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A. Nagpal, N. N. Vaidya, R. M. Lieberman, D. A. Chruscicki, R. M. Fischer; Severity and Duration of Uveitis as a Prognostic Factor in Patients With Cytomegalovirus Retinitis (CMVR) and Immune Reconstitution Uveitis (IRU). Invest. Ophthalmol. Vis. Sci. 2007;48(13):339.
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To correlate degree and duration of anterior chamber uveitis and vitritis with final visual outcome and complication rates in patients with CMVR and IRU.
Retrospective chart review performed to include the following data: patient demographics, BCVA at various time intervals, CD4 counts, viral loads, severity of anterior chamber uveitis and vitritis, treatment regimen, complications.
21 patients (37 eyes) were included in this cohort of patients with IRU. Mean age was 42.39 years. There were15 males and 6 females. Initial mean CD4 counts were 151 cells, ranging from 20 to 700. Final mean CD4 counts were 207 cells, ranging from 100 to 400. Initial BCVA at the time of presentation with IRU ranged from 20/20 to light perception (71% were 20/50 or better; 20% were 20/100 or worse). 62% of eyes had some degree of anterior chamber reaction on first presentation of IRU, with the majority of those (52%) noted to have 1+ cell. 90% of eyes had vitreous reaction initially, with 43% presenting with 1+ reaction. At one year follow-up, 64% of eyes were >20/50, and 20% were < 20/100. The majority of eyes had no anterior chamber (91%) or vitreous reaction (58%). 59% of eyes had cystoid macular edema (CME) as a complication of IRU, while 16% had visually significant cataracts, and 11% had retinal detachments (RD).
Severity and duration of anterior chamber uveitis and vitritis did not correspond to final visual outcome in this cohort of patients with CMVR and IRU. While uveitis and vitritis improved, the vision did not improve significantly at 1 year follow up. This is likely due to the complications of this disease process, which included CME, RD, and cataract. In a subset of eyes in which uveitis and vitritis worsened initially and then improved, improvement in uveitis and vitritis correlated with an improvement in vision in the majority of cases. However, these patients suffered from CME, RD, or cataract, which also limited final BCVA. In summary, final visual outcome in patients with CMVR and IRU appears to be limited by the complications of these diseases.
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