Cystoid macular edema in a patient with acquired immunodeficiency syndrome and past ocular history of cytomegalovirus retinitis after initiation of protease inhibitors

To describe a patient with acquired immunodeficiency syndrome (AIDS) who presented with cystoid macular edema (CME) which was not associated with active cytomegalovirus (CMV) retinitis or AIDS-related microvasculopathy. A 32-year-old man with AIDS and a past ocular history of inactive CMV retinitis...

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Bibliographic Details
Published in:Documenta ophthalmologica 1999, Vol.97 (3-4), p.311-315
Main Authors: Zafirakis, P, Markomichelakis, N N, Voudouri, A, Theodossiadis, G P, Theodossiadis, P G
Format: Article
Language:English
Subjects:
Adult
AIDS-Related Opportunistic Infections - complications
AIDS-Related Opportunistic Infections - drug therapy
AIDS-Related Opportunistic Infections - immunology
AIDS/HIV
CD4 Lymphocyte Count
Cytomegalovirus Retinitis - complications
Cytomegalovirus Retinitis - drug therapy
Cytomegalovirus Retinitis - immunology
Drug Therapy, Combination
Fluorescein Angiography
Fundus Oculi
Glucocorticoids - therapeutic use
HIV
Humans
Macular Edema - diagnosis
Macular Edema - drug therapy
Macular Edema - etiology
Male
Protease Inhibitors - therapeutic use
Visual Acuity
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Summary:To describe a patient with acquired immunodeficiency syndrome (AIDS) who presented with cystoid macular edema (CME) which was not associated with active cytomegalovirus (CMV) retinitis or AIDS-related microvasculopathy. A 32-year-old man with AIDS and a past ocular history of inactive CMV retinitis was placed on protease inhibitors when his CD4+ T lymphocyte counts dropped to 8 cells/mm3. Three months later, after his CD4+ T lymphocyte counts had increased to 196 cells/mm3 he complained of micropsia and metamorphopsia in his right eye of 1 week duration. The patient had a complete ocular examination including fluorescein angiography (FA). Visual acuity (VA) was 7/10 OD. Fundus examination revealed CME and inactive CMV retinitis, and FA demonstrated CME and a hot disc. Two transseptal injections of corticosteroids were administered 2 weeks apart in the right eye as treatment of the CME. The patient reported gradual visual improvement and 6 weeks later, his VA was 10/10(-2). CME had resolved clinically and angiographically. CME in our case is associated with inactive CMV retinitis and gradually increasing number of CD4+ T lymphocytes after initiation of treatment with protease inhibitors. It may be amenable to regional administration of corticosteroids without reactivation of retinitis.
ISSN:0012-4486
1573-2622
DOI:10.1023/a:1002186107044