Abstract
Purpose :
To compare cataract surgery complications and visual outcomes in patients with and without human immunodeficiency virus (HIV).
Methods :
A retrospective cohort study was conducted on eyes receiving phacoemulsification cataract surgery at an academic eye center from 1/1/2014 to 6/30/18. Outcomes included corrected distance visual acuity (CDVA), intraoperative complications, cystoid macular edema (CME), persistent anterior uveitis (PAU), endophthalmitis, and retinal detachment. Visual outcomes were analyzed using a linear mixed model with a Kronecker product covariance structure to model the correlation between eyes and between measurements on the same eye. Binary outcomes were analyzed using logistic regressions with generalized estimating equations.
Results :
8156 eyes from 5051 patients were included in the analysis. Of these, 50 eyes from 30 patients were HIV+. HIV+ patients were significantly younger at the time of surgery than HIV-negative patients (mean 61.2 versus 69.1, p<0.0001). Male gender and Hispanic ethnicity were also associated with HIV. Among HIV+ patients with available lab data, the mean CD4 count was 699 (SD=348), and 43.3% of subjects had an undetectable viral load. All HIV+ patients were taking HAART. Three eyes from two HIV+ patients had a history of cytomegalovirus retinitis (CMVR). After adjusting for age and race, eyes from HIV+ patients were at increased risk of developing clinically significant CME after surgery (OR=2.91, 95% CI: 1.01 – 8.33, p=0.0471). In a sub-analysis of HIV+ patients, eyes with a history of CMVR were at higher risk of developing CME compared to eyes without this history (p=0.0295). Eyes from HIV+ subjects also had a high incidence of PAU after surgery (10.0%) compared to previously published rates. Positive HIV status was not associated with increased risk of intraoperative complications. There were no cases of endophthalmitis or retinal detachment after surgery in the HIV+ group. Post-operative CDVA was better in the HIV-negative group (mean logMAR=0.09) compared to the HIV+ group but not significantly different (mean logMAR=0.16, p=0.0869).
Conclusions :
HIV+ patients had comparable visual outcomes after cataract surgery to HIV-negative patients; however, eyes from HIV+ patients were at greater risk of developing clinically significant CME and possibly PAU.
This is a 2020 ARVO Annual Meeting abstract.