Glasgow B J, Weisberger A K
Jules Stein Eye Institute, Los Angeles, CA 90024.
Am J Ophthalmol. 1994 Jul 15;118(1):46-56. doi: 10.1016/s0002-9394(14)72841-7.
We quantified the retinal microvascular abnormalities in 57 eyes from autopsy patients with the acquired immunodeficiency syndrome (AIDS) and in 24 eyes from gender- and age-matched control subjects. We related retinal vascular changes to the topography of cytomegalovirus retinitis. Analysis of retinal trypsin digests revealed more vascular attenuation (P = .005), increased ratio of endothelial cells to pericytes (P = .001), and more microaneurysms (P = .02) in eyes of AIDS patients without cytomegalovirus retinitis than in those of control subjects. Cytomegalovirus retinitis was frequently bilateral, extensive, and distributed along blood vessels. Peripheral retinitis was more frequent than macular infection. Lymphocytes aggregated focally in arterioles, venules, and capillaries leading to areas infected with cytomegalovirus. Acquired immunodeficiency syndrome microvasculopathy occurs in the absence of cytomegalovirus retinitis and is not accounted for by immunosuppression alone. The location and character of these vascular changes in AIDS indicate an ischemic pathogenesis. In AIDS patients with cytomegalovirus retinitis, the vascular changes are more profound and include capillary destruction.
我们对57例获得性免疫缺陷综合征（AIDS）尸检患者的眼睛以及24例性别和年龄匹配的对照受试者的眼睛中的视网膜微血管异常进行了量化。我们将视网膜血管变化与巨细胞病毒性视网膜炎的地形学相关联。对视网膜胰蛋白酶消化物的分析显示，没有巨细胞病毒性视网膜炎的AIDS患者的眼睛比对照受试者的眼睛有更多的血管变细（P = 0.005）、内皮细胞与周细胞的比例增加（P = 0.001）以及更多的微动脉瘤（P = 0.02）。巨细胞病毒性视网膜炎通常是双侧的、广泛的，并沿血管分布。周边视网膜炎比黄斑感染更常见。淋巴细胞在通向巨细胞病毒感染区域的小动脉、小静脉和毛细血管中局部聚集。获得性免疫缺陷综合征微血管病在没有巨细胞病毒性视网膜炎的情况下发生，并且不能仅由免疫抑制来解释。AIDS中这些血管变化的位置和特征表明存在缺血性发病机制。在患有巨细胞病毒性视网膜炎的AIDS患者中，血管变化更严重，包括毛细血管破坏。
