Rd. Levinson et al., CHRONIC MULTIFOCAL RETINAL INFILTRATES IN PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS, American journal of ophthalmology, 125(3), 1998, pp. 312-324
PURPOSE: To describe the clinical features of a disorder characterized
by chronic multifocal retinal infiltrates and uveitis in individuals
with human immunodeficiency virus (HIV) disease. METHODS: We reviewed
the medical records of HIV-infected patients with multifocal retinal i
n filtrates of unknown cause seen by investigators at four institution
s. The following data were collected: demographic characteristics, pre
senting signs and symptoms, laboratory test results, and course of dis
ease. RESULTS: We identified 26 HIV-infected pa patients (50 involved
eyes) with this syndrome. Median CD4(+) T-lymphocyte count at presenta
tion was 272 per mu l (range, 7 to 2,118 per mu l). The most common pr
esenting symptom was floaters, Median visual acuity of involved eyes a
t presentation was 20/20 (range, 20/15 to 20/100) and remained stable
(median, 20/20; range, 20/15 to 20/70) after a median follow up period
of 9 months (range, 0 to 110 months), Typical retinal lesions were gr
ay-white or yellow, irregular in shape, and less than 200 mu m in grea
test dimension, All were located in the midperiphery or anterior retin
a and enlarged slowly or remained static in size, Mild to moderate ant
erior chamber or vitreous humor inflammatory cells were present in 47
of 50 eyes (26 of 26 patients). Retinal lesions possibly responded to
zidovudine but not to acyclovir or ganciclovir. Anterior chamber and v
itreous humor inflammatory reactions responded to topical or periocula
r injections of corticosteroid. CONCLUSIONS: Uveitis with chronic mult
ifocal retinal infiltrates is a distinct clinical entity of unknown ca
use that occurs in HIV-infected patients. Retinal lesions may respond
to antiretroviral therapy. Visual prognosis is good. (C) 1998 by Elsev
ier Science Inc. All rights reserved.