Ischemic maculopathy in patients with acquired immunodeficiency syndrome.
OBJECTIVE
To describe the characteristics of ischemic maculopathy in patients with human immunodeficiency virus (HIV) infection, as a means of understanding this uncommon disorder more fully.


METHODS
This is a multicenter, retrospective review of clinical data available for five HIV-infected patients who were given the diagnosis of ischemic maculopathy.


RESULTS
All cases had been diagnosed on the basis of fluorescein angiograms obtained after patients complained of vision loss. Four of the five patients had bilateral macular disease. Visual acuity at presentation in the nine affected eyes ranged from 20/20 to count fingers. Vision loss was gradual in both eyes of one patient and was abrupt in onset in seven eyes. Each of the seven eyes with abrupt vision loss had opacification of the superficial retina and/or intraretinal hemorrhages near the fovea. Fluorescein angiography revealed enlargement of the foveal avascular zone and mild staining of the juxtafoveal vessels in affected eyes. Six eyes had active or clinically inactive cytomegalovirus retinitis at presentation, and a seventh eye developed cytomegalovirus retinitis 2 weeks later. All patients were receiving anticytomegalovirus drugs when they developed visual symptoms. Visual acuity remained stable in five eyes, became worse in two eyes, and improved in two eyes; final visual acuity ranged from 20/25 to count fingers.


CONCLUSIONS
Ischemic maculopathy may cause profound and permanent vision loss in HIV-infected individuals. Fluorescein angiography should be considered in all HIV-infected patients with unexplained loss of vision. The pathogenesis of ischemic maculopathy remains unknown.
Cunningham
E T
ET
Francis I. Proctor Foundation, and the Department of Ophthalmology, University of California, San Francisco, California 94143-0944, USA. emmett_cunningham@yahoo.com
Levinson
R D
RD
Jampol
L M
LM
Engstrom
R E
RE
Lewis
H
H
Holland
G N
GN
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D012164:Retinal Diseases / Q000209:etiology*; D012166:Retinal Hemorrhage / Q000209:etiology; D012171:Retinal Vessels / Q000473:pathology*; D012189:Retrospective Studies; D014786:Vision Disorders / Q000209:etiology; D014792:Visual Acuity
D000998:Antiviral Agents