Department of Ophthalmology, and the Center for Clinical Epidemiology and Biostatistics, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Ophthalmology. 2012 Nov;119(11):2343-50. doi: 10.1016/j.ophtha.2012.05.044. Epub 2012 Jul 30.
To evaluate cataract risk in eyes of patients with AIDS and cytomegalovirus (CMV) retinitis and to identify risk factors.
Prospective cohort study.
Patients with AIDS and CMV retinitis.
Patients 13 years of age and older were enrolled between 1998 and 2008. Demographic and clinical characteristics, slit-lamp biomicroscopy findings, and dilated ophthalmoscopy results were documented at quarterly visits. Cataract status was determined at the initial visit (prevalence) and at follow-up visits (incidence).
For cataract, a high grade of lens opacity by biomicroscopy to which best-corrected visual acuity worse than 20/40 was attributed. Eyes that had undergone cataract surgery before enrollment or between visits also were counted as having cataract.
Seven hundred twenty-nine eyes of 489 patients diagnosed with CMV retinitis were evaluated. Higher prevalence was observed for patients with bilateral versus unilateral CMV retinitis (adjusted odds ratio [aOR], 2.74; 95% confidence interval [CI], 1.76-4.26) and, among unilateral CMV retinitis cases, for eyes with retinitis versus without retinitis (15% vs. 1.4%; P<0.0001). The age-adjusted prevalence of cataract among CMV retinitis cases was higher than that in a population-based sample (P<0.0001). Cataract prevalence increased with age (aOR, 11.77; 95% CI, 2.28-60.65 for age ≥ 60 years vs. younger than 40 years) and longer duration of retinitis (aOR, 1.36; 95% CI, 1.20-1.54 per year). Among eyes with CMV retinitis initially free of cataract, the cataract incidence was 8.1%/eye-year (95% CI, 6.7%-10.0%). Prior retinal detachment was associated with higher cataract risk (if repaired with silicone oil: adjusted hazard ratio [aHR], 10.37; 95% CI, 6.51-16.52; otherwise: aHR, 2.90; 95% CI, 1.73-4.87). Large CMV retinitis lesions also were associated with higher risk of cataract (for involvement of 25-49% retinal area: aHR, 2.30; 95% CI, 1.51-3.50; for ≥ 50% involvement: aHR, 3.63; 95% CI, 2.18-6.04), each with respect to ≤ 24% involvement, as were anterior segment inflammation (aHR, 2.27; 95% CI, 1.59-3.25) and contralateral cataract (aHR, 2.52; 95% CI, 1.74-3.66).
Cytomegalovirus retinitis is associated with a high absolute and relative risk of cataract. Among several risk factors, large retinal lesion size and use of silicone oil in retinal detachment repair are potentially modifiable, albeit not in all cases. Cataract is likely to be an increasingly important cause of visual morbidity in this population.
评估 AIDS 合并巨细胞病毒（CMV）视网膜炎患者的白内障风险，并确定相关风险因素。
前瞻性队列研究。
AIDS 合并 CMV 视网膜炎患者。
本研究于 1998 年至 2008 年期间纳入年龄在 13 岁及以上的患者。每季度随访时记录患者的人口统计学和临床特征、裂隙灯生物显微镜检查结果和散瞳眼底检查结果。在初次就诊时（患病率）和随访就诊时（发病率）确定白内障的患病情况。
白内障定义为生物显微镜检查显示晶状体混浊程度较高，导致最佳矫正视力低于 20/40。在招募前或随访期间已接受白内障手术的眼睛也被视为患有白内障。
共评估了 489 例 CMV 视网膜炎患者的 729 只眼。与单侧 CMV 视网膜炎患者相比，双侧 CMV 视网膜炎患者的患病率更高（调整优势比[aOR]，2.74；95%置信区间[CI]，1.76-4.26）；在单侧 CMV 视网膜炎病例中，患有视网膜炎的眼睛比没有视网膜炎的眼睛患病率更高（15% vs. 1.4%；P<0.0001）。CMV 视网膜炎病例的白内障患病率高于基于人群的样本（P<0.0001）。白内障患病率随年龄增长而增加（年龄≥60 岁的患者 aOR，11.77；95%CI，2.28-60.65 与年龄<40 岁的患者相比），且视网膜炎持续时间越长（aOR，1.36；95%CI，1.20-1.54 每年）。在最初无白内障的 CMV 视网膜炎眼中，白内障发病率为 8.1%/眼年（95%CI，6.7%-10.0%）。既往视网膜脱离与更高的白内障风险相关（如果用硅油修复：调整后的危险比[aHR]，10.37；95%CI，6.51-16.52；否则：aHR，2.90；95%CI，1.73-4.87）。较大的 CMV 视网膜炎病变也与白内障风险增加相关（累及 25%-49%的视网膜面积：aHR，2.30；95%CI，1.51-3.50；累及≥50%的视网膜面积：aHR，3.63；95%CI，2.18-6.04），与累及≤24%的视网膜面积相比，前节炎症（aHR，2.27；95%CI，1.59-3.25）和对侧白内障（aHR，2.52；95%CI，1.74-3.66）也是如此。
CMV 视网膜炎与白内障的绝对和相对风险均较高。在几个风险因素中，较大的视网膜病变大小和在视网膜脱离修复中使用硅油可能是可改变的，但并非在所有情况下都如此。白内障可能是该人群中视力受损的一个日益重要的原因。
