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N.N. Vaidya, R.M. Lieberman, S.–R. Oh, R.M. Fischer; Long Term Follow Up of Immune Reconstitution Uveitis (IRU) in Patients with Human Immunodeficiency Virus (HIV) and Cytomegalovirus Retinitis (CMVR) . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2443.
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IRU may be a sequela of an immune reaction against CMV antigens within the eye, incited by the recovery of CD4+ T lymphocytes after the initiation of highly active anti–retroviral therapy (HAART) for HIV. We present the long term follow up of patients with this disorder, in addition to correlation with treatment.
Retrospective chart review was performed to include the following data: patient demographics, time to presentation of IRU after initiation of HAART and diagnosis of CMVR, best corrected visual acuity (BCVA) at presentation and at one, three, six and nine months through one year following presentation of uveitis. Other variables recorded included: CD4 counts, viral load (VL), level of anterior chamber and vitreous inflammation at each time interval and complications. Treatment modalities and prior use of cidofovir were also recorded.
21 patients (37 eyes) were included in this cohort. Mean age was 42 (range 28–62), with 15 males and 6 females. Average initial CD4 was 151 cells (range 20 – 700) and average VL was 60517 copies (range 0 – 210000). Time to presentation of IRU after initiation of HAART averaged 182 days (range 65–628). Initial BCVA ranged from 20/20 to count fingers vision. At presentation, 83% ≥ 20/50 and 8.3% ≤ 20/100. Final BCVA [(1 yr data) 41.7% ≥ 20/50, 13.9% ≤ 20/100] appeared to be achieved at 6 months. Moderate visual loss occurred in 13.8% and severe visual loss occurred in 11%.
Extent of inflammatory response was not noted to effect eventual visual outcome. Cystoid macular edema (CME) was noted in 27% of study participants, with 30% of those patients ≤ 20/100 at 1 yr. Cidofovir did not appear to effect eventual visual outcome. Complications included cataracts (8.3%), retinal detachment (5.6%), retinoschisis and epiretinal membrane (1 pt.each).
BCVA significantly decreased over time in 42% of eyes. A visual acuity nadir at six months showed a strong correlation to eventual visual acuity. Eventual BCVA also strongly correlated to the presence of CME, which was more prevalent in those with lower initial vitreous inflammation. Additionally, there appeared to be no direct correlation of CD–4, VL or cidofovir use to visual outcome. Various treatments did not correlate to improved visual outcome.
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