LONG-TERM VISUAL MORBIDITY OF CYTOMEGALOVIRUS RETINITIS IN PATIENTS WITH ACQUIRED-IMMUNE-DEFICIENCY-SYNDROME

Background. Patient survival with the acquired immune deficiency syndr ome (AIDS) and cytomegalovirus (CMV) retinitis is increasing because o f earlier diagnosis and improved medical therapy. Visual morbidity tha t occurs with prolonged survival has not been well described. Methods: To evaluate the progression of retinitis, ocular complications, and v isual morbidity, the authors retrospectively reviewed the records of 2 2 patients who had tested positive for human immunodeficiency virus si nce December 31, 1987. Each patient had an ophthalmologic diagnosis of CMV retinitis and had survived for a minimum of 6 months after diagno sis of retinitis. Patients were treated with intravenous ganciclovir a lone, ganciclovir followed by foscarnet, or foscarnet alone (1 patient ). Results: Mean survival was 16.7 months after the diagnosis of retin itis. The retinitis progressed in 74% of eyes during therapy. Visual a cuity of 20/70 or worse occurred in 79% of eyes at a mean of 7.6 month s from diagnosis of CMV retinitis. No light perception occurred in 49% of eyes after a mean of 15 months patient survival. Eleven patients w ith visual acuity of 20/70 or worse in both eyes survived a mean of 11 months. In 39 eyes with CMV retinitis, the following complications oc curred: retinal detachment (33%), papillitis (32%), branch retinal art ery occlusion (10%), persistent iritis (5%), and cataract (2.5%). Conc lusion: Improved modalities of therapy will continue to increase the s urvival of patients with AIDS and CMV retinitis. Progression of the re tinitis occurs with current therapeutic regimens in the majority of pa tients. As survival increases, significant visual loss and ocular comp lications may compromise patient care and quality of life.