Cystoid macular edema in a patient with acquired immunodeficiency syndromeand past ocular history of cytomegalovirus retinitis after initiation of protease inhibitors

Purpose: To describe a patient with acquired immunodeficiency syndrome (AID S) who presented with cystoid macular edema (CME) which was not associated with active cytomegalovirus (CMV) retinitis or AIDS-related microvasculopat hy. Method: A 32-year-old man with AIDS and a past ocular history of inacti ve CMV retinitis was placed on protease inhibitors when his CD4(+) T lympho cyte counts dropped to 8 cells/mm(3). Three months later, after his CD4(+) T lymphocyte counts had increased to 196 cells/mm(3) he complained of micro psia and metamorphopsia in his right eye of 1 week duration. The patient ha d a complete ocular examination including fluorescein angiography (FA). Res ults: Visual acuity (VA) was 7/10 OD. Fundus examination revealed CME and i nactive CMV retinitis, and FA demonstrated CME and a hot disc. Two transsep tal injections of corticosteroids were administered 2 weeks apart in the ri ght eye as treatment of the CME. The patient reported gradual visual improv ement and 6 weeks later, his VA was 10/10(-2). CME had resolved clinically and angiographically. Conclusions: CME in our case is associated with inact ive CMV retinitis and gradually increasing number of CD4(+) T lymphocytes a fter initiation of treatment with protease inhibitors. It may be amenable t o regional administration of corticosteroids without reactivation of retini tis.