Kestelyn P, Taelman H, Bogaerts J, Kagame A, Abdel Aziz M, Batungwanayo J, Stevens A M, Van de Perre P
Department of Ophthalmology, Centre Hospitalier de Kigali, Rwanda.
Am J Ophthalmol. 1993 Dec 15;116(6):721-7. doi: 10.1016/s0002-9394(14)73472-5.
The present study was undertaken to determine the nature and the prevalence of ophthalmic manifestations of infections with Cryptococcus neoformans in human immunodeficiency virus seropositive patients and to analyze whether the presence or absence of ocular signs is associated with improved survival. Eighty human immunodeficiency virus seropositive patients with cryptococcal infection were enrolled. We observed papilledema in 26 of the 80 patients (32.5%). Visual loss and abducens nerve palsy occurred in seven patients (9%). Only two patients (2.5%) had optic atrophy. Visual loss caused by optic nerve involvement was less frequent among the 62 patients treated with oral conazoles exclusively than among the 18 patients who had received amphotericin B or a combination of amphotericin B and conazoles. Actual invasion of the intraocular structures with Cryptococcus neoformans was an uncommon complication in our series. In addition to the ocular manifestations attributable to cryptococcal disease, human immunodeficiency virus-related retinopathy was present in nearly half of the patients. Cytomegalovirus retinitis was diagnosed in four patients (5%). The 26 patients (32.5%) with papilledema had a median survival of 182 days vs 160 days for the patients without papilledema. The median survival for 18 patients (22.5%) with cotton-wool spots was 102 days vs 186 days for those without cotton-wool spots. The differences between these subgroups were not statistically significant.
本研究旨在确定人类免疫缺陷病毒血清阳性患者感染新型隐球菌后眼部表现的性质和患病率，并分析眼部体征的有无是否与生存率提高相关。纳入了80例感染新型隐球菌的人类免疫缺陷病毒血清阳性患者。我们观察到80例患者中有26例（32.5%）出现视乳头水肿。7例患者（9%）出现视力丧失和外展神经麻痹。仅有2例患者（2.5%）出现视神经萎缩。仅接受口服唑类药物治疗的62例患者中，因视神经受累导致的视力丧失比接受两性霉素B或两性霉素B与唑类药物联合治疗的18例患者更为少见。在我们的系列研究中，新型隐球菌实际侵犯眼内结构是一种不常见的并发症。除了由隐球菌病引起的眼部表现外，近一半患者还存在与人类免疫缺陷病毒相关的视网膜病变。4例患者（5%）被诊断为巨细胞病毒性视网膜炎。26例（32.5%）有视乳头水肿的患者中位生存期为182天，而无视乳头水肿的患者为160天。18例（22.5%）有棉絮斑的患者中位生存期为102天，而无棉絮斑的患者为186天。这些亚组之间的差异无统计学意义。
