[Retinal diseases in AIDS].
Retinal diseases are the most frequent and most important ocular manifestations in AIDS. Electrophysiological changes can already be found in early stages of AIDS without funduscopic lesions and are a sign of damage to the retinal receptors and ganglion cells. HIV retinopathy (cotton-wool spots, retinal hemorrhages, microaneurysms) seldom occurs in the early stages with normal T-helper cell counts, but is present in about 40% of patients with AIDS-related complex and even in 70% of patients with full-blown AIDS. The cause of this microangiopathy is not known, but patients with lower T-helper cell counts of comparable stages more often have signs of HIV retinopathy. Infections of the retina and the choroid are always part of full-blown AIDS and represent the most important ophthalmological problem in AIDS, as these may lead to blindness if not treated. The specific diagnosis mainly relies on the ophthalmoscopic appearance, as antibody studies are of little help in final-stage AIDS patients. The amplification and proof of virus DNA particles by polymerase chain reaction seem to be more promising ways of obtaining an early laboratory diagnosis of viral retinal infections, but an intraocular specimen is required. Most (90-95%) of the retinal infections in AIDS are caused by the cytomegalovirus. In the final stage 11-40% of AIDS patients develop cytomegalovirus retinitis. Without treatment blindness can occur within a few weeks. Intravenous ganciclovir or foscarnet can prevent or postpone blindness in these patients, but the agents have to be given lifelong in a maintenance dose. Foscarnet offers a survival advantage over treatment with ganciclovir, although the patients may not tolerate foscarnet as well as ganciclovir. Another important infection is toxoplasmic retinochoroiditis, whereas acute retinal necrosis/herpes simplex retinitis, myotic and bacterial infections as well as Pneumocystis carinii choroiditis are seldom seen.
Hansen
L L
LL
Universitäts-Augenklinik Freiburg.
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000628:therapy; D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis* / Q000628:therapy; D005451:Fluorescein Angiography; D006801:Humans; D011379:Prognosis; D012164:Retinal Diseases / Q000175:diagnosis* / Q000628:therapy; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis / Q000628:therapy; D014786:Vision Disorders / Q000175:diagnosis / Q000628:therapy
Retinale Erkrankungen bei AIDS.