Atypical healing of cytomegalovirus retinitis. Significance of persistent border opacification.
OBJECTIVE
To analyze a phenomenon seen in patients with acquired immune deficiency syndrome (AIDS) with cytomegalovirus (CMV) retinitis undergoing systemic antiviral treatment: a persistent white border opacification on the edge of healed CMV retinitis.


METHODS
The authors prospectively evaluated a population of 137 patients with AIDS and CMV retinitis during a 44-month period. Eleven patients (12 eyes) who were undergoing maintenance antiviral treatment were identified with an atypical healing response--the persistence of a white flat border opacification that did not advance for many weeks to months. Patient records and photographs were reviewed. Results of one autopsy were analyzed with histopathology and special stains.


RESULTS
The persistent white edge maintained (without advancement or smoldering) for an average of 11.6 weeks (range, 4 to 41 weeks). This border opacification was not affected by reinduction treatment in the six patients to whom reinduction was given. Results from histopathologic examination of one patient with a persistent white border are presented: these results show that dead cytomegalic cells formed stable structures within the retina, causing white opacification that could be confused with active lesions. Immunoperoxidase stains identified CMV antigens.


CONCLUSIONS
This persistent white border opacification, which does not advance or smolder, represents an important clinical entity that should be recognized during antiviral treatment for CMV retinitis. It can often be observed. If it is not recognized as a stable configuration, patients may undergo unnecessary reinductions with potentially toxic doses of antiviral medications.
Keefe
K S
KS
Department of Ophthalmology, United States Navy Hospital, San Diego.
Freeman
W R
WR
Peterson
T J
TJ
Wiley
C A
CA
Crapotta
J
J
Quiceno
J I
JI
Listhaus
A D
AD
D017088:AIDS-Related Opportunistic Infections / Q000473:pathology*; D000998:Antiviral Agents / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000254:growth & development; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000473:pathology*; D015828:Eye Infections, Viral / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D005654:Fundus Oculi; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012160:Retina / Q000382:microbiology; D012173:Retinitis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D014779:Virus Replication; D014945:Wound Healing
D000998:Antiviral Agents; D017245:Foscarnet; D015774:Ganciclovir