Dowler J G, Towler H M, Mitchell S M, Cooling R J, Lightman S L
Moorfields Eye Hospital, London.
Br J Ophthalmol. 1995 Jun;79(6):575-80. doi: 10.1136/bjo.79.6.575.
The prolongation of survival of patients with herpesvirus retinitis and AIDS has been associated with a rise in the incidence of retinal detachment. In such cases, however, retinal reattachment may be difficult to achieve, and postoperative visual acuity may be poor despite anatomically successful surgery.
In order to examine factors affecting the visual outcome of surgery, a retrospective review of 29 patients with retinal detachment, herpesvirus retinitis, and AIDS was performed. Retinal reattachment surgery (32 procedures) or prophylactic laser demarcation (five procedures) was performed in 28 eyes of 23 patients.
The macula was attached in 23/28 (82%) eyes at the last outpatient visit. Best postoperative visual acuity (median 6/18, range 6/6-hand movements) was significantly greater than final postoperative acuity (median counting fingers, range 6/6-no perception of light) (Wilcoxon sign rank test, p = 0.003), and was retained for a median of 3 months (1-91 weeks) after surgery. Poor visual outcome as evidenced by submedian final visual acuity was invariably associated with persistence of macular detachment, and significantly associated with the occurrence of optic atrophy (odds ratio = 5, p = 0.02).
Retinal reattachment surgery appears justified in patients with herpesvirus retinitis and AIDS, but postoperative visual deterioration may occur in association with optic atrophy.
疱疹病毒性视网膜炎合并艾滋病患者生存期的延长与视网膜脱离发生率的上升有关。然而，在这类病例中，视网膜复位可能难以实现，尽管手术在解剖结构上成功，但术后视力可能较差。
为了研究影响手术视觉效果的因素，对29例患有视网膜脱离、疱疹病毒性视网膜炎和艾滋病的患者进行了回顾性研究。23例患者的28只眼接受了视网膜复位手术（32次手术）或预防性激光光凝（5次手术）。
在最后一次门诊随访时，28只眼中有23只（82%）黄斑区复位。术后最佳视力（中位数6/18，范围6/6 - 手动）显著高于最终术后视力（中位数数指，范围6/6 - 无光感）（Wilcoxon符号秩和检验，p = 0.003），且术后中位数保留3个月（1 - 91周）。最终视力低于中位数所证明的不良视觉效果总是与黄斑脱离的持续存在相关，并且与视神经萎缩的发生显著相关（优势比 = 5，p = 0.02）。
对于疱疹病毒性视网膜炎合并艾滋病患者，视网膜复位手术似乎是合理的，但术后视力恶化可能与视神经萎缩有关。
