Treatment of immune recovery vitritis with local steroids

Aims-To report a series of patients requiring treatment for falling visual acuity associated with immune recovery vitritis, a recently described syndr ome of a predominantly vitreous inflammatory reaction in patients with AIDS and cytomegalovirus (CMV) retinitis. Methods-The medical records of all patients requiring treatment for falling visual acuity associated with immune recovery vitritis were reviewed betwe en March 1996 and March 1998. Results-Nine eyes in seven patients required treatment for falling visual a cuity. All patients had inactive CMV retinitis and had received highly acti ve antiretroviral treatment including a protease inhibitor. Vitreous inflam mation developed at a mean of 5.5 months (range 1-14) after starting a prot ease inhibitor. The onset of inflammation correlated with a mean rise in CD 4(+) lymphocyte levels of 83 x 10(6)/l (range 30-128). The visual acuity fe ll by a mean of 2.8 Snellen lines (range 1-4) before treatment, and rose by a mean of 1.9 Snellen Lines (range 0-4) after treatment with orbital floor steroids. The mean time interval between treatment with orbital floor ster oids and improvement in visual acuity was 3.5 weeks (range 1-8). Following treatment the visual acuity improved or remained stable in all nine eyes, e ight eyes returning to within one line of their preinflammation Snellen vis ual acuity. No eyes developed reactivation or progression of CMV retinitis after treatment, and none developed any other pathology. Conclusions-Orbital floor steroids appear to be have a useful role in the t reatment of persistent immune recovery vitritis where the visual acuity is compromised.