Surgical outcomes and prognostic factors following vitrectomy in acquired immune deficiency syndrome patients with cytomegalovirus retinitis-related retinal detachment

Abstract

To determine the surgical outcomes and prognostic factors of cytomegalovirus (CMV) retinitis-related retinal detachment (RD) in acquired immune deficiency syndrome (AIDS) patients following vitrectomy. A retrospective charts review was carried out on AIDS patients who were diagnosed with CMV retinitis-related RD and treated with vitrectomy between 2002 and 2016. The main outcome measures were the rates of primary anatomical success and final visual acuity (VA) success defined as postoperative VA ≥20/200. Kaplan–Meier curves on the time to retinal redetachment were performed. Multivariate logistic regression models based on a directed acyclic graph were used to identify independent factors associated with achieving VA success. Forty five AIDS patients (52 eyes) were included. Over a mean follow-up period of 41.7 months, primary anatomical success was achieved in 44 eyes (84.6%) and VA success was achieved in 34 eyes (65.4%). Receiving highly active antiretroviral therapy (HAART) prior to RD (adjusted odds ratio [aOR]=4.9, P = .043), better preoperative VA (aOR = 4.3, P = .006), undergoing vitrectomy within 3 months (aOR=6.7, P = .008), absence of optic atrophy (aOR=58.1, P < .001), and absence of retinal redetachment (aOR=38.1, P = .007) increased the odds of achieving final VA success. Vitrectomy provided favorable anatomical reattachment in AIDS patients with CMV retinitis-related RD. Majority of patients was able to retain functional vision postoperatively. The use of HAART and early vitrectomy increased the probability of achieving both anatomical and VA success.

Clinical features of Cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome and efficacy of the current therapy

“…However, it is only reserved for unusual CMVR cases considering the risk of hemorrhage, infection, and vision loss associated with the sampling procedure. The previously reported aqueous CMV-DNA positivity was inconsistent, ranging from 20% to 100% (Suri et al, 2018;Sittivarakul et al, 2020); the pooled positivity in our study was 87%, suggesting its high sensitivity in diagnosing CMVR. However, its application is still limited since the anterior chamber paracentesis is still invasive and associated with the risks of hemorrhage and infection (Tang et al, 2020).…”

Long-term Outcomes of Surgeries for Retinal Detachment Secondary to Parasitic or Viral Infectious Retinitis

“…Surgical reattachment becomes necessary to preserve vision and improve the quality of life in these patients. The outcomes of reattachment surgeries in viral retinitis are relatively well-known, with various studies reporting reattachment rates of 70% to 89% [ 8 , 12 , 13 , 29 , 30 ] and postoperative ambulatory vision success rates varying between 50% to 65% [ 12 , 24 , 29 , 31 ]. Zone 1 disease, optic nerve involvement, and worse preoperative VA are associated with poor visual outcomes in these patient groups [ 30 , 32 , 33 ].…”

“…Rhegmatogenous RD typically manifests after the acute phase of infection, secondary to vitreous traction on necrotic retina and inflammatory membranes [8][9][10]. While vitrectomy has demonstrated favorable anatomical results in patients with RD secondary to viral retinitis, visual outcomes largely depend on the preoperative status of the optic disc and macula [11][12][13][14].…”

Prevention of Cytomegalovirus Retinitis-Related Retinal Detachment by Prophylactic Argon Laser Demarcation in patients with AIDS in Myanmar

“…) Retinal detachment (RD) is the most devastating complication of CMV retinitis. All CMVR patients are at risk of RD, arising from atrophic holes within necrotic retina (5,6,7). Risk increases with bilateral disease (8.)…”

“…Without surgery RD leads to permanent profound vision loss. Surgical repair is technically challenging (5,6,7), expensive, and often not available. Even with appropriate surgery, 34.6% − 42.1% of patients are left with visual acuity worse than 20/200 (6, 7).…”