RETINAL-DETACHMENT AND HERPESVIRUS RETINITIS IN PATIENTS WITH AIDS

Background-The prolongation of survival of patients with herpesvirus r etinitis and AIDS has been associated with a rise in the incidence of retinal detachment. In such cases, however, retinal reattachment may b e difficult to achieve, and postoperative visual acuity may be poor de spite anatomically successful surgery. Methods-In order to examine fac tors affecting the visual outcome of surgery, a retrospective review o f 29 patients with retinal detachment, herpesvirus retinitis, and AIDS was performed. Retinal reattachment surgery (32 procedures) or prophy lactic laser demarcation (five procedures) was performed in 28 eyes of 23 patients. Results-The macula was attached in 23/28 (82%) eyes at t he last outpatient visit. Best postoperative visual acuity (median 6/1 8, range 6/6-hand movements) was significantly greater than final post operative acuity (median counting fingers, range 6/6-no perception of light) (Wilcoxon sign rank test, p=0.003), and was retained for a medi an of 3 months (1-91 weeks) after surgery. Poor visual outcome as evid enced by submedian final visual acuity was invariably associated with persistence of macular detachment, and significantly associated with t he occurrence of optic atrophy (odds ratio=5, p=0.02). Conclusion-Reti nal reattachment surgery appears justified in patients with herpesviru s retinitis and AIDS, but postoperative visual deterioration may occur in association with optic atrophy.