Sittivarakul Wantanee, Prapakornkovit Virintorn, Jirarattanasopa Pichai, Bhurayanontachai Patama, Ratanasukon Mansing
Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Medicine (Baltimore). 2020 Oct 23;99(43):e22889. doi: 10.1097/MD.0000000000022889.
To determine the surgical outcomes and prognostic factors of cytomegalovirus (CMV) retinitis-related retinal detachment (RD) in acquired immune deficiency syndrome (AIDS) patients following vitrectomy.A retrospective charts review was carried out on AIDS patients who were diagnosed with CMV retinitis-related RD and treated with vitrectomy between 2002 and 2016. The main outcome measures were the rates of primary anatomical success and final visual acuity (VA) success defined as postoperative VA ≥20/200. Kaplan-Meier curves on the time to retinal redetachment were performed. Multivariate logistic regression models based on a directed acyclic graph were used to identify independent factors associated with achieving VA success.Forty five AIDS patients (52 eyes) were included. Over a mean follow-up period of 41.7 months, primary anatomical success was achieved in 44 eyes (84.6%) and VA success was achieved in 34 eyes (65.4%). Receiving highly active antiretroviral therapy (HAART) prior to RD (adjusted odds ratio [aOR]=4.9, P = .043), better preoperative VA (aOR = 4.3, P = .006), undergoing vitrectomy within 3 months (aOR=6.7, P = .008), absence of optic atrophy (aOR=58.1, P < .001), and absence of retinal redetachment (aOR=38.1, P = .007) increased the odds of achieving final VA success.Vitrectomy provided favorable anatomical reattachment in AIDS patients with CMV retinitis-related RD. Majority of patients was able to retain functional vision postoperatively. The use of HAART and early vitrectomy increased the probability of achieving both anatomical and VA success.
确定获得性免疫缺陷综合征(AIDS)患者巨细胞病毒(CMV)视网膜炎相关视网膜脱离(RD)玻璃体切除术后的手术效果及预后因素。对2002年至2016年间诊断为CMV视网膜炎相关RD并接受玻璃体切除术的AIDS患者进行回顾性病历审查。主要结局指标为定义为术后视力(VA)≥20/200的原发性解剖成功和最终视力成功的发生率。绘制视网膜再脱离时间的Kaplan-Meier曲线。使用基于有向无环图的多变量逻辑回归模型来识别与实现视力成功相关的独立因素。纳入45例AIDS患者(52只眼)。平均随访41.7个月,44只眼(84.6%)实现原发性解剖成功,34只眼(65.4%)实现视力成功。RD发生前接受高效抗逆转录病毒治疗(HAART)(调整优势比[aOR]=4.9,P=0.043)、术前视力较好(aOR=4.3,P=0.006)、在3个月内接受玻璃体切除术(aOR=6.7,P=0.008)、无视神经萎缩(aOR=58.1,P<0.001)以及无视网膜再脱离(aOR=38.1,P=0.007)增加了实现最终视力成功的几率。玻璃体切除术为CMV视网膜炎相关RD的AIDS患者提供了良好的解剖复位。大多数患者术后能够保留功能性视力。使用HAART和早期玻璃体切除术增加了实现解剖和视力成功的可能性。