Maguire A M, Nichols C W, Crooks G W
Department of Ophthalmology, Scheie Eye Institute, Philadelphia, USA.
Ophthalmology. 1996 Apr;103(4):601-5. doi: 10.1016/s0161-6420(96)30646-5.
Although serous macular exudation has been described in patients with the acquired immune deficiency syndrome (AIDS) with active cytomegalovirus (CMV) retinitis, cystoid macular edema (CME) is not encountered in this clinical setting. In contrast to these findings, we describe vision loss due to CME occurring in immunosuppressed patients without AIDS treated for CMV retinitis.
Three patients (four eyes) with systemic immunodeficiency presenting with vision loss underwent ophthalmologic examination, including fundus photography and fluorescein angiography. Systemic evaluation was performed to establish the etiology of immunodeficiency and to rule out human immunodeficiency virus infection. Patients were treated with topical corticosteroid and nonsteroidal anti-inflammatory medications for CME.
All patients had severe generalized immune deficiency, related either to drug-induced immunosuppression or primary immunodeficiency. Laboratory studies confirmed the presence of systemic CMV infection. Affected eyes had mild reduction of central vision (range, 20/40 to 20/60). Three of four affected eyes had resolving CMV retinitis outside the posterior pole with mild panuveitis. These eyes showed CME on clinical examination and fluorescein angiography. The CMV lesions regressed after reduction of immunosuppressive agents or after systemic antiviral treatment. Response of CME to topical anti-inflammatory medication was variable.
Cystoid macular edema can occur in the setting of resolving CMV retinitis in patients with immunodeficiency other than AIDS. This entity is distinct from serous macular exudation, which can occur in patients with AIDS with active CMV retinitis involving the posterior pole. The disparity between patients with and without AIDS in the development of CME may be important in understanding the pathogenesis of CME.
虽然在患有获得性免疫缺陷综合征（AIDS）且伴有活动性巨细胞病毒（CMV）视网膜炎的患者中已描述了浆液性黄斑渗出，但在这种临床情况下未发现黄斑囊样水肿（CME）。与这些发现相反，我们描述了在接受CMV视网膜炎治疗的非AIDS免疫抑制患者中发生的因CME导致的视力丧失。
对3例出现视力丧失的全身性免疫缺陷患者（4只眼）进行了眼科检查，包括眼底照相和荧光素血管造影。进行了全身评估以确定免疫缺陷的病因并排除人类免疫缺陷病毒感染。患者接受局部皮质类固醇和非甾体类抗炎药物治疗CME。
所有患者均有严重的全身性免疫缺陷，与药物性免疫抑制或原发性免疫缺陷有关。实验室研究证实存在全身性CMV感染。患眼的中心视力轻度下降（范围为20/40至20/60）。4只患眼中的3只在视盘后有正在消退的CMV视网膜炎，并伴有轻度全葡萄膜炎。这些眼睛在临床检查和荧光素血管造影中显示有CME。在减少免疫抑制剂或进行全身抗病毒治疗后，CMV病变消退。CME对局部抗炎药物的反应各不相同。
在非AIDS免疫缺陷患者中，CMV视网膜炎消退时可发生黄斑囊样水肿。这种情况与浆液性黄斑渗出不同，后者可发生在患有累及视盘后活动性CMV视网膜炎的AIDS患者中。AIDS患者与非AIDS患者在CME发生方面的差异可能对理解CME的发病机制很重要。
