Papavasileiou Evangelia, Younis Saad, Zygoura Vasiliki, Quijano Claudia, Jackson Timothy L
*King's College Hospital, London, United Kingdom; †Western Eye Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom; ‡Moorfields Eye Hospital, London, United Kingdom; and §King's College London, London, United Kingdom.
Retin Cases Brief Rep. 2017;11(4):306-309. doi: 10.1097/ICB.0000000000000350.
To report ritonavir-associated retinal pigment epithelium toxicity in a patient infected with the HIV on highly active antiretroviral therapy including ritonavir.
Retrospective single case report. The authors describe a case of gradual onset of blurry vision in both eyes in an HIV-positive male. Visual acuity, clinical examination findings, and functional testing (electroretinogram and Goldmann perimetry) were reviewed. Diagnostic imaging, including fundus photography, spectral domain optical coherence tomography, fluorescein angiography, and fundus autofluorescence were assessed.
59-year-old HIV-infected male, treated with ritonavir for eight years, presented with a history of decreased night vision and peripheral field loss. Ophthalmologic examination confirmed the diagnosis of retinal toxicity. Goldmann perimetry showed areas of central and para-central scotomas. Electroretinograms demonstrated mild to moderate photoreceptor dysfunction. Fundus examination revealed a diffuse pattern of retinal pigment epithelium mottling in both eyes. Spectral domain optical coherence tomography confirmed the presence of choroidal thinning, whereas fundus autofluorescence showed mottled hypoautofluorescence.
Although ritonavir-associated retinal toxicity is clinically uncommon, the clinical features of our findings support this diagnosis. Consideration of highly active antiretroviral therapy-associated retinal toxicity should be given to the differential diagnosis in HIV-positive patients with retinopathy of unclear etiology. This report also highlights the need for constant monitoring of patients using the ritonavir for early detection of possible retinal toxicity.
报告1例接受包括利托那韦在内的高效抗逆转录病毒治疗的HIV感染者出现的利托那韦相关性视网膜色素上皮毒性。
回顾性单病例报告。作者描述了1例HIV阳性男性双眼视力逐渐模糊的病例。回顾了视力、临床检查结果及功能测试（视网膜电图和戈德曼视野检查）。评估了包括眼底照相、光谱域光学相干断层扫描、荧光素血管造影和眼底自发荧光在内的诊断性影像学检查。
1例59岁接受利托那韦治疗8年的HIV感染男性，有夜间视力下降和周边视野缺损病史。眼科检查确诊为视网膜毒性。戈德曼视野检查显示中央和旁中央暗点区域。视网膜电图显示轻度至中度光感受器功能障碍。眼底检查发现双眼视网膜色素上皮呈弥漫性斑驳状。光谱域光学相干断层扫描证实存在脉络膜变薄，而眼底自发荧光显示斑驳状低自发荧光。
尽管利托那韦相关性视网膜毒性在临床上不常见，但我们的检查结果的临床特征支持这一诊断。对于病因不明的视网膜病变的HIV阳性患者，在鉴别诊断时应考虑高效抗逆转录病毒治疗相关性视网膜毒性。本报告还强调了对使用利托那韦的患者进行持续监测以早期发现可能的视网膜毒性的必要性。
