Ocular Involvement in HIV/AIDS

From EyeWiki

All content on Eyewiki is protected by copyright law and the Terms of Service. This content may not be reproduced, copied, or put into any artificial intelligence program, including large language and generative AI models, without permission from the Academy.

Article initiated by:
Janet L. Davis, Majid Moshirfar, M.D.
All contributors:
Alaa Eldanasoury, MD, Majid Moshirfar, M.D., Shruti Aggarwal, MD, Vandana Reddy, MD, Vatinee Y. Bunya, MD, MSCE, Brad H. Feldman, M.D., Janet L. Davis, Shruti Aggarwal, MD, Colleen Halfpenny, M.D., Alan Palestine, MD, Jessica Shantha, MD, Marissa Larochelle, MD
Assigned editor:
Marissa Larochelle, MD, Shruti Aggarwal, MD
Review:
Assigned status Up to Date
 by Marissa Larochelle, MD on September 18, 2024.


HIV infection can manifest in a variety of ways in and around the eyes, and these manifestations vary according to HIV disease severity, specifically, CD4+ T lymphocyte counts. In general, Kaposi sarcoma, herpes zoster ophthalmicus, candidiasis, and lymphoma are more common in earlier stages whereas tuberculosis, toxoplasmosis, and pneumocystosis occur with more impairment. Cytomegalovirus retinitis and mycobacterium-avium complex disease are usually seen in patients with profound reductions of CD4 counts. Achievement of a non-detectable HIV viral load is associated with a better prognosis.

Background

History

The identification in 1981 of a cluster of gay men with unusual clinical manifestations later ascribed to infection with human immunodeficiency virus-I (HIV-I) was followed within a year by publication of typical ocular manifestations: cotton wool spots, cytomegalovirus, periphlebitis, and conjunctival Kaposi sarcoma. [1] The acquired cellular immunodeficiency syndrome, rapidly became the world-wide focus of numerous surveys of eye disease, randomized clinical trials, and case series detailing optimal management of the ocular complications of AIDS. After 1996 ocular manifestations were modified by the improved immune status achieved by many patients who were treated with highly active antiretroviral therapy (HAART). [2] In 2007, a large observational study reported 9.2% of patients with visual impairment in the better eye and 41.4% of patients with other major ocular complications.[3] HIV infection remains a significant clinical problem for ophthalmologists. Ocular manifestations occur mainly in adults but can also occur in children with HIV/AIDS.[4]

Incidence and prevalence of HIV infection

In 2007, there were 33 million people worldwide with HIV/AIDS, 2.7 million people newly infected with HIV, 2 million death. Ninety-five per cent of infections and deaths occurred in developing countries. In the US, 1.1 million people are estimated to have HIV/AIDS in 2016 with approximately 37,832 new infections, disproportionately affecting African Americans.[5][6] Transmission occurs by sexual contact, by exposure to infected blood or blood products typically through needle-sharing, or through vertical transmission from an infected mother. Diagnosis is made by detection of virus-specific antibodies and confirmed by Western blot. After diagnosis patients are monitored by quantitative HIV-RNA determinations by PCR.

Spectrum of HIV disease

Acute infection with HIV causes nonspecific symptoms of viral infection and lymphadenopathy, followed by a minimally symptomatic phase during which CD4+ T lymphocyte counts decline from the normal values of 600 to 1500 cells/mm3. Below 200 cells/mm3, symptoms occur frequently from opportunistic infections, malignancies, and generalized malaise. Ocular manifestations attributable to HIV infection vary according to CD4+ T lymphocyte counts.[7] In general, Kaposi sarcoma, herpes zoster ophthalmicus, candidiasis, and lymphoma are more common in earlier stages whereas tuberculosis, toxoplasmosis, and pneumocystosis occur with more impairment. Cytomegalovirus retinitis and mycobacterium-avium complex disease are usually seen in patients with profound reductions of CD4 counts.[8] Achievement of a non-detectable HIV viral load is associated with a better prognosis.

Treatment of HIV

Current medical therapy of HIV infection is updated periodically by the International AIDS Society. [9]

Anatomic Categorization of Ocular Manifestations

Adnexa and orbit

Molluscum contagiosum presents as small, painless papules 1-3 mm in size with a central depression. The lesions are more likely to be numerous and bilateral in HIV infection but patients may be asymptomatic unless the eyelid margin is involved. Crusted, painful vesicles suggest herpetic infection. Herpes zoster ophthalmicus in individuals less than 50 years of age is suggestive of HIV infection and HIV infected patients are more likely to develop sequential necrotizing herpetic retinitis following HZO. [10] HZO has both an elevated risk ratio and increased incidence rate in HIV infected patients compared to immunocompetent individuals. [11] Kaposi sarcoma is an opportunistic malignancy produced by HHV-8 infection. The tumors are highly vascular with deep red or purple color and may distort the eyelid contours. [12] The orbit can become infected secondary to contiguous sinus disease. Aspergillosis is the most common orbital infection in HIV/AIDS. [13] Anterior and external disorders associated with AIDS were the subject of a comprehensive review. [14]

Conjunctiva

Malignant tumors can affect the conjunctiva in HIV/AIDS. Kaposi sarcoma has the same intense red, hemorrhagic appearance as the adnexal lesions. Conjunctival intraepithelial neoplasia (CIN) typically occurs at the conjunctival/corneal junction, causes mild redness and foreign body sensation; it may mimic pterygium or pinguecula. [15] Squamous cell carcinoma is elevated with an irregular, roughened surface and typically invasive. Excision is indicated for most neoplastic complications; local administration of interferon alfa-2b has efficacy for KS and CIN. Qureshi 2009, [16][17] Radiation and cryotherapy is useful in more advanced KS; disseminated KS is treated with chemotherapy. Conjunctival lymphoma has a characteristic salmon-patch appearance.

Cornea

Corneal manifestations range from relatively benign dry eye symptoms to severe, blinding bacterial pseudomonal keratitis. Recurrences of herpes simplex keratitis are more common in HIV/AIDS, but the clinical course and incidence differs little from HSV keratitis in immunocompetent individuals. [18] The intracellular, protozoal parasite Microsporidia causes a coarse, superficial punctate keratitis.

Iris and ciliary body

Iritis can accompany bacterial or viral keratitis or posterior segment infections or may be associated solely with HIV infection and improve with treatment of the underlying HIV disease. Certain drugs used in the treatment of HIV-related conditions can cause drug-induced iritis. Rifabutin is used in the treatment of mycobacterium-avium complex infection and can produce severe hypopyon iritis that may be confused with endogenous endophthalmitis. [19] Cidofovir, used in the treatment of cytomegalovirus retinitis (CMVR), can also cause iritis and occasionally hypotony. [20][21]

Neuroretina

In a subset of patients with HIV/AIDS, a disorder called HIV associated neuroretinal disorder has been described. It is defined as loss of the nerve fiber layer which manifests clinically as decreased contrast sensitivity, abnormal color vision, and visual field loss. Jab et al described risk factors for development which include Hepatitis C infection, detectable viral load, and low Cd4 T cells.[22]

Retina - Non-infectious

Microangiopathy is the most common ocular manifestation of HIV infection. Cotton wool patches are the most typical. They can be distinguished from infectious retinitis by a size less than 500 microns, a feathered edge, and transience, with fading over 6 to 8 weeks. Although microangiopathy is generally not felt to be visually threatening, permanent structural damage has been documented with scanning laser ophthalmoscopy and OCT. [23] Microangiopathy may also be responsible for alterations in visual function. In a large series of AIDS patients without retinitis, 3% of eyes had vision worse than 20/40, nearly 40% had some abnormal visual field, and 12% had low contrast sensitivity. [24]Decreasing visual function correlated with some measures of increasing disease severity.

Retina – Infectious - Cytomegalovirus retinitis (CMVR)

Prior to HAART therapy, CMVR occurred in 15 to 40% of HIV infected patients and was associated with increased mortality and death within 6 months for many patients. [25] Pre-HAART, patients with CMVR in three large clinical trials had 51.7 to 97.67 events per 100 eye-years for loss of visual acuity to worse than 20/40. [26] Use of HAART is associated with fewer symptoms, reduced border opacification, and better vision even in patients who acquire CMVR because they are failing HAART therapy. [25] HAART has also resulted in a decline in the incidence of CMVR by 80%. [27] CMVR is spread by contact with body fluids and has a high seroprevalence in the same populations at high risk for HIV infection. [28]The lesions follow a vascular distribution because the virus is endothelial-tropic. Depending on the size of the vessels infected, the retinitis can be either fulminantly hemorrhagic and exudative and follow the major vascular arcades, or superficial and granular. Clearing within lesions is typical because slow viral replication allows central healing. The border is yellow-white and studded with small satellite lesions marking progression of retinal necrosis into adjacent retina. Clinical diagnosis is considered adequate; PCR confirmation of CMV infection from aqueous humor is available if needed. [29]

Treatment of CMVR

Treatment of CMV retinitis is with intravenous ganciclovir administered as an initial, high-dose induction therapy (5 mg/kg twice daily for 2 weeks) followed by long-term maintenance therapy (5 mg/kg once daily). Oral valganciclovir is more commonly used because it is more convenient and achieves equivalent blood levels equivalent to intravenous administration. Induction therapy is 900 mg twice daily for 21 days followed by 900 mg once daily. [30] Both drugs can produce myelosuppression. Foscarnet is an intravenous alternative used mainly for virologic resistance and for synergistic therapy with ganciclovir in clinical resistance. It requires an initial 2-week, high- dose induction therapy (90 mg/kg every 12 hours for 2 weeks) followed by long-term maintenance therapy (90–120 mg/kg daily). Renal dysfunction and metabolic abnormalities of calcium and magnesium have been reported in up to 30% of patients. Intravitreal injections of 2.0 mg ganciclovir in 0.05 mL once per week can provide adequate maintenance therapy for control of CMV retinitis. Salvage or induction therapy with two to three injections per week for up to two weeks is safe. [31]Foscarnet, 2.4 mg in 0.1 mL, can be used intravitreally instead of ganciclovir or combined with ganciclovir, 1.2 mg in 0.05 mL, mixed immediately prior to injection to avoid crystallization. Intravitreal implantation of the ganciclovir intraocular device is less frequently used due to the high cost and limited duration of 8 months, but has a good safety profile. [32][33]Cidofovir, administered intravenously or intraocularly, has largely been abandoned because of both systemic and ocular toxicity.

Monitoring of treatment response

Monitoring of response to treatment is done by assessing border activity and position. Photographic monitoring is helpful to detect subtle changes in the border that may indicate progression. Patients with low CD4+ T lymphocyte counts, positive blood CMV by PCR, and longer duration of AIDS are more likely to progress. [34]With therapy, healing is generally expected in 4 to 6 weeks, although activity commonly recurs unless the underlying immunosuppression is effectively treated. Strategies for recurrence include reinduction, addition of foscarnet to ganciclovir, intravitreal injections, and implantation of the ganciclovir intraocular device. A recent review summarizes current treatment strategies for CMV retinitis. [35]

Discontinuation of anti-CMV therapy

Discontinuation of anti-CMV therapy can be considered in patients with stable retinitis who have CD4+ T lymphocyte counts ≥ 100 if they are taking HAART. [36]A nondetectable viral load increases the chances of success. Even with stability of the retinitis, patients may still experience vision loss from complications related to CMVR. [37] Elevated CD4+ T lymphocyte counts associated with immune recovery may lead to macular edema and epiretinal membrane. [34] Risk of immune recovery vitritis and uveitis increases with CMVR surface area greater than 30%. [38]Other risk factors are posterior pole involvement and treatment with intravitreal cidofovir. [39] Overall, immune recovery is associated with a decreased risk visual acuity loss in patients with CMVR. [40]

Retinal detachment

Retinal detachment is associated with CMVR in up to 50% of cases and is the third most common cause of vision loss in AIDS patients after posteriorly located CMVR and cataract. [41]Laser photocoagulation of retinal holes or partial detachments may reduce the risk of progression and need for vitrectomy with silicone oil tamponade. [20][42][43] HAART therapy is also associated with a 60% reduction in risk of retinal detachment, presumably due to better control of the retinitis. [44]

Retinitis – Infectious – Necrotizing Herpetic Retinitis

Progressive outer retinal necrosis (PORN) is the usual term used to describe necrotizing herpetic retinitis due to varicella zoster. It is characterized by rapid progression and minimal anterior or vitreous inflammation. There is a high frequency of no light perception in patients treated with intravenous acyclovir by one month. [45] It often occurs in the setting of cutaneous zoster infection. There is a high incidence of retinal detachment and bilateral involvement. Intravitreal antiviral treatment or combined intravenous ganciclovir and foscarnet seem to control the infection better than intravenous acyclovir.[46] Because of the rapidity of progression, very aggressive initial therapy is usually selected.

Retinitis – Infectious - Toxoplasma retinochoroiditis

Toxoplasmic chorioretinitis has an increased incidence in HIV-positive compared to HIV-negative patients. [11] Large lesion sizes and bilateral involvement are more common in immunocompromised patients. A distinctive pattern of diffuse toxoplasmic chorioretinitis mimicking a viral necrotizing retinitis and involving more than 3 clock hours of the fundus can be seen. [47] Preexisting scars may be less common in HIV/AIDS, suggesting that acquired disease or dissemination from remote sites may be the initiating factor. [48] Patients with HIV infection may be more prone to progression if left untreated. Standard anti-toxoplasmosis regimens are used. In addition, ocular toxoplasmosis may be associated with cerebral or toxoplasmosis in immunocompromised patients. MRI of the brain to rule out CNS involvement can be considered.

Retinitis – Infectious - Syphilitic chorioretinitis

Manifestations of ocular syphilis include anterior or intermediate uveitis, optic neuritis, and chorioretinitis. The chorioretinitis typically presents as placoid subretinal lesions in the posterior pole. OCT examination often shows outer retinal and subretinal fluid. Geographic areas of non-necrotizing retinitis can also occur that heal with stippled hyperpigmentation of the RPE over time. Relapse and negative nontreponemal serology may be more common in HIV infected patients. [49] Treatment with a neurosyphilis regimen is required: either 24 million units of intravenous penicillin G daily for 10–14 days, followed by 2.4 million units of intramuscular benzathine penicillin G administered weekly for 3 weeks or 2.4 million units of procaine penicillin G intramuscularly for 10 days with probenecid 500 mg orally four times daily.

Choroiditis – Infectious

Pneumocystis carinii choroiditis was relatively common in the early years of the HIV pandemic because of ineffective prophylaxis against P carinii pneumonia. Use of systemic antimicrobials such as trimethoprim-sulfamethoxazole rather than aerosolized pentamidine essentially eradicated this ocular manifestation. Deep orange lesions are characteristic of P carinii choroiditis; they generally do not affect vision and fade with antimicrobial treatment. Cryptococcus neoformans choroiditis is also much less common in the HAART era. It can occur from systemic dissemination or from optic nerve involvement via the central nervous system in the setting of cryptococcal meningitis. Optic nerve edema from increased intracranial pressure with risk of optic atrophy is likely a more common complication of CNS cryptococcosis than intraocular invasion. [50]

Other choroidal infections

Ocular tuberculosis is rare even in HIV-infected patients residing in endemic areas. Prevalence was 15 (19 eyes) in 766 HIV/AIDS patients (1.95%) in India. [51]Choroidal granuloma was the most common manifestation, present in more than 50% of eyes. Subretinal abscess in 7 eyes worsed to panophthalmitis in 3. The average CD4+ T lymphocyte count was 160, indicating that marked immunocompromised is not necessary for ocular tuberculosis to develop in patients with active pulmonary tuberculosis and HIV. Autopsy studies have identified histoplasma capsulatum, candida, aspergillus, toxoplasma, and mycobacterium avium-intracellulare in the choroid of patients with HIV/AIDS. [52]

LASIK in Patients With HIV/AIDS[edit | edit source]

There is very little data available on the safety and efficacy of LASIK in HIV positive patients. Currently, the US FDA considers HIV positivity a relative contraindication to refractive surgery, and the American Academy of Ophthalmology has no official opinion.

There are two primary concerns that led to the US FDA issuing their recommendation: the risk of infection in immunosuppressed patients, and the risk of viral transmission via the laser.

Risk of Transmission[edit | edit source]

Anecdotal reports from refractive surgeons seem to indicate a significant majority feel confident there is minimal risk for viral transmission via the laser equipment. There are no reports in the literature of HIV infection transmission due to LASIK surgery that might contradict this opinion. Despite this belief, a recent study on the practices of refractive surgeons indicates most surgeons (72.7%) who preform LASIK surgery on HIV positive patients do take additional precautions. Precautions included unilateral surgery, scheduling the patient for the last surgery of the day, wearing double gloves and immediate postoperative evacuation the laser plume.

LASIK in Patients HIV Positive Patients[edit | edit source]

There is limited literature evaluating the safety and efficacy of LASIK in patients with HIV positivity but without evidence of AIDS. Anecdotal reports from refractive surgeons indicate the majority believe LASIK can be safely performed in these patients without significant increased risk for infection. Aref et al found that 58% of US practitioners believe HIV positive patients without any AIDS defining characteristics were acceptable candidates for LASIK, while only 14% believed it was an absolute contraindication to surgery.

There is one case report of post-LASIK bilateral bacterial keratitis in an HIV positive patient. Additionally, Aref et al found 3.4% of survey responders (2 providers) reported postoperative keratitis in HIV positive patients, although the total number of cases was not reported. One survey responder reported an incidence of delayed wound healing and dry-eye.

A prospective observational cohort study was conducted and published recently. Amongst the U.S. Military HIV Natural History Study database which comprises of HIV+ service members and beneficiaries, participants who underwent LASIK/PRK and other refractive surgeries were identified. 79 out of a total of 2073 participants underwent refractive surgery with 53 undergoing PRK, 23 LASIK, 2 Radial keratotomy and 1 astigmatic correction. Complications were reported in 6 patients ranging 8 to 217 days post op; 5 of whom had undergone PRK and one RK. None of the patients undergoing LASIK had a complication. Out of the 6 patients with complications, 3 developed central corneal ulcers, one marginal corneal ulcer, one perforated ulcer and one unspecified keratitis. Type of surgery and prior history of AIDS were identified as risk factors for complications following refractive surgery in HIV+ patients in univariate analysis. However, no risk factors were identified in logistic regression analysis. Four of 6 patients with complications had viral load of >400 copies/ml and 3 out of 6 patients were on HAART at the time of surgery. None of the patients had CD4 counts <200/mm3.

There are no reports of HZO, HSV keratitis or CMV retinitis following LASIK in this patient population.

LASIK in Patients With AIDS[edit | edit source]

There are no studies on the safety and efficacy of LASIK surgery in patients with HIV positivity who meet the defining criteria for AIDS (presence of an AIDS defining symptom or CD 4 T lymphocyte count less than 200/mm3). In the observational study conducted on HIV+ patients undergoing refractive surgery, none of the patients who had complications had CD4 count<200/mm3 at the time of the surgery although prior history of AIDS was identified as a risk factor for complications in univariate analysis.

Aref et al found that refractive surgeons are much less likely to perform elective LASIK on this patient population than on those with HIV positivity without evidence of immunosuppression. Only 12.5% of responders believe AIDS patients are acceptable candidates for refractive surgery, while the vast majority (88%) believes it to be a relative or absolute contraindication.

Recommendations[edit | edit source]

There is a lack of clinical research on this issue, which means the decision on whether to perform LASIK on HIV/AIDS patients varies by practitioner, and is often made on a case-by-case basis. Given these limitations, it is difficult to find broad recommendations; however there seems to be some consensus among practitioners, who agree with the following:

  1. Elective LASIK surgery should not performed on any patient with evidence of HIV/AIDS related ocular pathology or a history of any recurring ocular infection such as HZO, HSV keratitis or CMV retinitis.
  2. Elective LASIK surgery should be avoided in patients with HIV positivity and evidence of immunosuppression (AIDS defining condition or CD 4 T lymphocyte count below 200/mm3).
  3. Current viral load should be taken into account. Surgery should be deferred if viral load is >10,000 copies/ml at the time of planned surgery.
  4. Elective LASIK surgery can generally be safely performed in HIV positive patients without evidence of immunosuppression, who do not have history of recurring ocular or eyelid infection.
  5. HIV positive patients considered for LASIK should be on HAART and compliant with treatment.
  6. Refractive surgeons should take care when performing LASIK surgery on HIV positive patients to strictly adhere to universal precautions.
  7. It is not unreasonable for the physician to take extra precautions when performing LASIK on HIV positive patients, such as avoiding bilateral surgery, scheduling the patient for the last case of the day, or evacuating the laser plume immediately after surgery, although there is no evidence of the efficacy of these measures.

Additional Resources

References

  1. ↑ Holland GN, Gottlieb MS, Yee RD, Schanker HM, Pettit TH. Ocular disorders associated with a new severe acquired cellular immunodeficiency syndrome. Am J Ophthalmol. 1982 Apr;93(4):393-402. PubMed ID:6280503
  2. ↑ Holland GN. AIDS and ophthalmology: the first quarter century. Am J Ophthalmol. 2008 Mar;145(3):397-408. PubMed ID:18282490
  3. ↑ Jabs DA, Van Natta ML, Holbrook JT, Kempen JH, Meinert CL, Davis MD; Studies of the Ocular Complications of AIDS Research Group. Longitudinal study of the ocular complications of AIDS: 2. Ocular examination results at enrollment. Ophthalmology. 2007 Apr;114(4):787-93. PMID: 17210182
  4. ↑ Dennehy PJ, Warman R, Flynn JT, Scott GB, Mastrucci MT. Ocular manifestations in pediatric patients with acquired immunodeficiency syndrome. Arch Ophthalmol. 1989 Jul;107(7):978-82. PMID: 2546525
  5. ↑ NIAID. http://www.niaid.nih.gov/topics/HIVAIDS/Understanding/Pages/quickFacts.aspx
  6. ↑ https://www.cdc.gov/hiv/statistics/overview/index.html
  7. ↑ Cunningham ET Jr, Margolis TP. Ocular manifestations of HIV infection.N Engl J Med. 1998 Jul 23;339(4):236-44. PMID: 9673303
  8. ↑ Hoover DR, Peng Y, Saah A, Semba R, Detels RR, Rinaldo CR Jr, Phair JP. Occurrence of cytomegalovirus retinitis after human immunodeficiency virus immunosuppression. Arch Ophthalmol. 1996 Jul;114(7):821-7. PMID: 8660165
  9. ↑ Hammer SM, Eron JJ Jr, Reiss P, Schooley RT, Thompson MA, Walmsley S, Cahn P, Fischl MA, Gatell JM, Hirsch MS, Jacobsen DM, Montaner JS, Richman DD, Yeni PG,Volberding PA; International AIDS Society-USA. Antiretroviral treatment of adult HIV infection: 2008 recommendations of the International AIDS Society-USA panel.JAMA. 2008 Aug 6;300(5):555-70. PMID: 18677028
  10. ↑ Sellitti TP, Huang AJ, Schiffman J, Davis JL. Association of herpes zoster ophthalmicus with acquired immunodeficiency syndrome and acute retinal necrosis. Am J Ophthalmol. 1993 Sep 15;116(3):297-301. PMID: 8357053
  11. ↑ 11.0 11.1 Hodge WG, Seiff SR, Margolis TP. Ocular opportunistic infection incidences among patients who are HIV positive compared to patients who are HIV negative. Ophthalmology. 1998 May;105(5):895-900. PMID: 9593394
  12. ↑ Brun SC, Jakobiec FA. Kaposi's sarcoma of the ocular adnexa. Int Ophthalmol Clin. 1997 Fall;37(4):25-38.PMID: 9429930
  13. ↑ Kronish JW, Johnson TE, Gilberg SM, Corrent GF, McLeish WM, Scott KR.Orbital infections in patients with human immunodeficiency virus infection. Ophthalmology. 1996 Sep;103(9):1483-92. PMID: 8841310
  14. ↑ Jeng BH, Holland GN, Lowder CY, Deegan WF 3rd, Raizman MB, Meisler DM. Anterior segment and external ocular disorders associated with human immunodeficiency virus disease. Surv Ophthalmol. 2007 Jul-Aug;52(4):329-68. PMID: 17574062
  15. ↑ Karp CL, Scott IU, Chang TS, Pflugfelder SC. Conjunctival intraepithelial neoplasia. A possible marker for human immunodeficiency virus infection? Arch Ophthalmol. 1996 Mar;114(3):257-61. PMID: 8600883
  16. ↑ Qureshi YA, Karp CL, Dubovy SR. Intralesional interferon alpha-2b therapy for adnexal Kaposi sarcoma. Cornea. 2009 Sep;28(8):941-3. PMID: 19654515
  17. ↑ Galor A, Karp CL, Chhabra S, Barnes S, Alfonso EC. Topical interferon alpha 2b eye-drops for treatment of ocular surface squamous neoplasia: a dose comparison study.Br J Ophthalmol. 2010 May;94(5):551-4. PMID: 19493859
  18. ↑ Hodge WG, Margolis TP. Herpes simplex virus keratitis among patients who are positive or negative for human immunodeficiency virus: an epidemiologic study. Ophthalmology. 1997 Jan;104(1):120-4. PMID: 9022115
  19. ↑ Saran BR, Maguire AM, Nichols C, Frank I, Hertle RW, Brucker AJ, Goldman S, Brown M, Van Uitert B. Hypopyon uveitis in patients with acquired immunodeficiency syndrome treated for systemic Mycobacterium avium complex infection with rifabutin. Arch Ophthalmol. 1994 Sep;112(9):1159-65. PubMed PMID: 8085960.
  20. ↑ 20.0 20.1 Davis JL, Hummer J, Feuer WJ. Laser photocoagulation for retinal detachments and retinal tears in cytomegalovirus retinitis. Ophthalmology. 1997 Dec;104(12):2053-60. PMID: 9400765
  21. ↑ Ambati J, Wynne KB, Angerame MC, Robinson MR. Anterior uveitis associated with intravenous cidofovir use in patients with cytomegalovirus retinitis.Br J Ophthalmol. 1999 Oct;83(10):1153-8. PMID: 10502577
  22. ↑ Jabs DA, Drye L, Van Natta ML, Thorne JE, Holland GN; Studies of the Ocular Complications of AIDS Research Group. Incidence and long-term outcomes of the human immunodefıciency virus neuroretinal disorder in patients with AIDS.Ophthalmology. 2015 Apr;122(4):760-8. doi: 10.1016/j.ophtha.2014.11.009. Epub2015 Jan 16. PubMed PMID: 25600199; PubMed Central PMCID: PMC4372475.
  23. ↑ Gomez ML, Mojana F, Bartsch DU, Freeman WR. Imaging of long-term retinal damage after resolved cotton wool spots. Ophthalmology. 2009 Dec;116(12):2407-14. PMID: 19815278
  24. ↑ Freeman WR, Van Natta ML, Jabs D, Sample PA, Sadun AA, Thorne J, Shah KH, Holland GN; SOCA Research Group. Vision function in HIV-infected individuals without retinitis: report of the Studies of Ocular Complications of AIDS Research Group. Am J Ophthalmol. 2008 Mar;145(3):453-462. PMID: 18191094
  25. ↑ 25.0 25.1 Holland GN, Vaudaux JD, Shiramizu KM, Yu F, Goldenberg DT, Gupta A, Carlson M, Read RW, Novack RD, Kuppermann BD; Southern California HIV/Eye Consortium. Characteristics of untreated AIDS-related cytomegalovirus retinitis. II. Findings in the era of highly active antiretroviral therapy (1997 to 2000). Am J Ophthalmol. 2008 Jan;145(1):12-22. PMID: 18154751
  26. ↑ Holbrook JT, Jabs DA, Weinberg DV, Lewis RA, Davis MD, Friedberg D; Studies of Ocular Complications of AIDS (SOCA) Research Group. Visual loss in patients with cytomegalovirus retinitis and acquired immunodeficiency syndrome before widespread availability of highly active antiretroviral therapy. Arch Ophthalmol. 2003 Jan;121(1):99-107. PMID: 12523893
  27. ↑ Goldberg DE, Smithen LM, Angelilli A, Freeman WR. HIV-associated retinopathy in the HAART era. Retina. 2005 Jul-Aug;25(5):633-49. PMID: 16077362
  28. ↑ Bowen EF, Griffiths PD, Davey CC, Emery VC, Johnson MA. Lessons from the natural history of cytomegalovirus. AIDS. 1996 Nov;10 Suppl 1:S37-41. PMID: 8970675
  29. ↑ Harper TW, Miller D, Schiffman JC, Davis JL. Polymerase chain reaction analysis of aqueous and vitreous specimens in the diagnosis of posterior segment infectious uveitis. Am J Ophthalmol. 2009 Jan;147(1):140-147. PMID: 9593394
  30. ↑ Segarra-Newnham M, Salazar MI. Valganciclovir: A new oral alternative for cytomegalovirus retinitis in human immunodeficiency virus-seropositive individuals. Pharmacotherapy. 2002 Sep;22(9):1124-8. PMID: 12222548
  31. ↑ Young SH, Morlet N, Heery S, Hollows FC, Coroneo MT. High dose intravitreal ganciclovir in the treatment of cytomegalovirus retinitis. Med J Aust. 1992 Sep 21;157(6):370-3. PMID: 1333036
  32. ↑ Dunn JP, Van Natta M, Foster G, Kuppermann BD, Martin DF, Zong A, Jabs DA; Studies of Ocular Complications of AIDS Research Group. Complications of ganciclovir implant surgery in patients with cytomegalovirus retinitis: the Ganciclovir Cidofovir Cytomegalovirus Retinitis Trial.Retina. 2004 Feb;24(1):41-50. PMID: 15076943
  33. ↑ Kappel PJ, Charonis AC, Holland GN, Narayanan R, Kulkarni AD, Yu F, Boyer DS, Engstrom RE Jr, Kuppermann BD; Southern California HIV/Eye Consortium. Outcomes associated with ganciclovir implants in patients with AIDS-related cytomegalovirus retinitis. Ophthalmology. 2006 Apr;113(4):683.e1-8. PMID: 16581428
  34. ↑ 34.0 34.1 Jabs DA, Van Natta ML, Thorne JE, Weinberg DV, Meredith TA, Kuppermann BD, Sepkowitz K, Li HK; Studies of Ocular Complications of AIDS Research Group Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy: 1. Retinitis progression. Ophthalmology. 2004 Dec;111(12):2224-31. PMID: 15582078
  35. ↑ Stewart MW. Optimal management of cytomegalovirus retinitis in patients with AIDS. Clin Ophthalmol. 2010 Apr 26;4:285-99. PMID: 20463796
  36. ↑ Whitcup SM, Fortin E, Lindblad AS, Griffiths P, Metcalf JA, Robinson MR, Manischewitz J, Baird B, Perry C, Kidd IM, Vrabec T, Davey RT Jr, Falloon J, Walker RE, Kovacs JA, Lane HC, Nussenblatt RB, Smith J, Masur H, Polis MA. Discontinuation of anticytomegalovirus therapy in patients with HIV infection and cytomegalovirus retinitis. JAMA. 1999 Nov 3;282(17):1633-7. PMID: 10553789
  37. ↑ Robinson MR, Reed G, Csaky KG, Polis MA, Whitcup SM. Immune-recovery uveitis in patients with cytomegalovirus retinitis taking highly active antiretroviral therapy. Am J Ophthalmol. 2000 Jul;130(1):49-56. PMID: 11004259
  38. ↑ Karavellas MP, Azen SP, MacDonald JC, Shufelt CL, Lowder CY, Plummer DJ, Glasgow B, Torriani FJ, Freeman WR. Immune recovery vitritis and uveitis in AIDS: clinical predictors, sequelae, and treatment outcomes. Retina. 2001;21(1):1-9. PMID: 11217922
  39. ↑ Kempen JH, Min YI, Freeman WR, Holland GN, Friedberg DN, Dieterich DT, Jabs DA; Studies of Ocular Complications of AIDS Research Group. Risk of immune recovery uveitis in patients with AIDS and cytomegalovirus retinitis. Ophthalmology. 2006 Apr;113(4):684-94. PMID: 16581429
  40. ↑ Thorne JE, Jabs DA, Kempen JH, Holbrook JT, Nichols C, Meinert CL; Studies of Ocular Complications of AIDS Research Group. Incidence of and risk factors for visual acuity loss among patients with AIDS and cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Ophthalmology. 2006 Aug;113(8):1432-40. PMID: 16766032
  41. ↑ Thorne JE, Jabs DA, Kempen JH, Holbrook JT, Nichols C, Meinert CL; Studies of Ocular Complications of AIDS Research Group. Causes of visual acuity loss among patients with AIDS and cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Ophthalmology. 2006 Aug;113(8):1441-5. PMID: 16781775
  42. ↑ Althaus C, Loeffler KU, Schimkat M, Hudde T, Sundmacher R. Prophylactic argon laser coagulation for rhegmatogenous retinal detachment in AIDS patients with cytomegalovirus retinitis.Graefes Arch Clin Exp Ophthalmol. 1998 May;236(5):359-64. PMID: 9602320
  43. ↑ Shah GK, Vander J. Rhegmatogenous retinal detachments with cytomegalovirus retinitis. Curr Opin Ophthalmol. 1998 Jun;9(3):6-10. PMID: 10182103
  44. ↑ Kempen JH, Jabs DA, Dunn JP, West SK, Tonascia J. Retinal detachment risk in cytomegalovirus retinitis related to the acquired immunodeficiency syndrome. Arch Ophthalmol. 2001 Jan;119(1):33-40. PMID: 11146724
  45. ↑ Engstrom RE Jr, Holland GN, Margolis TP, Muccioli C, Lindley JI, Belfort R Jr,Holland SP, Johnston WH, Wolitz RA, Kreiger AE. The progressive outer retinal necrosis syndrome. A variant of necrotizing herpetic retinopathy in patients with AIDS. Ophthalmology. 1994 Sep;101(9):1488-502. PMID: 8090452
  46. ↑ Scott IU, Luu KM, Davis JL. Intravitreal antivirals in the management of patients with acquired immunodeficiency syndrome with progressive outer retinal necrosis. Arch Ophthalmol. 2002 Sep;120(9):1219-22. PubMed PMID: 12215102.
  47. ↑ Moshfeghi DM, Dodds EM, Couto CA, Santos CI, Nicholson DH, Lowder CY, Davis JL. Diagnostic approaches to severe, atypical toxoplasmosis mimicking acute retinal necrosis. Ophthalmology. 2004 Apr;111(4):716-25. PMID: 15051204
  48. ↑ Holland GN. Ocular toxoplasmosis in the immunocompromised host. Int Ophthalmol. 1989 Dec;13(6):399-402. PMID: 2697706
  49. ↑ Browning DJ. Posterior segment manifestations of active ocular syphilis, their response to a neurosyphilis regimen of penicillin therapy, and the influence of human immunodeficiency virus status on response. Ophthalmology. 2000 Nov;107(11):2015-23. PMID: 11054325
  50. ↑ Kestelyn P, Taelman H, Bogaerts J, Kagame A, Abdel Aziz M, Batungwanayo J, Stevens AM, Van de Perre P. Ophthalmic manifestations of infections with Cryptococcus neoformans in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol. 1993 Dec 15;116(6):721-7. PubMed PMID: 8250075.
  51. ↑ Babu RB, Sudharshan S, Kumarasamy N, Therese L, Biswas J. Ocular tuberculosis in acquired immunodeficiency syndrome.Am J Ophthalmol. 2006 Sep;142(3):413-8. PMID: 16935585
  52. ↑ Morinelli EN, Dugel PU, Riffenburgh R, Rao NA. Infectious multifocal choroiditis in patients with acquired immune deficiency syndrome. Ophthalmology. 1993 Jul;100(7):1014-21. PMID: 8321524
Retrieved from "https://eyewiki.org/w/index.php?title=Ocular_Involvement_in_HIV/AIDS&oldid=112118"
The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website.
Learn more
Powered by MediaWiki
Powered by Canasta
Powered by Semantic MediaWiki