Ischemic maculopathy in patients with acquired immunodeficiency syndrome

PURPOSE: To describe the characteristics of ischemic maculopathy in patient s with human immunodeficiency virus (HIV) infection, as a means of understa nding this uncommon disorder more fully. METHODS: This is a multicenter, retrospective review of clinical data avail able for five HIV,infected patients who were given the diagnosis of ischemi c maculopathy. RESULTS: All cases had been diagnosed on the basis of fluorescein angiogram s obtained after patients complained of vision loss. Four of the five patie nts had bilateral macular disease. Visual acuity at presentation in the nin e affected eyes ranged from 20/20 to count fingers. Vision loss was gradual in both eyes of one patient and was abrupt in onset in seven eyes. Each of the seven eyes with abrupt vision loss had opacification of the superficia l retina and/or intraretinal hemorrhages near the fovea. Fluorescein angiog raphy revealed enlargement of the foveal avascular zone and mild staining o f the juxtafoveal vessels in affected eyes. Six eyes had active or clinical ly inactive cytomegalovirus retinitis at presentation, and a seventh eye de veloped cytomegalovirus retinitis 2 weeks later. All patients were receivin g anticytomegalovirus drugs when they developed visual symptoms. Visual acu ity remained stable in five eyes, became worse in two eyes, and improved in two eyes; final visual acuity ranged from 20/25 to count fingers. CONCLUSIONS: Ischemic maculopathy may cause profound and permanent vision l oss in HIV-infected individuals. Fluorescein angiography should be consider ed in all HIV-infected patients with unexplained loss of vision. The pathog enesis of ischemic maculopathy remains unknown. (C) 2001 by Elsevier Scienc e Inc. All rights reserved.