IMMUNE RECOVERY VITRITIS ASSOCIATED WITH INACTIVE CYTOMEGALOVIRUS RETINITIS - A NEW SYNDROME

Objective: To describe a syndrome of posterior segment intraocular inf lammation that causes visual loss in patients with acquired immunodefi ciency syndrome and cytomegalovirus retinitis. This syndrome was assoc iated with immune recovery mediated by combination antiretroviral trea tment including protease inhibitors. Design: A. case-control study at 2 university medical centers. Participants: One hundred thirty patient s with acquired immunodeficiency syndrome and cytomegalovirus retiniti s were examined at 2 medical centers for 15 months. In addition, the m edical records of 509 patients examined at 1 center for 11 years befor e the initiation of protease inhibitor therapy were analyzed retrospec tively. Results: Five patients with symptomatic vitritis and papilliti s with cystoid macular edema or epiretinal membrane formation were doc umented. In each patient there was inactive cytomegalovirus retinitis that had not caused visual decrease before the onset of inflammation. All patients had elevated CD4(+) T lymphocyte levels (median increase, 86X10(6)/L [86 cells/mm(3)]) after combination treatment including pr otease inhibitors. Two patients with cystoid macular edema were treate d with corticosteroids and had resolution of the cystoid macular edema and an increase in visual acuity without reactivation of the retiniti s. Retrospective analysis failed to disclose similar patients with int raocular inflammation in the era before the introduction of protease i nhibitors. Conclusions: This newly described syndrome of posterior seg ment inflammation related to cytomegalovirus retinitis is a cause of v isual morbidity in patients with acquired immunodeficiency syndrome. I t is associated with increased immune competence as a result of combin ed antiretroviral treatment with protease inhibitors and may be amenab le to corticosteroid therapy without reactivation of retinitis.