AIDSRelated Retinal Disorders Definition

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Retinal disorders in AIDS involve either AIDS-associated microangiopathy or infection.

Epidemiology: Up to 80% of all AIDS patients have retinal disorders as a result of the disease. Other ocular involvement is rare.

Pathogenesis: The pathogenesis of microangiopathy is still unclear. Opportunistic infections are frequently caused by viruses.

Symptoms: Microangiopathy is usually asymptomatic. Patients with infectious retinal disorders report loss of visual acuity and visual field defects.

Diagnostic considerations: Ophthalmoscopic findings in AIDS-associated microangiopathy include hemorrhages, microaneurysms, telangiectasia, and cotton-wool spots. Direct involvement of vascular endothelial cells in HIV infection or immune-complex-mediated damage to endothelial cells and vascular structures is thought to play a role.

Cytomegalovirus retinitis.

— Cytomegalovirus retinitis.

rhages.

Typical signs include extensive white areas of retinal necrosis and hemor-

Fig. 12.35

rhages.

Typical signs include extensive white areas of retinal necrosis and hemor-

Fig. 12.35

Cytomegalovirus retinitis occurs in 20-40% of older patients. Peripheral retinal necrosis and intraretinal bleeding (Fig. 12.35) are frequently observed. Vascular occlusion is rare. Secondary rhegmatogenous retinal detachment may develop. These lesions heal to produce fine granular pigment epithelial scars.

Less frequently, AIDS may involve retinal infection caused by herpes simplex and varicella-zoster viruses, Toxoplasma gondii, or Pneumocystis carinii. The diagnosis of a viral retinal infection in AIDS is confirmed by attempting to obtain positive serum cultures and by resistance testing.

Differential diagnosis: Inflammatory retinal changes due to other causes should be excluded by serologic studies.

Treatment: Microangiopathy does not require treatment. Viral retinitis is treated with ganciclovir or foscarnet. Herpes simplex and varicella-zoster viruses are treated with acyclovir.

Prophylaxis: Ophthalmologic screening examinations are indicated in the presence of known viral infection.

Clinical course and prognosis: The prognosis for microangiopathy is very good. Infectious retinitis will lead to blindness if left untreated. Visual acuity can often be preserved if a prompt diagnosis is made.

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