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H Brilakis, CL Cowan; Retinal Neovascularization with HIV Infection in the absence of CMV Retinitis or Hematologic Abnormalities . Invest. Ophthalmol. Vis. Sci. 2002;43(13):502.
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Purpose: Retinal neovascularization has been described in patients with HIV, in the presence usually of a coexisting condition, such as cytomegalovirus (CMV) retinitis. We present a case of peripheral retinal neovascularization in the absence of CMV or other specific abnormalities and we review the literature. Methods: A 36-year-old HIV positive African-American male patient with chronic hepatitis B and no history of interferon treatment presented with a three-day history of decreased vision in the left eye. Uncorrected vision was 20/20 in the right eye and 20/100 in the left eye. External exam, motility, pupils and slit lamp biomicroscopy were normal. Results: On fundus exam, vitreous hemorrhage was seen in the left eye, along with peripheral vessel anastomoses simulating stage II sickle-cell retinopathy and peripheral sea-fan neovascular lesions in both eyes. A fluorescein angiogram showed leakage from the sea-fan lesions with decreased but present perfusion anterior to the lesions. There was no vessel wall staining. (see figures). Laboratory workup was negative for, among other tests, hemoglobin S and ACE, while a serum protein electrophoresis revealed hypergammaglobulinemia, with polyclonal bands. This hematologic finding is frequent in HIV-infected patients and is of no known significance. We present a literature review on HIV-related retinal neovascularization. Conclusion: Whether it be microvascular occlusion due to hypergammaglobulinemia as the underlying condition, whether it be a sublinical vasculitis or a protein expressed by the HIV virus like «TAT»(described in cases of Kaposi’s sarcoma) with VEGF-like angiogenetic activity , peripheral neovascularization may be an ocular aftermath of HIV infection.
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