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. 1999 May;83(5):540–545. doi: 10.1136/bjo.83.5.540

Treatment of immune recovery vitritis with local steroids

H Henderson 1, S Mitchell 1
PMCID: PMC1723023  PMID: 10216051

Abstract

AIMS—To report a series of patients requiring treatment for falling visual acuity associated with immune recovery vitritis, a recently described syndrome 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 between March 1996 and March 1998.
RESULTS—Nine eyes in seven patients required treatment for falling visual acuity. All patients had inactive CMV retinitis and had received highly active antiretroviral treatment including a protease inhibitor. Vitreous inflammation developed at a mean of 5.5 months (range 1-14) after starting a protease inhibitor. The onset of inflammation correlated with a mean rise in CD4+ lymphocyte levels of 83 × 106/l (range 30-128). The visual acuity fell 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 steroids 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, eight eyes returning to within one line of their preinflammation Snellen visual 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 treatment of persistent immune recovery vitritis where the visual acuity is compromised.



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Selected References

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  1. Akler M. E., Johnson D. W., Burman W. J., Johnson S. C. Anterior uveitis and hypotony after intravenous cidofovir for the treatment of cytomegalovirus retinitis. Ophthalmology. 1998 Apr;105(4):651–657. doi: 10.1016/S0161-6420(98)94019-2. [DOI] [PubMed] [Google Scholar]
  2. Bloch-Michel E., Nussenblatt R. B. International Uveitis Study Group recommendations for the evaluation of intraocular inflammatory disease. Am J Ophthalmol. 1987 Feb 15;103(2):234–235. doi: 10.1016/s0002-9394(14)74235-7. [DOI] [PubMed] [Google Scholar]
  3. Connors M., Kovacs J. A., Krevat S., Gea-Banacloche J. C., Sneller M. C., Flanigan M., Metcalf J. A., Walker R. E., Falloon J., Baseler M. HIV infection induces changes in CD4+ T-cell phenotype and depletions within the CD4+ T-cell repertoire that are not immediately restored by antiviral or immune-based therapies. Nat Med. 1997 May;3(5):533–540. doi: 10.1038/nm0597-533. [DOI] [PubMed] [Google Scholar]
  4. Cox S. N., Hay E., Bird A. C. Treatment of chronic macular edema with acetazolamide. Arch Ophthalmol. 1988 Sep;106(9):1190–1195. doi: 10.1001/archopht.1988.01060140350030. [DOI] [PubMed] [Google Scholar]
  5. Davis J. L., Taskintuna I., Freeman W. R., Weinberg D. V., Feuer W. J., Leonard R. E. Iritis and hypotony after treatment with intravenous cidofovir for cytomegalovirus retinitis. Arch Ophthalmol. 1997 Jun;115(6):733–737. doi: 10.1001/archopht.1997.01100150735008. [DOI] [PubMed] [Google Scholar]
  6. Farber M. D., Lam S., Tessler H. H., Jennings T. J., Cross A., Rusin M. M. Reduction of macular oedema by acetazolamide in patients with chronic iridocyclitis: a randomised prospective crossover study. Br J Ophthalmol. 1994 Jan;78(1):4–7. doi: 10.1136/bjo.78.1.4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Godfrey W. A., Smith R. E., Kimura S. J. Chronic cyclitis: corticosteroid therapy. Trans Am Ophthalmol Soc. 1976;74:178–188. [PMC free article] [PubMed] [Google Scholar]
  8. Holland G. N., Pepose J. S., Pettit T. H., Gottlieb M. S., Yee R. D., Foos R. Y. Acquired immune deficiency syndrome. Ocular manifestations. Ophthalmology. 1983 Aug;90(8):859–873. doi: 10.1016/s0161-6420(83)80009-8. [DOI] [PubMed] [Google Scholar]
  9. Hoover D. R., Peng Y., Saah A., Semba R., Detels R. R., Rinaldo C. R., Jr, Phair J. P. Occurrence of cytomegalovirus retinitis after human immunodeficiency virus immunosuppression. Arch Ophthalmol. 1996 Jul;114(7):821–827. doi: 10.1001/archopht.1996.01100140035004. [DOI] [PubMed] [Google Scholar]
  10. Jabs D. A., Green W. R., Fox R., Polk B. F., Bartlett J. G. Ocular manifestations of acquired immune deficiency syndrome. Ophthalmology. 1989 Jul;96(7):1092–1099. doi: 10.1016/s0161-6420(89)32794-1. [DOI] [PubMed] [Google Scholar]
  11. Jacobson M. A., Zegans M., Pavan P. R., O'Donnell J. J., Sattler F., Rao N., Owens S., Pollard R. Cytomegalovirus retinitis after initiation of highly active antiretroviral therapy. Lancet. 1997 May 17;349(9063):1443–1445. doi: 10.1016/S0140-6736(96)11431-8. [DOI] [PubMed] [Google Scholar]
  12. Karavellas M. P., Lowder C. Y., Macdonald C., Avila C. P., Jr, Freeman W. R. Immune recovery vitritis associated with inactive cytomegalovirus retinitis: a new syndrome. Arch Ophthalmol. 1998 Feb;116(2):169–175. doi: 10.1001/archopht.116.2.169. [DOI] [PubMed] [Google Scholar]
  13. Kuo I. C., Kapusta M. A., Rao N. A. Vitritis as the primary manifestation of ocular syphilis in patients with HIV infection. Am J Ophthalmol. 1998 Mar;125(3):306–311. doi: 10.1016/s0002-9394(99)80136-6. [DOI] [PubMed] [Google Scholar]
  14. Kuppermann B. D., Petty J. G., Richman D. D., Mathews W. C., Fullerton S. C., Rickman L. S., Freeman W. R. Correlation between CD4+ counts and prevalence of cytomegalovirus retinitis and human immunodeficiency virus-related noninfectious retinal vasculopathy in patients with acquired immunodeficiency syndrome. Am J Ophthalmol. 1993 May 15;115(5):575–582. doi: 10.1016/s0002-9394(14)71453-9. [DOI] [PubMed] [Google Scholar]
  15. Mitchell S. M., Youle M. S., Membrey W. L., Jones C. D. Cytomegalovirus retinitis after initiation of highly active antiretroviral therapy. Lancet. 1997 Aug 23;350(9077):588–590. doi: 10.1016/s0140-6736(97)26034-4. [DOI] [PubMed] [Google Scholar]
  16. Nelson M. R., Erskine D., Hawkins D. A., Gazzard B. G. Treatment with corticosteroids--a risk factor for the development of clinical cytomegalovirus disease in AIDS. AIDS. 1993 Mar;7(3):375–378. doi: 10.1097/00002030-199303000-00011. [DOI] [PubMed] [Google Scholar]
  17. Palestine A. G., Rodrigues M. M., Macher A. M., Chan C. C., Lane H. C., Fauci A. S., Masur H., Longo D., Reichert C. M., Steis R. Ophthalmic involvement in acquired immunodeficiency syndrome. Ophthalmology. 1984 Sep;91(9):1092–1099. doi: 10.1016/s0161-6420(84)34201-4. [DOI] [PubMed] [Google Scholar]
  18. Pollard R. B., Egbert P. R., Gallagher J. G., Merigan T. C. Cytomegalovirus retinitis in immunosuppressed hosts. I. Natural history and effects of treatment with adenine arabinoside. Ann Intern Med. 1980 Nov;93(5):655–664. doi: 10.7326/0003-4819-93-5-655. [DOI] [PubMed] [Google Scholar]
  19. Reed J. B., Schwab I. R., Gordon J., Morse L. S. Regression of cytomegalovirus retinitis associated with protease-inhibitor treatment in patients with AIDS. Am J Ophthalmol. 1997 Aug;124(2):199–205. doi: 10.1016/s0002-9394(14)70784-6. [DOI] [PubMed] [Google Scholar]
  20. Rosberger D. F., Heinemann M. H., Friedberg D. N., Holland G. N. Uveitis associated with human immunodeficiency virus infection. Am J Ophthalmol. 1998 Mar;125(3):301–305. doi: 10.1016/s0002-9394(99)80135-4. [DOI] [PubMed] [Google Scholar]
  21. Silverstein B. E., Smith J. H., Sykes S. O., Jones M. R., Schwartz D., Cunningham E. T., Jr Cystoid macular edema associated with cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol. 1998 Mar;125(3):411–415. doi: 10.1016/s0002-9394(99)80164-0. [DOI] [PubMed] [Google Scholar]
  22. Tural C., Romeu J., Sirera G., Andreu D., Conejero M., Ruiz S., Jou A., Bonjoch A., Ruiz L., Arnó A. Long-lasting remission of cytomegalovirus retinitis without maintenance therapy in human immunodeficiency virus-infected patients. J Infect Dis. 1998 Apr;177(4):1080–1083. doi: 10.1086/517399. [DOI] [PubMed] [Google Scholar]
  23. Walsh J. C., Jones C. D., Barnes E. A., Gazzard B. G., Mitchell S. M. Increasing survival in AIDS patients with cytomegalovirus retinitis treated with combination antiretroviral therapy including HIV protease inhibitors. AIDS. 1998 Apr 16;12(6):613–618. doi: 10.1097/00002030-199806000-00010. [DOI] [PubMed] [Google Scholar]
  24. Whitcup S. M., Fortin E., Nussenblatt R. B., Polis M. A., Muccioli C., Belfort R., Jr Therapeutic effect of combination antiretroviral therapy on cytomegalovirus retinitis. JAMA. 1997 May 21;277(19):1519–1520. [PubMed] [Google Scholar]
  25. Zegans M. E., Walton R. C., Holland G. N., O'Donnell J. J., Jacobson M. A., Margolis T. P. Transient vitreous inflammatory reactions associated with combination antiretroviral therapy in patients with AIDS and cytomegalovirus retinitis. Am J Ophthalmol. 1998 Mar;125(3):292–300. doi: 10.1016/s0002-9394(99)80134-2. [DOI] [PubMed] [Google Scholar]

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