DIAGNOSIS AND TREATMENT OF HUMAN UVEITIS AND AIDS-RELATED OCULAR DISEASE

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The goal of this project is to develop improved methods for diagnosing and treating human uveitis and the ocular complications of acquired immunodeficiency syndrome (AIDS). This project encompasses clinical trials evaluating new diagnostic and therapeutic approaches for patients with intraocular inflammatory disease or AIDS-related eye disorders as well as natural history studies of patients with uveitis. Recent data suggest that the ocular manifestations of AIDS differs between adults and children. We completed a natural history study of 405 children with AIDS. Ophthalmic manifestations were found in 179 of 405 (44 percent) patients. Sight-threatening infectious retinitis occurred in 29 (7 percent) patients. Cytomegalovirus (CMV) retinitis accounted for 24 of the 29 cases of retinitis. Only 2 of the 29 patients with sight-threatening retinitis had visual complaints at the time of diagnosis. Ten of the 55 eyes with retinitis had a visual acuity worse than 20/200; 6 eyes were totally blind. Most children with CMV retinitis had CD4 T-cell counts less than 50 cells per ml. These data suggest that ocular complications are common among children with AIDS. Vision damaging, infectious retinitis occurred in 7 percent of children, few who complained of symptoms. These data suggest that routine ophthalmologic screening may be indicated in children with AIDS, especially when the CD4 T-cell count falls below 50 cells per ml. CMV retinitis is even more common in adults with AIDS, occurring in up to 40 percent of patients during the course of their disease. Because early diagnosis and prompt therapy appear to limit visual disability, we are investigating the use of laser-flare photometry, a device that measures inflammation in the eye, for the screening of CMV retinitis. In our study, laser flare photometry readings were significantly elevated in patients with CMV retinitis as compared with controls. Furthermore, the highest values were obtained from patients with the most severe, sight-threatening disease. Sarcoidosis is a systemic disease that can cause severe ocular inflammation and blindness. We have studied the prognostic factors for vision loss in these patients. In a study of 249 patients with ocular sarcoidosis, vision loss was significantly associated with the presence of glaucoma (p = 0.0021), suggesting that more aggressive antiglaucoma therapy may be warranted in patients with this disorder. Finally, our Branch is interested in new approaches to the management of cataracts in patients with uveitis. Cataracts are a major cause of vision loss in uveitis, often requiring surgery. Unfortunately, cataract surgery with intraocular lens implantation in these patients is associated with increased postsurgical complications, including cellular deposits on the artificial lens. We have completed the enrollment of patients into a multicenter, double-masked, randomized clinical trial examining the safety and efficacy of a heparin surface-modified intraocular lens in patients with uveitis, and results will be forthcoming after the 1-year patient followup is completed in December 1996.