AIDS AND THE EYE - A 10-YEAR EXPERIENCE

Background: The AIDS database at Fairfield Hospital, Melbourne, mainta ins information on eye pathology as identified by the three visiting o phthalmologists. Patients underwent an eye consultation: if they had o cular symptoms; if signs were seen on direct ophthalmoscopy by physici ans; or when their CD4+ve cell count fell below 50/mu L. The first AID S-associated eye signs were identified in mid-1984. In the subsequent decade, 3257 patients in Victoria tested positive for HIV, and 845 of the 1123 who developed AIDS were treated at Fairfield Hospital. Method s: We undertook a retrospective review of the Fairfield Hospital datab ase to identify the AIDS-associated ocular problems seen. Results: Som e 723 patients had an eye consultation. In the earliest stage of HIV i nfection, minor non-specific ophthalmic involvement may occur. As the disease progresses, microvasculopathy (cottonwool spots and haemorrhag es) appears. External disease also occurs such as molluscum contagiosu m and Kaposi's sarcoma of the conjunctiva. With more suppression of th e immune system, opportunistic infections become common, and have a co nsiderable visual morbidity. Cerebral toxoplasmosis (117 patients) is only rarely associated with ocular involvement (three patients), but c ytomegalovirus (CMV) commonly causes retinitis [204 patients (24%)]. I t has been the AIDS-defining illness in 26 patients. A majority had th e disease confined to one eye. Mean CD4 cell count at onset is 15+/-5 mu L and it has been associated with a viraemia in all but two patient s. Late complications of CMV retinitis include relapse in 41 (20%), sp read to the other eye in 24 (12%), and retinal detachment in 30 (15%). Visual impairment follows from retinal destruction, optic nerve invol vement, and retinal detachment. Conclusion: The ophthalmic workload fr om late ocular complications of AIDS is increasing. Newer and more eff ective methods of treatment are being developed. Ophthalmologists are becoming more aware of the need for universal precautions to avoid ris ks from this and other blood-borne infections.