Department of Epidemiology, Center for Clinical Trials, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21287, USA.
Am J Ophthalmol. 2012 Apr;153(4):728-33, 733.e1-2. doi: 10.1016/j.ajo.2011.09.010. Epub 2012 Jan 20.
To describe the clinical outcomes of patients with cytomegalovirus (CMV) retinitis and AIDS treated with ganciclovir implant.
Retrospective cohort study.
The charts of 115 patients (166 affected eyes) with CMV retinitis treated with ganciclovir implant in the Division of Ocular Immunology, Wilmer Eye Institute from April 1996 through November 2009 were reviewed. Ophthalmologic data collected included visual acuity, ocular complications, treatment, and presence of immune recovery. Kaplan-Meier analyses and Cox regression models were used to investigate relationships between potential risk factors and ocular outcomes.
At implantation, 55% of patients were prescribed highly active antiretroviral therapy (HAART), 21% were formerly on HAART, and 24% were HAART-naïve. One hundred sixty-six eyes received 257 ganciclovir implants. Fifty-seven of the implanted eyes were diagnosed with a total of 126 ocular complications after implant surgery (rate=0.19/eye-year [EY]), the 3 most common being cataract, vitreous hemorrhage, and retinal detachment. Despite these ocular complications, the development of severe vision loss (≥6 lines lost) was low (0.005/EY). Patients with immune recovery during follow-up were less likely to have ocular complications after implant surgery; however, only the risk reduction for retinal detachment achieved statistical significance (hazard ratio=0.29, 95% CI: 0.08, 0.98).
Our data suggest that ocular complications after implant surgery, including cataract, vitreous hemorrhage, and retinal detachment, were relatively common after ganciclovir implantation but severe vision loss after surgery was low. Presence of immune recovery may lessen the risk of postoperative ocular complications.
描述接受更昔洛韦植入物治疗的巨细胞病毒（CMV）视网膜炎和艾滋病患者的临床结果。
回顾性队列研究。
回顾了 1996 年 4 月至 2009 年 11 月在威尔默眼科研究所眼免疫科接受更昔洛韦植入物治疗的 115 例（166 只受影响的眼睛）CMV 视网膜炎患者的图表。收集的眼科数据包括视力、眼部并发症、治疗和免疫恢复情况。采用 Kaplan-Meier 分析和 Cox 回归模型来研究潜在危险因素与眼部结果之间的关系。
在植入时，55%的患者接受了高效抗逆转录病毒治疗（HAART），21%的患者以前接受过 HAART，24%的患者是 HAART 初治患者。166 只眼睛接受了 257 只更昔洛韦植入物。植入手术后，57 只植入眼共诊断出 126 只眼部并发症（发生率为 0.19/眼年 [EY]），最常见的 3 种并发症是白内障、玻璃体积血和视网膜脱离。尽管存在这些眼部并发症，但严重视力丧失（≥6 行丧失）的发生率较低（0.005/EY）。在随访期间免疫恢复的患者在植入手术后发生眼部并发症的可能性较小；然而，只有视网膜脱离的风险降低具有统计学意义（风险比=0.29，95%置信区间：0.08，0.98）。
我们的数据表明，植入手术后的眼部并发症，包括白内障、玻璃体积血和视网膜脱离，在接受更昔洛韦植入物治疗后相对常见，但手术后严重视力丧失的情况较少。免疫恢复的存在可能会降低术后眼部并发症的风险。
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