Proliferative vitreoretinopathy in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy.
OBJECTIVE
To assess the prevalence of proliferative vitreoretinopathy (PVR) and prognosis of cytomegalovirus (CMV) retinitis-related retinal detachment (RD) surgery in the era of highly active antiretroviral therapy (HAART).


METHODS
Retrospective interventional cohort study.


METHODS
Thirty-five human immunodeficiency virus (HIV)-positive patients with CMV retinitis-related RD who underwent surgical repair were assessed for PVR, CD4-positive T cell counts, and use of HAART. Main outcome measures included anatomic and functional outcomes of RD surgery as well as the presence of PVR and CD4-positive T cell counts.


RESULTS
PVR was present in 10 of 35 patients (29%) at the time of the first surgery. The presence of PVR was associated with worse preoperative and postoperative visual acuity (P = .017 and P = .009, respectively), with the CD4-positive T cell counts above 200 cells/microL (P = .054), and with a longer interval between the diagnosis of RD and surgery (P = .025). The odds ratio for development of PVR in patients with CD4-positive T cells above 200 cells/microL was 11.3 (95% confidence interval 1.01-125). PVR was not associated with age, gender, or duration of HIV infection. Anatomic reattachment was obtained in 31 patients (89%), though the functional outcomes were limited. The central location of CMV retinitis was associated with postoperative visual acuity (VA) of less than 0.1 (P = .000). Postoperative logMAR VA was associated with preoperative logMAR VA (P < .001) and development of PVR (P = .009).


CONCLUSIONS
PVR was present in 29% of CMV retinitis-related RD and was associated with higher CD4-positive T cell counts and longer interval between the diagnosis of RD and surgery.
Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Thailand.
Paradee
P
Kunavisarut
Ward R
WR
Bijlsma
Kessara
K
Pathanapitoon
Direk
D
Patikulsila
Janejit
J
Choovuthayakorn
Aniki
A
Rothova
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003452:Cryosurgery; D017726:Cytomegalovirus Retinitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage; D006801:Humans; D053685:Laser Therapy; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012163:Retinal Detachment / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D012827:Silicone Oils / Q000008:administration & dosage; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D018630:Vitreoretinopathy, Proliferative / Q000175:diagnosis / Q000209:etiology*
D005466:Fluorocarbons; D012827:Silicone Oils; C042852:perflutren