PROPHYLACTIC ARGON-LASER COAGULATION FOR RHEGMATOGENOUS RETINAL-DETACHMENT IN AIDS PATIENTS WITH CYTOMEGALOVIRUS RETINITIS

Background: The incidence of cytomegalovirus (CMV) retinitis in patien ts with acquired immunodeficiency syndrome (AIDS) reaches 20-45%. Desp ite aggressive medical treatment, rhegmatogenous retinal detachments d evelop in up to 30% of the affected eyes. Surgical repair is often dif ficult due to multiple, large and hardly visible retinal holes with vi treal traction. Pars plana vitrectomy with instillation of silicone oi l is the procedure of choice, giving limited functional results with a natomical reattachment. Methods: We performed prophylactic laser coagu lation in AIDS patients with medically treated CMV retinitis to preven t a progressive retinal detachment. Twenty-two quiescent CMV lesions i n 22 eyes of 20 patients were treated with argon green laser coagulati on. Each CMV lesion was completely surrounded with a double or triple row of laser spots (500-600 mu m; 0.2 s; gray-white lesions). Results: The duration of follow-up was 2-24 months. Histopathologic evaluation was possible in two eyes of one patient. Reactivated or smoldering CM V retinitis crossed the laser scars in 11 eyes, making additional lase r coagulation necessary. In four eyes retinal holes in the CMV scar ti ssue led to retinal detachment, which stopped at the laser scar. In th ree eyes the detachment is still controlled by the laser scar. In one eye, the detachment stopped at the laser scar for 6.5 months and then slowly progressed across it. There were no complications associated wi th our laser treatment. Conclusion: Prophylactic argon laser coagulati on in quiescent CMV retinitis seems to reduce the rate of progressive retinal detachment with no need for vitrectomy and silicone oil tampon ade.