A quantitative and cartographic study of retinal microvasculopathy in acquired immunodeficiency syndrome.

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.