression of lesions, a course of vidarabine was attempted, but this caused leukopenia and myalgias, and therapy was stopped after 2 weeks. Two weeks later, after resolution of the myalgias, interferon was begun at a dose of 5 x 106 U per day. Pretreatment urine culture showed 3.9 log TCID50 per 0.2 ml of CMV, with a positive DNA hybridization assay. A buffy coat culture was positive for CMV on day 2 of treatment. During therapy, granulocyte counts fell from 1,300/mm3 to a range of 700 to 1,000/mm3. The interferon dose was nevertheless increased to 5 x 106 U twice daily beginning 12 days after beginning therapy. This did not result in any further decrease of granulocyte counts; in fact, they rose to pretreatment levels. The patient experienced moderately severe anorexia and malaise, which appeared worse than that present before treatment. The increased interferon dosage was given for 26 days (for a total of 38 days of interferon). Four-hour post-injection interferon levels in the blood ranged from 80 U/ml at the lower dose to 225 U/ml at the higher d...

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Section: Antiviral Therapy Of Systemic Cytomegalovirus (Cmv)mentioning

confidence: 99%

Alpha-interferon administration in cytomegalovirus retinitis

Chou¹,

Dylewski²,

Gaynon³

et al. 1984

Antimicrob Agents Chemother

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“…Ever since the first description on ocular manifestation of AIDS was made by Holland et al in 1982 several reports have been published on ocular involvement in AIDS in different part of the world. [4,[13][14][15][16][17][18][19][20][21][22] In India the eye abnormalities in HIV infected patients was first reported in 1995 from Chennai. [1,5,10,11] The estimated prevalence of HIV-related eye diseases in India is reported to be between 8-45%.…”

Section: Introductionmentioning

confidence: 99%

A Study of Ocular Complications of HIV/AIDS in a Teaching Medical College in North-Eastern India

Singh¹,

Singh²

2018

AIMDR

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Background: HIV infection/AIDS is becoming a public health hazard globally. Ocular complications of HIV/AIDS are very common and its severity increases as the disease progresses and ultimately leads to blindness. Objective: The purpose of the present study was to determine the prevalence and type of ocular complications in patients with HIV/AIDS. Methods: A cross-sectional study was done on patients with HIV infection/AIDS who attended or referred to eye OPD and also cases from General Medicine ward of JNIMS. A complete ophthalmic evaluation of both anterior and posterior segments was conducted. HIV sero-positivity was established by ELISA and confirmed by Western Blot in all cases. Results: The majority of the patients were in the age group of 21-40yrs. The prevalence of ocular involvement was 47%. The commonest involvement was on posterior segment with HIV retinopathy and cotton wool spots (20%) and CMV retinitis (5%). Anterior segment involvement was 18% with conjunctival micro-vasculopathy being the commonest (8%) and HZO in 5 cases. Conclusion: HIV infection is fairly common in Manipur among the age group of 20-40yrs., IDU being the commonest route of infection. Ocular involvement occurred in 47% of cases and it may be the first manifestation. So, the ophthalmologist must be aware for prompt treatment and prevention of visual disabilities.

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“…The first published series of AIDS-related ocular disease already described CMV retinitis as a complication of the syndrome (15)(16)(17). In AIDS patients, CMV primarily infects the retina, but some papers have reported infection of other ocular structures such as cornea, conjunctiva, iris and ciliary body (18).…”

Section: Introductionmentioning

confidence: 99%

Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant

Muccioli

Belfort

2000

Braz J Med Biol Res

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The objective of this prospective study was to evaluate the efficacy and complications of the use of an intraocular sustained-release ganciclovir implant for the treatment of active cytomegalovirus (CMV) retinitis in AIDS patients. Thirty-nine eyes of 26 patients were submitted to ocular surgery. All patients underwent complete ocular examination before and after surgery. The surgical procedure was always done under local anesthesia using the same technique. The mean time for the surgical procedure was 20 min (range, 15 to 30 min). The average follow-up period was 3.7 months. Of all patient, only 4 presented recurrence of retinitis after 8, 8, 9 and 2 months, respectively. Three of them received a successful second implant. All 39 eyes of the 26 patients presented healing of retinitis as shown by clinical improvement evaluated by indirect binocular ophthalmoscopy and retinography. Retinitis healed within a period of 4 to 6 weeks in all patients, with clinical regression signs from the third week on. Six (15.4%) eyes developed retinal detachment. None of the patients developed CMV retinitis in the contralateral eye. The intraocular implant proved to be effective in controlling the progression of retinitis for a period of up to 8 months even in patients for whom systemic therapy with either ganciclovir or foscarnet or both had failed. The intraocular sustained-release ganciclovir implant proved to be a safe new procedure for the treatment of CMV retinitis, avoiding the systemic side effects caused by the intravenous medications and improving the quality of life of the patients.

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Ocular Disorders Associated with a new Severe Acquired Cellular Immunodeficiency Syndrome

Cited by 192 publications

References 29 publications

Alpha-interferon administration in cytomegalovirus retinitis

Alpha-interferon administration in cytomegalovirus retinitis

A Study of Ocular Complications of HIV/AIDS in a Teaching Medical College in North-Eastern India

Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant

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