Ocular microangiopathic syndrome in patients with acquired immunodeficiency syndrome and its relationship to alterations in cell adhesion and in blood flow.

Ocular microangiopathic syndrome is the most frequent ophthalmic finding in patients with acquired immunodeficiency syndrome (AIDS). Ocular microvascular changes, including cotton-wool spots, are closely associated with neuroretinal and cognitive deficits in patients infected with the human immunodeficiency virus type 1 (HIV-1). Cell adhesion has become an important pathogenetic concept in infectious diseases. We studied 39 patients with AIDS by indirect ophthalmoscopy and by slit-lamp biomicroscopy. Cotton-wool spots were counted as an indicator of retinal microvasculopathy. Conjunctival blood-flow sludging in conjunctival vessels was determined by a standardized rating scale as an indicator of blood-cell adhesion abnormalities. Parameters of immunosystemic damage were determined by fluorescein-activated cell-sorter scan, radioimmunoassay, and enzyme-linked immunosorbent assay. Conjunctival blood-flow sludging was present in 92% of our patients, and cotton-wool spots were observed in 44%. Cotton-wool spots occurred only in patients with significant blood-flow sludging, and the quantity of cotton-wool spots was closely associated with blood-flow sludging (r = 0.64, P < 0.0001). Lower correlations were found between the numbers of cotton-wool spots and the serum level of neopterin (r = 0.40, P = 0.01) or the CD4+ count (r = -0.39, P = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)