LASER PHOTOCOAGULATION REPAIR OF MACULA-SPARING CYTOMEGALOVIRUS-RELATED RETINAL-DETACHMENT

Objective: The purpose of the study is to investigate the role of lase r photocoagulation in the treatment of macula-sparing cytomegalovirus (CMV)-related retinal detachment (CMVRD) in patients with acquired imm une deficiency syndrome (AIDS). Design: Seven macula-sparing CMVRD ide ntified between July 1995 and February 1997 were managed with laser ph otocoagulation and observed prospectively (group I). Seven CMVRD reatt ached with pars plana vitrectomy (PPV) and silicone oil injection (gro up II) between January 1992 and June 1996 were analyzed retrospectivel y. Participants: Patients with AIDS with macula-sparing rhegmatogenous CMVRD with no proliferative vitreoretinopathy and visual acuity bette r than 20/30 were studied. Intervention: Demarcation laser photocoagul ation (group I) or PPV with silicone oil injection (group II) was perf ormed. Main Outcome Measures: Postoperative best-corrected visual acui ty (BCVA), temporary or permanent visual loss, CMVRD progression or re currence, and cataract were measured. Results: Follow-up ranged from 2 to 19 months (mean, 9 months) in group I. Posttreatment BCVA was unch anged in all eyes after laser. One retina redetached 9 months after la ser treatment. Final visual acuity was less than 20/40 in one eye beca use of progressive CMV retinitis. Follow-up ranged from 2 to 24 months (mean, 10.4 months) in group II. All group II RDs were reattached suc cessfully with PPV and silicone oil injection. Best-corrected visual a cuity was an average of 1.6 lines worse after vitrectomy. Silicone-ind uced hyperopic shift caused temporary visual loss in all eyes (mean du ration, 5.6 weeks). Delayed visual loss due to cataract formation occu rred in five eyes. Three eyes had cataract extraction within 6 months. Two partial redetachments developed. One was repaired with repeat vit rectomy. Final visual acuity was less than 20/40 in five of seven eyes because of progressive CMV retinitis (1), dense cataract (2), uncorre cted refractive error (2), and uncertain cause (1). Conclusions: Demar cation laser photocoagulation appears to be an effective treatment for many macula-sparing CMVRD. Lass of BCVA, temporary postoperative visu al loss due to silicone-induced refractive error, and delayed visual l oss due to cataract after vitrectomy with silicone oil injection may b e avoided. Demarcation laser photocoagulation may be an effective alte rnative to vitrectomy in macula-sparing CMVRD.