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Grace Chew, Stephen C B Teoh; Cataract surgery in HIV patients. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2794.
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© ARVO (1962-2015); The Authors (2016-present)
To report the complication profile of HIV patients undergoing cataract surgery in a tertiary referral hospital in Singapore
A retrospective review of HIV patients who underwent cataract surgery from 2000-2011 in Tan Tock Seng Hospital was performed. Cataract surgeries on different eyes of the same patient were counted as separate cases. Data regarding patient demographics, preoperative HIV management, CD4 count and visual acuity, type of cataract surgery performed, post-operative course and complications, if any, were collected. Prolonged postoperative inflammation was taken as persistent anterior chamber activity lasting for more than 1 month after the operation date. This data was then analyzed to determine surgical outcomes.
46 eyes from 28 patients were identified, with 25 patients on antiretroviral therapy at time of surgery (median CD4=201/mm3). Preoperatively, 41.3% had no ophthalmic manifestations of HIV/AIDS. 17 eyes had quiescent cytomegalovirus retinitis(CMVR) of which 4 were still on maintenance therapy at time of surgery; 5 eyes had quiescent immune reactivation uveitis(IRU). 3 eyes had corneal scarring secondary to limbal stem cell deficiency(n=2) and previous corneal abscess(n=1); 2 eyes had previous gonococcal conjunctivitis. 54.3% had nuclear sclerotic cataracts, 34.8% had posterior subcapsular cataracts and 10.9% had intumescent cataracts. 41 eyes(89.1%) underwent phacoemulsification, while 10.9% underwent extracapsular cataract extraction. 63% of surgeries followed an uneventful perioperative course. Intraoperatively 1 eye had a posterior capsule rupture with postoperative raised intraocular pressure. 1 eye developed new CMVR(CD4=19/mm3) postoperatively, while 1 eye had reactivation of previous CMVR(CD4=92/mm3); 1 eye experienced reactivation of IRU. 2 eyes with new or previous CMVR developed rhegmatogenous retinal detachments(RD) within 3 months postoperatively. 3 eyes had prolonged postoperative inflammation which settled with topical steroids. There were no cases of endophthalmitis or cystoid macular edema. Postoperative improvement of at least 2 Snellen lines was achieved in 80.4% of eyes. Visual acuity remained at baseline in 5 eyes due to previous zone 1 CMVR in all eyes.
Cataract surgery in HIV patients is safe with outcomes similar to the general population, but their ocular and general health should be optimized prior to cataract surgery. Patient with prior CMVR may be at risk of reactivation or RD.
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