title: Risk of cataract in persons with cytomegalovirus retinitis and the acquired immune deficiency syndrome.
abstract: OBJECTIVE
  To evaluate cataract risk in eyes of patients with AIDS and cytomegalovirus (CMV) retinitis and to identify risk factors.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Patients with AIDS and CMV retinitis.
  
  
  METHODS
  Patients 13 years of age and older were enrolled between 1998 and 2008. Demographic and clinical characteristics, slit-lamp biomicroscopy findings, and dilated ophthalmoscopy results were documented at quarterly visits. Cataract status was determined at the initial visit (prevalence) and at follow-up visits (incidence).
  
  
  METHODS
  For cataract, a high grade of lens opacity by biomicroscopy to which best-corrected visual acuity worse than 20/40 was attributed. Eyes that had undergone cataract surgery before enrollment or between visits also were counted as having cataract.
  
  
  RESULTS
  Seven hundred twenty-nine eyes of 489 patients diagnosed with CMV retinitis were evaluated. Higher prevalence was observed for patients with bilateral versus unilateral CMV retinitis (adjusted odds ratio [aOR], 2.74; 95% confidence interval [CI], 1.76-4.26) and, among unilateral CMV retinitis cases, for eyes with retinitis versus without retinitis (15% vs. 1.4%; P<0.0001). The age-adjusted prevalence of cataract among CMV retinitis cases was higher than that in a population-based sample (P<0.0001). Cataract prevalence increased with age (aOR, 11.77; 95% CI, 2.28-60.65 for age ≥ 60 years vs. younger than 40 years) and longer duration of retinitis (aOR, 1.36; 95% CI, 1.20-1.54 per year). Among eyes with CMV retinitis initially free of cataract, the cataract incidence was 8.1%/eye-year (95% CI, 6.7%-10.0%). Prior retinal detachment was associated with higher cataract risk (if repaired with silicone oil: adjusted hazard ratio [aHR], 10.37; 95% CI, 6.51-16.52; otherwise: aHR, 2.90; 95% CI, 1.73-4.87). Large CMV retinitis lesions also were associated with higher risk of cataract (for involvement of 25-49% retinal area: aHR, 2.30; 95% CI, 1.51-3.50; for ≥ 50% involvement: aHR, 3.63; 95% CI, 2.18-6.04), each with respect to ≤ 24% involvement, as were anterior segment inflammation (aHR, 2.27; 95% CI, 1.59-3.25) and contralateral cataract (aHR, 2.52; 95% CI, 1.74-3.66).
  
  
  CONCLUSIONS
  Cytomegalovirus retinitis is associated with a high absolute and relative risk of cataract. Among several risk factors, large retinal lesion size and use of silicone oil in retinal detachment repair are potentially modifiable, albeit not in all cases. Cataract is likely to be an increasingly important cause of visual morbidity in this population.
authors.affiliation: Department of Ophthalmology, and the Center for Clinical Epidemiology and Biostatistics, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. john.kempen@uphs.upenn.edu
authors.forename: John H
authors.initials: JH
authors.lastname: Kempen
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sugar
authors.forename: Alice T
authors.initials: AT
authors.lastname: Lyon
authors.forename: Richard Alan
authors.initials: RA
authors.lastname: Lewis
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.forename: Murk-Hein
authors.initials: MH
authors.lastname: Heinemann
authors.forename: James P
authors.initials: JP
authors.lastname: Dunn
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000175:diagnosis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D002386:Cataract / Q000453:epidemiology / Q000209:etiology*; D002387:Cataract Extraction / Q000706:statistics & numerical data; D015331:Cohort Studies; D017726:Cytomegalovirus Retinitis / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology*; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult