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D. Heiden, N. J. S. London, N. Tun, F. Smithuis; Outcomes for a 42 Patient CMV Retinitis Cohort From the Slums of Rangoon. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3813.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the visual, clinical, and social outcomes of a cohort of 42 patients with CMV retinitis, identified in November 2006 in the HIV/AIDS Yangon project of MSF/H.
CMV retinitis was identified in 42 of 179 patients referred for retinal screening examination with an indirect ophthalmoscope by a Uveitis specialist familiar with CMV retinitis during a single week in November 2006. Clinical determination of disease activity was made, and if the CMV retinitis was inactive, this was correlated with duration of Antiretroviral Therapy (ART). At one and two years, an attempt was made to re-examine all patients who had active retinitis on initial screening. At 30 months another attempt at re-examination was made, and charts for all patients who initially presented with active CMV retinitis were reviewed to determine survival and social outcomes. Visual acuity was evaluated at the bedside by the ophthalmologist, to document blindness.
Baseline CD4 counts were below 50 cells/uL in 36/42 (86%) of patients, and were between 50-100 (measured 3-5 months prior) or unknown in the remaining 6 patients. 20 of 42 patients had inactive CMV retinitis on initial examination (bilateral in 6 patients; 26 eyes with inactive retinitis). These patients had never been treated with specific Anti-CMV medication. All of these patients were on ART, with 18/20 patients treated with ART 6 months or longer. 12/26 (46%) of eyes were blind, and vision loss was profound with Va HM or worse in 11/12 eyes. In the group of patients with active CMV retinitis, 10/22 patients could be located at one year, and 9/9 eyes that had intact vision at baseline maintained intact vision at one year, after treatment with weekly intravitreal injection by the Aids clinician (5/9 of these patients had Zone 1 disease). At 30 months, in the group that initially present with active CMV retinitis, 7/22 (32%) were dead, 6/22 were alive, and 9/22 (41%) were lost to followup (3 patients within 1 month of initial visit).
First, CMV retinitis does heal with ART alone and without specific anti-CMV therapy, but visual outcomes are extremely poor. Second, AIDS clinicians can successfully manage active CMV retinitis with intravitreal injection. Third, in resource-poor settings, active CMV retinitis identifies a patient group of extraordinary "vulnerability" with 16/22 (73%) of patients either dead or lost to followup at 30 months.
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