Risk of retinal detachment and vision loss in patients with cytomegalovirus retinitis and the acquired immune deficiency syndrome (Immune deficiency)

Objectives. To characterize the effect of cytomegalovirus (CMV) retinitis and of its treatment on the risk of retinal detachment and of loss of visual acuity.; Background. Cytomegalovirus retinitis in patients with the Acquired Immune Deficiency Syndrome (AIDS) is often complicated by retinal detachment and vision loss. Use of highly active anti-retroviral therapy (HAART) and intraocular ganciclovir implants for treatment of CMV retinitis are major new developments in the treatment of patients with AIDS and CMV retinitis which may modify risk of retinal detachment and vision loss.; Methods. Data on consecutive patients with AIDS and CMV retinitis at a single center were entered prospectively into a computerized database at the time of CMV retinitis diagnosis. Patients were then followed for incidence of retinal detachment. Use of anti-CMV treatment and HAART were noted during followup, as well as the occurrence of immune recovery in response to HAART. Visual acuity measurements for all eyes at all visits were obtained by retrospective chart review. The observed incidences of retinal detachment and of loss of visual acuity were calculated, and their relationships to ganciclovir implant therapy, HAART, demographic and clinical characteristics were evaluated.; Results. Retinal detachment occurred at a rate of 36% per eye-year, and 42% per patient-year. Use of HAART was associated with a 60% reduction in retinal detachment risk, with the greatest benefit in patients observed to have immune recovery. Use of ganciclovir implant therapy was associated with retinal detachment risk similar to that with systemic therapy. The incidence of loss of 3-, 6-, and 10-lines of loss of visual acuity among affected eyes by the end of the first year after CMV retinitis diagnosis was 42%, 30%, and 23% respectively. After adjustment for confounding, eyes of patients with immune recovery while receiving HAART had relative risks of loss of visual acuity ranging from 0.11–0.21, depending on the definition of loss of visual acuity used, with respect to eyes of patients who did not receive HAART. No significant differences in risk of vision loss were observed according to use of ganciclovir implant versus systemic anti-CMV therapy, after adjustment for confounding.; Conclusions. The risks of retinal detachment and of loss of visual acuity are high in patients with AIDS and CMV retinitis. Use of HAART appears to reduce the risks of retinal detachment and of loss of visual acuity substantially in these patients, particularly when immune recovery is observed. We did not observe differences in the risks of retinal detachment or of loss of visual acuity according to treatment with ganciclovir implants versus systemic anti-CMV therapy.