Long-term posterior and anterior segment complications of immune recovery uveitis associated with cytomegalovirus retinitis.
OBJECTIVE
To identify and describe long-term posterior and anterior segment complications of immune recovery uveitis in patients with inactive cytomegalovirus retinitis who are undergoing highly active antiretroviral therapy-mediated recovery of immune function.


METHODS
A prospective cohort study at a university medical center. Twenty-nine eyes of 21 patients with immune recovery uveitis and inactive cytomegalovirus retinitis were followed for 14.5 to 116 weeks (median, 43 weeks) after diagnosis of immune recovery uveitis.


RESULTS
Nine eyes of nine patients developed visually important complications involving the posterior segment, anterior segment, or a combination of both. Posterior segment complications included severe proliferative vitreoretinopathy in three eyes and spontaneous vitreous hemorrhage from avulsion of a blood vessel secondary to contraction of the inflamed vitreous in one eye. Proliferative vitreoretinopathy recurred in all cases after surgery, severely compromising the visual outcome. Anterior segment complications included posterior subcapsular cataracts with vision decrease in five eyes and persistent anterior chamber inflammation after cataract extraction, resulting in posterior synechiae and large visually important lens deposits in three eyes.


CONCLUSIONS
Persistent inflammation in immune recovery uveitis may lead to vision-threatening complications, such as proliferative vitreoretinopathy, posterior subcapsular cataracts, and severe postoperative inflammation. Immune recovery uveitis is a chronic inflammatory syndrome that may result in complications months to years after the onset of inflammation.
Karavellas
M P
MP
Department of Ophthalmology, University of California, San Diego, California 92093-0946, USA.
Song
M
M
Macdonald
J C
JC
Freeman
W R
WR
D000328:Adult; D000869:Anterior Eye Segment / Q000473:pathology*; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000502:physiology*; D002386:Cataract / Q000209:etiology* / Q000473:pathology; D015331:Cohort Studies; D017726:Cytomegalovirus Retinitis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D006801:Humans; D007107:Immune System / Q000502:physiology; D007500:Iritis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors; D014605:Uveitis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D014792:Visual Acuity; D018630:Vitreoretinopathy, Proliferative / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D014823:Vitreous Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000601:surgery
D000998:Antiviral Agents