Immune recovery vitritis and uveitis in AIDS - Clinical predictors, sequelae, and treatment outcomes
Immune recovery vitritis and uveitis in AIDS - Clinical predictors, sequelae, and treatment outcomes
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DOI：
10.1097/00006982-200102000-00001
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发表时间：
2001-01-01
影响因子：
3.3
通讯作者：
Freeman, WR
中科院分区：
文献类型：
--
作者：
Karavellas, MP;Azen, SP;Freeman, WR
目的：确定与巨细胞病毒(CMV)视网膜炎(免疫恢复性玻璃体炎或葡萄膜炎[IRV或IRU])相关的炎症综合征的临床预测因子；2)IRV的临床后遗症；3)皮质类固醇治疗对视力的影响。方法：一项来自加州大学圣地亚哥分校艾滋病眼科研究室的队列研究和来自克利夫兰诊所的病例系列包括获得性免疫缺陷综合征和对高效抗逆转录病毒疗法(HAART)有反应的CMV视网膜炎(HAART)患者。在CD4计数增加后，该队列被跟踪了13.5个月的中位数。作者研究了IRV的发生，IRV被定义为1+或更严重的症状性(视力下降和/或飞蚊)玻璃体炎，与非活动性CMV视网膜炎相关。黄斑水肿或视网膜前膜形成由临床检查和荧光素血管造影术确定。结果：在队列研究中，30名HAART应答者中有19人(63%)发生了IRV(26眼)。临床表现包括玻璃体炎、乳头炎、黄斑水肿和视网膜前膜，CMV表面积和GT的眼，30%的视网膜处于发生IRV的最高风险(相对风险=4.5)(P=0.03)，在随访期间，炎症持续中位数为20周，14例(16眼)患者出现黄斑病变。治疗后视力得到改善，而视网膜没有复发。组织学和免疫组织化学相关的视网膜前膜显示慢性炎症的证据，以T淋巴细胞为主。在病例系列中，8名HAART应答者中有3名(38%)发生了IRV(4只眼)。所有四只眼睛都接受了治疗，视力提高了一行。结论：HAART成功后，大量CMV视网膜炎患者出现了症状性IRV或IRU。视网膜有30%的CMV表面积的眼睛风险最大。有IRV的眼睛对抗炎治疗反应良好，而不会再次激活视网膜炎。免疫恢复性玻璃体炎可能是眼内对潜伏的CMV抗原的免疫反应的结果，T淋巴细胞在其中起作用。
Purpose: To determine Ij clinical predictors of an inflammatory syndrome associated with cytomegalovirus (CMV) retinitis (immune recovery vitritis or uveitis [IRV or IRU]); 2) clinical sequelae of IRV; and 3) the effect of corticosteroid treatment on visual acuity.Methods: A cohort study from the AIDS Ocular Research Unit of the University of California, San Diego, and a case series from the Cleveland Clinic consisted of patients who had acquired immunodeficiency syndrome and inactive CMV retinitis who responded to highly active antiretroviral therapy (HAART) with CD4 T-lymphocyte levels >60 cells/mm(3). The cohort was followed for a median of 13.5 months following increase in CD4 count. The authors studied the occurrence of IRV, defined as symptomatic (vision decrease and/or floaters) vitritis of 1+ or greater severity associated with inactive CMV retinitis. Macular edema or epiretinal membrane formation was determined by clinical examination and fluorescein angiography. Five eyes were treated with sub-Tenon corticosteroid injections.Results: In the cohort study, 19 (63%) of 30 HAART responders developed IRV (26 eyes). The clinical spectrum of inflammation included vitritis, papillitis, macular edema, and epiretinal membranes, Eyes with CMV surface area >30% of the retina were at the highest risk (relative risk = 4.5) of developing IRV (P = 0.03), During follow-up, inflammation persisted without treatment for a median of 20 weeks and 14 patients (16 eyes) developed macular changes. Treatment resulted in vision improvement without reactivation of retinitis. Histology and immunohistochemistry of associated epiretinal membranes showed evidence of chronic inflammation with a predominant T-lymphocyte cell population. In the case series, 3 (38%) of 8 HAART responders developed IRV (4 eyes). All four eyes were treated and resulted in visual acuity improvement of one line.Conclusions: Symptomatic IRV or IRU develops in a significant number of patients with CMV retinitis following successful HAART. Eyes with CMV surface area >30% of the retina are at the greatest risk. Eyes with IRV respond favorably to antiinflammatory therapy without reactivation of retinitis. Immune recovery vitritis may be the result of an immunologic reaction to latent CMV antigens in the eye in which T-lymphocytes play a role.