OPHTHALMIC MANIFESTATIONS OF INFECTIONS WITH CRYPTOCOCCUS-NEOFORMANS IN PATIENTS WITH THE ACQUIRED-IMMUNODEFICIENCY-SYNDROME

The present study was undertaken to determine the nature and the preva lence of ophthalmic manifestations of infections with Cryptococcus neo formans in human immunodeficiency virus seropositive patients and to a nalyze whether the presence or absence of ocular signs is associated w ith improved survival. Eighty human immunodeficiency virus seropositiv e patients with cryptococcal infection were enrolled. We observed papi lledema in 26 of the 80 patients (32.5%). Visual loss and abducens ner ve palsy occurred in seven patients (9%). Only two patients (2.5%) had optic atrophy. Visual loss caused by optic nerve involvement was less frequent among the 62 patients treated with oral conazoles exclusivel y than among the 18 patients who had received amphotericin B or a comb ination of amphotericin B and conazoles. Actual invasion of the intrao cular structures with Cryptococcus neoformans was an uncommon complica tion in our series. In addition to the ocular manifestations attributa ble to cryptococcal disease, human immunodeficiency virus-related reti nopathy was present in nearly half of the patients. Cytomegalovirus re tinitis was diagnosed in four patients (5%).The 26 patients (32.5%) wi th papilledema had a median survival of 182 days vs 160 days for the p atients without papilledema. The median survival for 18 patients (22.5 %) with cotton-wool spots was 102 days vs 186 days for those without c otton-wool spots. The differences between these subgroups were not sta tistically significant.