Zafirakis P, Markomichelakis N N, Voudouri A, Theodossiadis G P, Theodossiadis P G
Department of Ophthalmology, School of Medicine, Athens, Greece.
Doc Ophthalmol. 1999;97(3-4):311-5. doi: 10.1023/a:1002186107044.
To describe a patient with acquired immunodeficiency syndrome (AIDS) who presented with cystoid macular edema (CME) which was not associated with active cytomegalovirus (CMV) retinitis or AIDS-related microvasculopathy.
A 32-year-old man with AIDS and a past ocular history of inactive CMV retinitis was placed on protease inhibitors when his CD4+ T lymphocyte counts dropped to 8 cells/mm3. Three months later, after his CD4+ T lymphocyte counts had increased to 196 cells/mm3 he complained of micropsia and metamorphopsia in his right eye of 1 week duration. The patient had a complete ocular examination including fluorescein angiography (FA).
Visual acuity (VA) was 7/10 OD. Fundus examination revealed CME and inactive CMV retinitis, and FA demonstrated CME and a hot disc. Two transseptal injections of corticosteroids were administered 2 weeks apart in the right eye as treatment of the CME. The patient reported gradual visual improvement and 6 weeks later, his VA was 10/10(-2). CME had resolved clinically and angiographically.
CME in our case is associated with inactive CMV retinitis and gradually increasing number of CD4+ T lymphocytes after initiation of treatment with protease inhibitors. It may be amenable to regional administration of corticosteroids without reactivation of retinitis.
描述一名获得性免疫缺陷综合征（AIDS）患者，其出现了囊样黄斑水肿（CME），但与活动性巨细胞病毒（CMV）视网膜炎或AIDS相关微血管病变无关。
一名32岁患有AIDS且既往有非活动性CMV视网膜炎眼部病史的男性，当他的CD4 + T淋巴细胞计数降至8个细胞/mm³时开始使用蛋白酶抑制剂。三个月后，在他的CD4 + T淋巴细胞计数增至196个细胞/mm³后，他主诉右眼出现视物显小症和视物变形症，持续1周。该患者接受了包括荧光素血管造影（FA）在内的全面眼部检查。
右眼视力（VA）为7/10。眼底检查发现CME和非活动性CMV视网膜炎，FA显示有CME和热点状病变。右眼每隔2周进行两次经中隔皮质类固醇注射，作为CME的治疗方法。患者报告视力逐渐改善，6周后，其VA为10/10（-2）。CME在临床和血管造影上均已消退。
我们病例中的CME与非活动性CMV视网膜炎以及开始使用蛋白酶抑制剂治疗后CD4 + T淋巴细胞数量逐渐增加有关。它可能适合局部应用皮质类固醇治疗而不会导致视网膜炎复发。
