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Elizabeth A. Sugar, Alice T. Lyon, Richard A. Lewis, Douglas A. Jabs, Murk-Hein Heinemann, James P. Dunn, John H. Kempen, Studies of Ocular Complications of AIDS Research Group; Risk Of Cataract In Persons With Acquired Immune Deficiency Syndrome And Cytomegalovirus Retinitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6218.
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To evaluate the prevalence and incidence of cataract, and the associated risk factors, in the eyes of patients with acquired immune deficiency syndrome (AIDS) and cytomegalovirus retinitis (CMVR).
Demographic, clinical, and treatment characteristics were recorded quarterly for 489 patients (729 eyes) with CMVR in the Longitudinal Study of the Complications of AIDS. Eyes were identified as having cataract if they underwent cataract surgery or had a high grade of lens opacity by biomicroscopy that was determined to cause a reduction in visual acuity to worse than 20/40.
Overall, 144 (20%) of eyes with CMVR had prevalent cataract and 145 incident cases were observed. Individuals with bilateral CMVR had a higher prevalence of cataract than those with unilateral disease (adjusted odds ratio [aOR] = 2.7, p < 0.001). For those with unilateral disease, the eye with CMVR was more likely to have a cataract than the fellow eye without retinitis (15% vs 1.4%, p < 0.001). The age-adjusted prevalence was significantly higher than that of a comparable population-based study (p < 0.001). A history of retinal detachment was associated with increased incidence (adjusted hazard ratio [aHR]=14.5, p < 0.001, if repaired with silicone oil and aHR = 2.5, p < 0.001, otherwise). As the fraction of retinal involvement in CMVR lesions increased, the risk of cataract increased (aHR=2.1, p < 0.001, for 25-49% and aHR = 4.4, p < 0.001, for ≥ 50% as compared to ≤ 24% involvement). Anterior inflammation (aHR = 2.1, p < 0.001) and a history of cataract in the contralateral eye (aHR: 2.1, p < 0.001) also were associated with increased incidence. These factors also were risk factors for prevalent cataract, as were increased age (aOR = 11.5, p =0.003, for age ≥60 years versus less than 40) and time since CMVR diagnosis (aOR = 1.4, p < 0.001). Ganciclovir implants did not significantly increase the incidence (aHR = 1.3, 95% confidence interval: 0.8 to 1.9, p = 0.17).
Eyes with CMV retinitis are at high risk to develop cataracts. Some of the risk factors (large retinal lesion size and use of silicone oil in retinal detachment repair) are potentially modifiable, albeit not in all cases. Given the high prevalence and incidence rates, cataract is likely to be an important cause of visual acuity loss in a population with AIDS and CMVR.
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