Decreased visual acuity in patients with cytomegalovirus retinitis and AIDS

Purpose To investigate the causes of decreased visual acuity in patients wi th cytomegalovirus (CMV) retinitis in the acquired immunodeficiency syndrom e (AIDS). Methods All human immunodeficiency virus (HIV)-positive patients seen in tw o ophthalmology units over a 15 month period from September 1996 were inclu ded in this retrospective study. A detailed ophthalmic examination was perf ormed on all patients and in addition those with CMV retinitis underwent se rial fundus photography. Decreased visual acuity was defined as a best corr ected visual acuity less than or equal to 6/12. CMV and retroviral treatmen t, CD4(+) count and HIV viral load were also documented for each patient. Results Of 110 patients seen over the 15 month period, 26 ( 41 eyes) had a diagnosis of CMV retinitis. Twelve patients (16 eyes) with CMV retinitis ha d decreased visual acuity. The decreased visual acuity in 7 eves was initia lly due to the CMV retinitis involving the macula and the optic nerve. Reti nal detachment was responsible in 2 eyes and optic nerve atrophy in I eye. In 6 eyes (4 patients) the decreased visual acuity was due to a maculopathy - cystoid macular oedema and/or an epiretinal membrane in the presence of an inactive zone 2 or 3 CMV retinitis - with all these patients exhibiting a vitritis of varying grade. The decreased visual acuity in the maculopathy subgroup was irreversible in all except 1 eye, and 2 eyes in this category later developed a cataract. Conclusion In this series, CMV-retinitis-'related' maculopathy was a major (38%) cause of decreased visual acuity, occurring in the absence of zone 1 retinitis and despite inactive peripheral CMV retinitis. A varying degree o f vitritis was an associated feature in all these patients. This study ther efore highlights maculopathy as an important and previously unrecognised si gnificant cause of visual morbidity in CMV retinitis.