July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Prevention of Blindness from CMV Retinitis-Related Retinal Detachment by Prophylactic Argon Laser Demarcation
Author Affiliations & Notes
  • Lynn M Hassman
    Ophthalmology and Vision Sciences, Washington University in St. Louis, St Louis, Missouri, United States
  • Khin Thida Oo
    Myanmar Eye Centre, Myanmar
  • Marissa Larochelle
    Ophthalmology, Moran Eye Center, Salt Lake City, Utah, United States
  • Partho Kalyani
    Kaiser Permanente, California, United States
  • NiNi Tun
    Medical Action Myanmar, Myanmar
  • Zaw Minn Din
    Medical Action Myanmar, Myanmar
  • Gary N Holland
    Jules Stein Eye Institute, California, United States
  • David Heiden
    Pacific Vision Foundation, California, United States
  • Albert T Vitale
    Ophthalmology, Moran Eye Center, Salt Lake City, Utah, United States
  • Footnotes
    Commercial Relationships   Lynn Hassman, None; Khin Oo, None; Marissa Larochelle, None; Partho Kalyani, None; NiNi Tun, None; Zaw Din, None; Gary Holland, None; David Heiden, None; Albert Vitale, None
  • Footnotes
    Support  none
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 882. doi:
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      Lynn M Hassman, Khin Thida Oo, Marissa Larochelle, Partho Kalyani, NiNi Tun, Zaw Minn Din, Gary N Holland, David Heiden, Albert T Vitale; Prevention of Blindness from CMV Retinitis-Related Retinal Detachment by Prophylactic Argon Laser Demarcation. Invest. Ophthalmol. Vis. Sci. 2019;60(9):882.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : CMV retinitis (CMVR) and associated retinal detachment (RD) are the most frequent causes of severe vision loss among patients with HIV/AIDS, both in the developed world and in resource-poor settings. While the incidence of CMVR-associated RD have declined in countries with widespread access to antiretroviral therapy and systemic anti-CMV treatment., these entities remain a significant cause of irreversible visual loss in developing countries. Barriers to timely diagnosis and treatment as well as limited access to vitreoretinal expertise exist in these settings. To address this problem, we applied prophylactic strategies, including training primary care physicians to recognize ocular pathology and argon laser barrier photocoagulation to limit the devastating visual sequelae.

Methods : Training workshops in diagnosis and management of CMVR were conducted in Myanmar in both non-governmental organization (NGO) sponsored and government hospital HIV clinics since 2007. Patients in this study were among those referred to these workshops from 2014-2017. Ophthalmologists with experience in both medical and surgical management of CMVR from the US, Myanmar and India administered the training program and examinations.
Indirect ophthalmoscopy was performed to detect CMVR and patients with inactive CMVR involving greater than 25% of the retina in zones II or III were referred for prophylactic argon laser barrier photocoagulation in order to assess whether this intervention was safe and effective in preventing the occurrence of RD. Patients found to have CMVR-associated RDs during the same time interval were referred for surgical evaluation.

Results : Sixty-three eyes from 51 patients were treated with barrier laser photocoagulation. There were no retinal detachments. Visual acuity remained stable or improved in all but 5 patients, most of whom lost only 1-2 lines. In contrast, 18 eyes from 15 patients underwent repair of their retinal detachments. Post-operatively, only 71% remained attached and only 35% retained stable vision.

Conclusions : Prophylactic argon laser barrier photocoagulation is a facile procedure with low ocular morbidity and potentially high visual benefit, which may limit progressive CMVR-associated RD in resource-poor countries.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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