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

这个项目的目标是开发出更好的诊断方法 以及治疗人类葡萄膜炎和后天性葡萄膜炎的眼部并发症 免疫缺陷综合征（艾滋病）。 该项目包括临床 评估患者新诊断和治疗方法的试验 眼内炎症性疾病或艾滋病相关眼病， 以及葡萄膜炎患者的自然史研究。 最近的数据表明，艾滋病的眼部表现不同， 成人和儿童之间的关系。 我们完成了一项自然历史研究， 艾滋病儿童。 405例中179例有眼部表现 (44%）患者。 威胁视力的感染性视网膜炎发生 29例（7%）患者。 巨细胞病毒（CMV）视网膜炎占 29例视网膜炎中的24例。 29名患者中只有2名 威胁视力的视网膜炎在2005年时有视力问题。 诊断. 55只患视网膜炎的眼睛中有10只视力变差 全盲6眼。 大多数患有CMV视网膜炎的儿童 CD4 T细胞计数低于每毫升50个细胞。 这些数据表明 眼部并发症在艾滋病儿童中很常见。 愿景 7%的儿童发生了破坏性的感染性视网膜炎， 抱怨症状。 这些数据表明，常规眼科 筛查可能适用于患有艾滋病的儿童，特别是当CD4 T细胞计数福尔斯低于每毫升50个细胞。 CMV视网膜炎在艾滋病成人中更为常见， 40%的病人在他们的疾病过程中。 因为 早期诊断和及时治疗似乎可以限制视力残疾，我们 正在研究使用激光闪光测光，一种设备， 测量眼睛的炎症，用于筛查CMV视网膜炎。 在我们的研究中，激光耀斑测光读数显着升高 CMV视网膜炎患者与对照组相比。 此外，委员会认为， 最高值来自最严重的患者， 威胁视力的疾病 结节病是一种全身性疾病， 炎症和失明。 我们已经研究了 这些患者的视力下降。 在一项对249名眼部疾病患者的研究中， 结节病，视力丧失与存在显著相关 青光眼（p = 0.0021），表明更积极的抗青光眼药物 对患有这种疾病的患者可能需要治疗。 最后，我们的分支感兴趣的是新的管理方法， 葡萄膜炎患者的白内障。 白内障是一个主要的原因 葡萄膜炎导致视力丧失，通常需要手术。 不幸的是白内障 在这些患者中进行眼内透镜植入手术， 与术后并发症增加相关，包括细胞 人造透镜上的沉积物。 我们已经完成了 患者进入多中心、双盲、随机临床试验 检查肝素表面修饰的 眼内透镜在葡萄膜炎患者，结果将 将在12月完成1年患者随访后进行 1996.

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.