Retinal detachment (RD) with macular involvement is linked to poor visual outcomes in patients with HIV/AIDS presenting with cytomegalovirus (CMV) retinitis, according to research presented at the American Society of Retina Specialists meeting in New York, July 13 to 16, 2022.

CMV retinitis is the most common ocular infection among HIV-positive patients and it can potentially cause blindness, the study explains. Researchers obtained medical records of 219 patients (mean age: 35.9 years, 194 men, 25 women) with HIV/AIDS presenting with CMV retinitis between January 1, 2009 and December 31, 2019. 

Participants were thoroughly examined at the slit lamp biomicroscope using a lens of 90 D and a 20 D lens using the indirect microscope. The study excluded patients lost to follow-up and those not treated at the Center for Research Infectious Diseases at the National Institute of Respiratory Diseases in Mexico City. 


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A total of 312 eyes were diagnosed with CMV retinitis, 109 (49.8%) patients were asymptomatic at the time of diagnosis, and 92% of patients were treated with valganciclovir, according to the study.

The researchers found that the most common complication was holes and tears (93%), followed by RD in 87 (28%) cases, of which 49.4% had macular involvement and 65 (75%) RD were treated with vitrectomy and silicone placement. 

They also found that 69 (32%) patients had immune reconstitution inflammatory syndrome (IRIS), with a median presentation of 8 weeks (IQR 4-13 weeks), 26 (38%) corresponded with unmasking CMV-immune recovery retinitis (CMV-IRR), 25 (36%) paradoxical CMV-IRR and 18 (26%) immune recovery uveitis (IRU), according to the report. The team notes that the most frequent IRU was epiretinal membrane (ERM), which occurred in 51% of cases, followed by vitritis in 46%.

In total, 56% of patients with RD had visual acuity (VA) equal to or better than 20/150 and 43% had equal to or worse than 20/200. After management, 67% had 20/200 or worse, of which 44 patients ended up in NLP. Researchers report that only 33% ended up with vision better than 20/150.

The 87% of patients with IRIS had VA equal to or better than 20/150 and 76% maintained that VA following treatment. The researchers also report that only 7% of patients with IRIS ended up in NLP. 

“The complication associated with worse visual outcome is RD with macular involvement; visual outcome depends more on the location of the lesions than on the CD4+ count,” according to the researchers. “Patients with RD involving the macula had worse visual outcomes than those with IRIS. Early diagnosis and correct follow-up is crucial to improve visual prognosis.”

Limitations of the study included its retrospective nature, single-center design and the predominately male study population.  

Reference

Sánchez-Olguin E, Romero-Castro RM, González-Cannata MG, Espinosa-Sosa A, Ávila-Rios S. Fundus findings, risk factors and their correlation with visual outcomes in HIV-positive patients with CMV retinitis at the National Institute of Respiratory Diseases. Poster presented at: the 40th annual meeting of the American Society of Retina Specialists (ASRS); July 13-16, 2022; New York. Presentation 239.