Canzano J C, Reed J B, Morse L S
Department of Ophthalmology, University of California, Davis, Sacramento 95816-7051, USA.
Retina. 1998;18(5):443-7. doi: 10.1097/00006982-199809000-00010.
To report the development of vitreomacular traction syndrome (VMT) following highly active antiretroviral therapy (HAART) in AIDS patients with cytomegalovirus retinitis (CMV-R).
We identified two AIDS patients with evidence of CMV-R who later developed VMT following HAART-associated immune recovery vitritis.
The CD4+ T-lymphocyte count increased from 5 to 190 cells/microL in Patient 1 and from 26 to 713 cells/microL in Patient 2. HIV-RNA copies/mL decreased from 341,000 to less than 400 in Patient 1 and from 43,900 to less than 400 in Patient 2. Increased vitreous inflammation occurred during this period of immune recovery. After resolution of vitritis, VMT developed in both patients and was confirmed by B-scan ultrasound and fluorescein angiography. In both patients, CMV-R was clinically inactive at the time of VMT development. Both patients underwent pars plana vitrectomy with peeling of the posterior hyaloid, which confirmed VMT intraoperatively.
VMT appears to be a sequelae of HAART-associated immune recovery vitritis in AIDS-related CMV-R. Changes in immune status may permit an inflammatory response that can lead to VMT. As advances in pharmacologic intervention continue, clinical manifestations and ocular sequelae in CMV-R will change, as will the approach and management of this disease.
报告艾滋病合并巨细胞病毒性视网膜炎（CMV-R）患者在接受高效抗逆转录病毒治疗（HAART）后发生玻璃体黄斑牵引综合征（VMT）的情况。
我们确定了两名有CMV-R证据的艾滋病患者，他们在HAART相关的免疫恢复性葡萄膜炎后发生了VMT。
患者1的CD4 + T淋巴细胞计数从5个/微升增加到190个/微升，患者2从26个/微升增加到713个/微升。患者1的HIV-RNA拷贝数/毫升从341,000降至400以下，患者2从43,900降至400以下。在此免疫恢复期间玻璃体炎症增加。葡萄膜炎消退后，两名患者均发生了VMT，并通过B超超声和荧光素血管造影得以证实。在两名患者中，VMT发生时CMV-R在临床上均无活动。两名患者均接受了玻璃体后皮质剥除的玻璃体切除术，术中证实为VMT。
VMT似乎是艾滋病相关CMV-R中HAART相关免疫恢复性葡萄膜炎的后遗症。免疫状态的变化可能引发炎症反应，进而导致VMT。随着药物干预的不断进展，CMV-R的临床表现和眼部后遗症将会改变，该病的治疗方法和管理也会随之改变。
