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S. Bozorg, I. Kozak, J. S. Kim, L. Cheng, S. F. Oster, W. R. Freeman; Macular Structure in Eyes With Healed Extramacular CMV Retinitis Using Spectral-Domain Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5891.
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To evaluate the macula in eyes with inactive/healed extramacular CMV retinitis using spectral-domain optical coherence tomography (OCT).
A case-control study including 45 eyes of 43 patients. The macula was evaluated using spectral-domain OCT (Heidelberg Engineering, Vista, CA). Group A included 25 eyes of 23 patients with healed CMV retinitis not involving the macula. Group B was composed of 10 eyes of 10 HIV+ patients with no history of CMV retinitis. Group C was composed of 10 eyes of 10 patients who were HIV- normal controls. We graded foveal contour, presence of epiretinal membrane (ERM), history of immune recovery uveitis (IRU), area of retinitis, foveal and parafoveal retinal thickness and morphology of individual retinal layers. We used ANOVA and contingency analysis for statistical comparisons.
In Group A, 6 patients had zone 1 disease, 7 had zone 2 disease, and 10 had zone 3 disease. Nine of the 23 patients had at one time been diagnosed with IRU. Spectral-domain OCT images of the macula revealed the following: 11 eyes had evidence of ERM formation, 12 eyes demonstrated abnormal macular morphology, 7 eyes demonstrated distorted and or cystic changes of the outer nuclear layer, and 10 eyes revealed similar changes localized to the inner nuclear layer. Two eyes demonstrated formation of a glial membrane. This resulted in significant loss of foveal contour compared to control group (p=0.011). Loss of foveal contour correlated best with the presence of ERM (p=0.017) but not with the area of CMV retinitis (p=0.32) or history of IRU (p=0.272). The average foveal thickness in group A was 282.9±10.7 µm, in group B 246.3±28.4 µm and in group C 229.1±17.4 µm (p=0.036). Parafoveal retinal thickness among the three groups did not reveal statistical difference.
The eyes of patients with healed CMV retinitis not involving the macular area show subtle structural abnormalities in the fovea detected by SD-OCT technology. This may explain previously reported visual function impairment.
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