A MASKED PROSPECTIVE EVALUATION OF OUTCOME PARAMETERS FOR CYTOMEGALOVIRUS-RELATED RETINAL-DETACHMENT SURGERY IN PATIENTS WITH ACQUIRED-IMMUNE-DEFICIENCY-SYNDROME

Purpose: The management of cytomegalovirus (CMV)-related rhegmatogenou s retinal detachments in patients with acquired immune deficiency synd rome (AIDS) has been the subject of recent attention and controversy b ecause of the high degree of variability in visual outcome, as well as significant differences in the reported incidence of profound postope rative optic atrophy. This study was designed to evaluate the various parameters affecting postoperative visual outcome, and to quantitate t he degree of postoperative optic disc parlor. Methods: The results of 65 consecutive surgeries for CMV-related retinal detachments in 51 pat ients with AIDS were prospectively studied. Postoperative vision, surv ival, optic disc pallor, and retinitis extent were analyzed. Serial ph otographs of optic discs underwent masked evaluation. Results: Mean po stoperative survival was 30 weeks (range, 2-146 weeks). Mean best post operative visual acuity was 20/66 (range, 20/20-2/200) and mean final postoperative visual acuity was 20/100 (range, 20/25-no light percepti on). Analysis of visual outcome for eyes with no macular or papillo-ma cular retinitis showed a best postoperative visual acuity of 20/60 (ra nge, 20/25-2/200) and mean final postoperative visual acuity of 20/80 (range, 20/25-no light perception). Postoperative vision was not affec ted by the presence of a preoperative macular detachment, with both gr oups (macula on or off detachments), achieving a best postoperative vi sual acuity of 20/60 in the absence of macular retinitis. Mild postope rative optic disc pallor was observed in 30% of surgical eyes at the f inal postoperative visit, and moderate pallor was noted in 13%. The me an degree of optic disc pallor was not different from the degree of op tic disc pallor seen in fellow, nonsurgical eyes with CMV retinitis (s urgical versus fellow nonsurgical eyes, 29% +/- 23% versus 26% +/- 30% ; P = 0.64). Conclusion: In this largest reported series of reattachme nt surgery for CMV-related retinal detachments, patients are experienc ing increased postoperative survival, good vision, and relative optic nerve health.