Cystoid macular edema in a patient with acquired immunodeficiency syndrome and past ocular history of cytomegalovirus retinitis after initiation of protease inhibitors.
OBJECTIVE
To describe a patient with acquired immunodeficiency syndrome (AIDS) who presented with cystoid macular edema (CME) which was not associated with active cytomegalovirus (CMV) retinitis or AIDS-related microvasculopathy.


METHODS
A 32-year-old man with AIDS and a past ocular history of inactive CMV retinitis was placed on protease inhibitors when his CD4+ T lymphocyte counts dropped to 8 cells/mm3. Three months later, after his CD4+ T lymphocyte counts had increased to 196 cells/mm3 he complained of micropsia and metamorphopsia in his right eye of 1 week duration. The patient had a complete ocular examination including fluorescein angiography (FA).


RESULTS
Visual acuity (VA) was 7/10 OD. Fundus examination revealed CME and inactive CMV retinitis, and FA demonstrated CME and a hot disc. Two transseptal injections of corticosteroids were administered 2 weeks apart in the right eye as treatment of the CME. The patient reported gradual visual improvement and 6 weeks later, his VA was 10/10(-2). CME had resolved clinically and angiographically.


CONCLUSIONS
CME in our case is associated with inactive CMV retinitis and gradually increasing number of CD4+ T lymphocytes after initiation of treatment with protease inhibitors. It may be amenable to regional administration of corticosteroids without reactivation of retinitis.
Zafirakis
P
P
Department of Ophthalmology, School of Medicine, Athens, Greece.
Markomichelakis
N N
NN
Voudouri
A
A
Theodossiadis
G P
GP
Theodossiadis
P G
PG
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D000328:Adult; D018791:CD4 Lymphocyte Count; D017726:Cytomegalovirus Retinitis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D004359:Drug Therapy, Combination; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D005938:Glucocorticoids / Q000627:therapeutic use; D006678:HIV; D006801:Humans; D008269:Macular Edema / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D011480:Protease Inhibitors / Q000627:therapeutic use*; D014792:Visual Acuity
D005938:Glucocorticoids; D011480:Protease Inhibitors