ENDOTHELIAL PRECIPITATES AND LASER FLARE PHOTOMETRY IN PATIENTS WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME - A SCREENING-TEST FOR CYTOMEGALOVIRUS RETINITIS

Patients with acquired immunodeficiency syndrome (AIDS) who present wi th cytomegalovirus (CMV) retinitis show pathognomonic endothelial prec ipitates suggestive of primary anterior uveitis or secondary changes d ue to a spillover from the posterior chamber. Laser flare photometry a llows quantification, of the intensity of anterior affection. We wante d to establish anterior-chamber flare values in AIDS patients with and without CMV retinitis and to find out whether CMV retinitis is preced ed by an elevation of the flare value. In all, 25 men with AIDS who pr esented with CMV retinitis and 27 who did not have CMV retinitis but s howed a CD 4 count of less than or equal to 200 cells/mu I blood were enrolled in a prospective study. Slit-lamp examination was performed, followed by indirect ophthalmoscopy and laser flare photometry after d ilation of the pupil with tropicamide eye drops, Patients with CMV ret initis were followed every 10 days and the others, every 4 weeks. A gr oup of 51 human immunodeficiency virus (HIV)-negative men served as a control group. AIDS patients with CMV retinitis showed a significantly higher flare count in the affected eye. (12.4 photons/ms; n = 26) as compared with the unaffected partner eye (4.2 photons/ms; P less than or equal to 0.0001; n = 18) and with eyes of AIDS patients without CMV retinitis (4.1 photons/ms; P less than or equal to 0.0001; n = 50). T he count in the latter eyes was also significantly higher than the con trol value (3.1 photons/ms; P less than or equal to 0.0001; n = 102). Typical reticulate endothelial precipitates were found in 92% of AIDS patients with CMV retinitis. During the study, five eyes of three pati ents developed a fresh CMV retinitis, but a preceding rise in the flar e count was not observed. Laser flare photometry follows the occurrenc e of pathognomonic reticulate endothelial precipitates. It lags behind the development and the extension of CMV retinitis. Therefore, it can not be used as a screening test for early detection of CMV retinitis.