Kempen J H, Jabs D A, Dunn J P, West S K, Tonascia J
Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Arch Ophthalmol. 2001 Jan;119(1):33-40.
To compare the incidence of retinal detachment in patients treated with the ganciclovir implant compared with those treated using systemic therapy only, among 511 patients with the acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis and to describe the influence of highly active antiretroviral therapy (HAART) on retinal detachment incidence.
All patients with AIDS and CMV retinitis at 1 center were followed up prospectively from CMV retinitis diagnosis for incidence of retinal detachment. Patient- and eye-specific data regarding demographic and clinical characteristics were collected at the time of CMV retinitis diagnosis. Use of anti-CMV and antiretroviral treatments and the development of an immunologic response to HAART during follow-up were recorded.
No significant difference in the rate of retinal detachment was found between eyes treated with systemic therapy only and those treated with ganciclovir implants, whether used as primary therapy or subsequent to using systemic anti-CMV therapy. The use of HAART was associated with a 60% reduction in retinal detachment rate (P<.001), with the greatest benefit observed among patients who developed an immunologic response to HAART.
Our results suggest that there is no substantial excess risk of retinal detachment when patients with AIDS and CMV retinitis are treated with ganciclovir implants as opposed to systemic anti-CMV therapy only. However, the use of HAART in these patients appears to reduce the risk of retinal detachment substantially.
在511例获得性免疫缺陷综合征（AIDS）合并巨细胞病毒（CMV）视网膜炎患者中，比较接受更昔洛韦植入物治疗的患者与仅接受全身治疗的患者视网膜脱离的发生率，并描述高效抗逆转录病毒治疗（HAART）对视网膜脱离发生率的影响。
对1个中心所有患有AIDS和CMV视网膜炎的患者从CMV视网膜炎诊断开始进行前瞻性随访，以观察视网膜脱离的发生率。在CMV视网膜炎诊断时收集患者和患眼的人口统计学和临床特征等特定数据。记录随访期间抗CMV和抗逆转录病毒治疗的使用情况以及对HAART产生免疫反应的情况。
仅接受全身治疗的患眼与接受更昔洛韦植入物治疗的患眼（无论作为初始治疗还是在全身抗CMV治疗之后使用）之间，视网膜脱离发生率无显著差异。使用HAART与视网膜脱离率降低60%相关（P<0.001），在对HAART产生免疫反应的患者中观察到最大益处。
我们的结果表明，与仅进行全身抗CMV治疗相比，AIDS合并CMV视网膜炎患者接受更昔洛韦植入物治疗时，视网膜脱离的额外风险并不显著。然而，在这些患者中使用HAART似乎可大幅降低视网膜脱离的风险。
