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

该项目的目标是开发改进的诊断方法 治疗人类葡萄膜炎和获得性眼部并发症 免疫缺陷综合征(艾滋病)。这个项目包括临床 评估患者新诊断和治疗方法的试验 患有眼内炎性疾病或艾滋病相关眼病的患者 以及葡萄膜炎患者的自然病史研究。 最近的数据表明，艾滋病的眼部表现有所不同 在成人和儿童之间。我们完成了405年的自然历史研究 患有艾滋病的儿童。在405例患者中有179例出现眼部症状 (44%)患者。发生危及视力的感染性视网膜炎 29例(7%)患者。巨细胞病毒(CMV)视网膜炎 对于29例视网膜炎中的24例。在29名患者中只有2人患有 威胁视力的视网膜炎当时有视觉主诉 诊断。55只患视网膜炎的眼睛中有10只视力较差 20/200以上，6只眼完全失明。大多数患有CMV视网膜炎的儿童 CD4T细胞计数不到每毫升50个细胞。这些数据表明 眼部并发症在患有艾滋病的儿童中很常见。视觉 破坏性的感染性视网膜炎发生在7%的儿童中，很少有人 抱怨症状。这些数据表明，常规眼科 对患有艾滋病的儿童进行筛查可能是有指征的，特别是当CD4 T细胞计数降至每毫升50个细胞以下。 CMV视网膜炎在成年艾滋病患者中更为常见，发生在UP中 到40%的患者在他们的疾病过程中。因为 早期诊断和及时治疗似乎限制了视力残疾，我们 正在调查激光耀斑测光的使用，这是一种 测量眼睛中的炎症，用于筛查CMV视网膜炎。 在我们的研究中，激光耀斑光度读数显著升高。 巨细胞病毒视网膜炎患者与对照组比较。此外， 最高值来自最严重的患者， 威胁视力的疾病。 结节病是一种可导致严重眼部疾病的全身性疾病。 发炎和失明。我们已经研究了影响预后的因素 这些患者的视力丧失。对249例眼科疾病患者的研究 结节病，视力丧失与存在显著相关 青光眼的发生率(p=0.0021)，表明更具侵袭性的抗青光眼 患有这种疾病的患者可能需要接受治疗。 最后，我们的事务科对管理的新方法感兴趣。 葡萄膜炎患者的白内障。白内障是导致白内障的主要原因 葡萄膜炎引起的视力丧失，通常需要手术。不幸的是，白内障 这些患者的人工晶状体植入手术是 与术后并发症增加有关，包括细胞 人造晶状体上的沉积物。我们已经完成了 患者进入一项多中心、双掩蔽、随机临床试验 肝素表面修饰的安全性和有效性检测 葡萄膜炎患者的人工晶状体，结果将是 将在12月完成为期1年的患者随访后进行 1996年。

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.