Guex-Crosier Y
Hôpital Ophtalmique Jules Gonin, Lausanne.
Klin Monbl Augenheilkd. 1999 May;214(5):317-20. doi: 10.1055/s-2008-1034803.
A patient was till now considered at high risk of developing a cytomegalovirus retinitis when the CD4+ cells were under 100/mm3. The risk was major when the CD4+ were under 50/mm3. With the onset of a Highly Active Antiretroviral Therapy (HAART) the follow-up of AIDS patients has changed. The introduction of a HAART is associated with an increase in CD4+ cells. The aim of the study was to highlight clinical modifications of classical AIDS associated ocular diseases.
Clinical observations will be correlated to recent data published in literature.
An immune response can be present against opportunitic infections. Cytomegalovirus retinitis can present an atypical pattern: The host immune response can be responsible for an increase of ocular inflammation, a hypopyon can even be seen. An intense vitritis can be present and frosted angiitis syndrome can be observed. A severe macular edema can be present and has to be treated with posterior sub-Tenon's steroid injections.
With the restoration of an immune response under HAART therapy, clinical manifestation of AIDS associated ocular diseases has changed and the differential diagnosis of ocular lesions must include endogenous uveitis.
迄今为止，当CD4+细胞低于100/mm³时，患者被认为有发生巨细胞病毒性视网膜炎的高风险。当CD4+细胞低于50/mm³时，风险更高。随着高效抗逆转录病毒疗法（HAART）的出现，艾滋病患者的随访情况发生了变化。HAART的引入与CD4+细胞数量增加有关。本研究的目的是突出经典艾滋病相关眼部疾病的临床变化。
临床观察将与文献中发表的最新数据相关联。
机体可对机会性感染产生免疫反应。巨细胞病毒性视网膜炎可呈现非典型表现：宿主免疫反应可导致眼部炎症加重，甚至可见前房积脓。可出现强烈的玻璃体炎，并可观察到霜样树枝状视网膜血管炎综合征。可出现严重的黄斑水肿，必须通过Tenon囊下注射类固醇进行治疗。
在HAART治疗下，随着免疫反应的恢复，艾滋病相关眼部疾病的临床表现发生了变化，眼部病变的鉴别诊断必须包括内源性葡萄膜炎。
