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Retinal Detachment Risk in Cytomegalovirus Retinitis Related to the Acquired Immunodeficiency Syndrome
John H. Kempen, MD, MPH, MHS;
Douglas A. Jabs, MD, MS;
James P. Dunn, MD;
Sheila K. West, PhD;
James Tonascia, PhD
Arch Ophthalmol. 2001;119:33-40.
Objectives To compare the incidence of retinal detachment in patients treated with
the ganciclovir implant compared with those treated using systemic therapy
only, among 511 patients with the acquired immunodeficiency syndrome (AIDS)
and cytomegalovirus (CMV) retinitis and to describe the influence of highly
active antiretroviral therapy (HAART) on retinal detachment incidence.
Patients and Methods All patients with AIDS and CMV retinitis at 1 center were followed up
prospectively from CMV retinitis diagnosis for incidence of retinal detachment.
Patient- and eye-specific data regarding demographic and clinical characteristics
were collected at the time of CMV retinitis diagnosis. Use of anti-CMV and
antiretroviral treatments and the development of an immunologic response to
HAART during follow-up were recorded.
Results No significant difference in the rate of retinal detachment was found
between eyes treated with systemic therapy only and those treated with ganciclovir
implants, whether used as primary therapy or subsequent to using systemic
anti-CMV therapy. The use of HAART was associated with a 60% reduction in
retinal detachment rate (P<.001), with the greatest
benefit observed among patients who developed an immunologic response to HAART.
Conclusions Our results suggest that there is no substantial excess risk of retinal
detachment when patients with AIDS and CMV retinitis are treated with ganciclovir
implants as opposed to systemic anti-CMV therapy only. However, the use of
HAART in these patients appears to reduce the risk of retinal detachment substantially.
From the Departments of Ophthalmology (Drs Kempen, Jabs, Dunn, and
West) and Medicine (Dr Jabs), The Johns Hopkins University School of Medicine,
and Departments of Epidemiology (Drs Kempen, West, and Tonascia) and Biostatistics
(Drs Kempen and Tonascia), The Johns Hopkins University School of Hygiene
and Public Health, Baltimore, Md. The authors have no proprietary or financial
interests in the subject matter or materials discussed in this article.
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Kempen et al.
Arch Ophthalmol 2003;121:466-476.
ABSTRACT
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