Bilateral cystoid macular edema following successful treatment of AIDS-associated CMV retinitis

Background: Cystoid macular edema (CME) in AIDS patients with inactive cyto megalo-virus (CMV) retinitis is an uncommon but potentially sight-threateni ng complication. The pathogenesis of CME in these patients is unclear. This study tries to identify possible risk factors by analyzing the charts of f ive patients. Methods: Ten eyes of 5 patients that finally developed CME were followed fo r an average of 18 months. The initial retinal lesions, their response to a ntiviral treatment, the development of CME, and the patients' immune status were prospectively monitored. Results: CMV retinitis was diagnosed at a median CD4+ count of 3 cells/mm(3 ) (range 0-11). All eyes responded to the initial systemic anti-viral treat ment. At the onset of CME, CMV retinitis was controlled by antiviral mainte nance therapy in all patients [ganciclovir (n = 2), cidofovir (n = 2), fosc arnet (n = 1)]. The median time between diagnosis of CMV retinitis and onse t of CME was 11.5 months (range 5-24). Development of CME was associated wi th significant visual loss: acuity ranged from 0.05 to 0.7 when CME was fir st noticed, compared to 0.8-1.25 at diagnosis of CMV retinitis. Duration of inflammation, size or zone of retinal necrosis did not favor the developme nt of CME, neither did the antiviral therapy. A weak correlation of CME dev elopment and immune status (expressed as increase of CD4+ cells) was found. Due to systemic corticosteroids CME resolved. Conclusions: CME is a new visual threat to AIDS-patients with CMV retinitis whose immune status improved under the latest combined antiretroviral ther apy. Therapy with oral corticosteroids may positively influence this condit ion.