Abstract
Purpose :
Cytomegalovirus (CMV) retinitis-related retinal detachment (RD) is the leading cause of visual morbidity in patients with acquired immunodeficiency syndrome (AIDS). Pars plana vitrectomy (PPV) with endotamponade agents is widely accepted as the surgery of choice for this type of RD. We conducted this retrospective study to determine the surgical outcomes and predicting factors associated with favorable outcomes in these patients.
Methods :
Fifty-two eyes (45 patients) undergoing PPV due to CMV-related RD from 2002 through 2016 were included. The main outcome measurements were the incidence of retinal redetachment after primary PPV and the rate of achieving functional success defined as postoperative VA of ≥ 20/200 at 6 months and final follow-up. The Kaplan-Meier curve and log rank rest analyses were performed on the time to retinal redetachment. Multivariate logistic regression models based on the directed acyclic graph (DAG) were used to identify independent factors associated with achieving functional success.
Results :
Over a mean follow-up of 41.7 months, 8 out of 52 eyes (15.4%) developed retinal redetachment after primary PPV. The cumulative incidence of retinal redetachment at 6 months and 1 year was 11.5% (95% CI=5.4-23.9), and 13.5% (95% CI=6.7-26.3), respectively. Eyes without antiretroviral therapy (ARV) by the time CMV retinitis was diagnosed (crude hazard ratio [cHR]=5.6;p=0.049) and with a delayed PPV of >3 months (cHR=5.5; p=0.019) were associated with an increased risk of retinal redetachment. Postoperative functional success was achieved in 28 eyes (53%) and 34 eyes (65.4%) at 6 months and final follow-up, respectively. Receiving ARV at the initial diagnosis of CMV retinitis (adjusted odds ratio [aOR]=4.9;p=0.043), a preoperative VA of ≥ 5/200(aOR=5.6; p<0.001), early PPV within 3 months (aOR= 6.7; p=0.008), absence of optic atrophy postoperatively (aOR=58.1; p<0.001), and successful retinal reattachment (aOR=36.4; p=0.006) were independently associated with achieving functional success at final follow-up.
Conclusions :
PPV was associated with favorable anatomical and functional outcomes in our setting. The use of ARV and early PPV appeared to increase the incidence of both anatomical and functional success.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.