title: Retinal detachment associated with AIDS-related cytomegalovirus retinitis: risk factors in a resource-limited setting.
abstract: OBJECTIVE
  To determine risk factors predictive of retinal detachment in patients with cytomegalovirus (CMV) retinitis in a setting with limited access to ophthalmic care.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Sixty-four patients with CMV retinitis and retinal detachment were identified from the Ocular Infectious Diseases and Retina Clinics at Chiang Mai University. Three control patients with CMV retinitis but no retinal detachment were selected for each case, matched by calendar date. The medical records of each patient were reviewed, with patient-level and eye-level features recorded for the clinic visit used to match cases and controls, and also for the initial clinic visit at which CMV retinitis was diagnosed. Risk factors for retinal detachment were assessed separately for each of these time points using multivariate conditional logistic regression models that included 1 eye from each patient.
  
  
  RESULTS
  Patients with a retinal detachment were more likely than controls to have low visual acuity (odds ratio [OR], 1.24 per line of worse vision on the logMAR scale; 95% confidence interval [CI], 1.16-1.33) and bilateral disease (OR, 2.12; 95% CI, 0.92-4.90). Features present at the time of the initial diagnosis of CMV retinitis that predicted subsequent retinal detachment included bilateral disease (OR, 2.68; 95% CI, 1.18-6.08) and lesion size (OR, 2.64 per 10% increase in lesion size; 95% CI, 1.41-4.94).
  
  
  CONCLUSIONS
  Bilateral CMV retinitis and larger lesion sizes, each of which is a marker of advanced disease, were associated with subsequent retinal detachment. Earlier detection and treatment may reduce the likelihood that patients with CMV retinitis develop a retinal detachment.
authors.affiliation: Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California; Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Yen
authors.affiliation: Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California; Ocular Inflammatory Disease Center, Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Jenny
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Somsanguan
authors.initials: S
authors.lastname: Ausayakhun
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Paradee
authors.initials: P
authors.lastname: Kunavisarut
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Pornpattana
authors.initials: P
authors.lastname: Vichitvejpaisal
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Sakarin
authors.initials: S
authors.lastname: Ausayakhun
authors.affiliation: Department of Ophthalmology, Nakornping Hospital, Chiang Mai, Thailand.
authors.forename: Choeng
authors.initials: C
authors.lastname: Jirawison
authors.affiliation: Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California.
authors.forename: Jessica
authors.initials: J
authors.lastname: Shantha
authors.affiliation: Ocular Inflammatory Disease Center, Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Gary N
authors.initials: GN
authors.lastname: Holland
authors.affiliation: Department of Ophthalmology and Pacific Vision Foundation, California Pacific Medical Center, San Francisco, California.
authors.forename: David
authors.initials: D
authors.lastname: Heiden
authors.affiliation: Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
authors.forename: Todd P
authors.initials: TP
authors.lastname: Margolis
authors.affiliation: Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California. Electronic address: jeremy.keenan@ucsf.edu.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000328:Adult; D016022:Case-Control Studies; D017726:Cytomegalovirus Retinitis / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D015658:HIV Infections / Q000150:complications; D006295:Health Resources / Q000600:supply & distribution; D006801:Humans; D016015:Logistic Models; D008297:Male; D012163:Retinal Detachment / Q000175:diagnosis / Q000209:etiology*; D012307:Risk Factors; D013785:Thailand; D014792:Visual Acuity