IMPROVED VISUAL RESULTS AFTER SURGICAL REPAIR OF CYTOMEGALOVIRUS-RELATED RETINAL DETACHMENTS

Purpose: This study was conducted to determine whether visual outcomes have improved after repair of retinal detachments (RDs) associated wi th cytomegalovirus (CMV) retinitis, and, if so, whether factors such a s earlier intervention and changes in surgical technique have led tc t hese results. Methods: The authors performed a retrospective review of 35 eyes in 30 immunocompromised patients with CMV retinitis and RD wh o underwent pars plana vitrectomy with the use of silicone oil injecti on. Visual and anatomic results in eyes treated between January 1998 a nd April 1992 (group 1) were compared with eyes treated before January 1991 (group 2). Follow-up was limited due to patient mortality; media n follow-up was 4.1 months in group 1 and 2.5 months in group 2. Resul ts: Best-attained postoperative visual acuities were better for group 1 than group 2 eyes, with 71% of group 1 eyes attaining visual acuity of 20/200 or better compared with 17% of group 2 eyes (chi-square, tre nd = 12.3; P < 0.001). A similar result was found among eyes with macu la-off detachments. Ambulatory visual acuity of 5/200 or better was ac hieved in 86% of group 1 versus 33% of group 2 eyes. There was a longe r interval between diagnosis and surgery in group 2 compared with grou p 1 (7 versus 3 days); scleral buckling in conjunction with pars plana vitrectomy and silicone oil injection was used in more group 1 eyes. Conclusion: Earlier intervention, absence of preoperative optic atroph y, and macular CMV correlate with better postoperative visual acuity r esults. Pars plana vitrectomy combined with silicone oil for eyes with macula-off RDs can result in improved visual acuity.