Study of the retinal fiber layer in patients with acquired immunodeficiency syndrome.

A study using the monochromatic photography technique to examine the retina of a group of patients with human immunodeficiency virus (HIV) infections in different degrees of evolution and with no history of opportunistic retinal infection revealed the existence of lesions on the level of the retinal nerve fiber layer. The lesions detected included wide, slit-like defects; sector defects; and generalized diffuse atrophies. Both the sector defects and the diffuse atrophies appeared at times to be related to retinal cotton-wool exudates, but at other times they occurred in eyes with no observable retinal pathology. The results of this study can be interpreted as "in vivo" confirmations of the findings obtained by other authors in the postmortem study of optic nerves of patients with acquired immunodeficiency syndrome (AIDS), presenting a generalized degenerative process of the optic nerve with a loss of up to 40% of the axons of the retinal ganglion cells. In some cases, the results obtained in our study directly related the presence of cotton-wool exudates to the production of lesions in the retinal nerve fiber layer, whereas in other cases, the fiber lesions did not appear to be secondary to the cotton-wool exudates. Therefore, a primary lesion of the retinal ganglion cells or of the optic nerve fibers could be considered, as studies by other authors have suggested.