To the question of retinal detachment in cytomegalovirus uveitis in HIV-infected patients: treatment outcomes

Cytomegalovirus uveitis (CMV-uveitis) is one of the most common causes of vision loss in HIV-infected patients. The purpose is to characterize the clinical features of the course of retinal detachment in HIV infection. Material and methods. The study group included 29 patients, 34 eyes (9 men and 20 women). All patients underwent a standard routine ophthalmological examination. To confirm the diagnosis, an ultrasound of the eyeball was performed. Results. The following forms of retinal detachment were identified: acute retinal necrosis, regmatogenic and traction detachment. In 50% of cases, the disease occurred as acute retinal necrosis of CMV-etiology. Visual acuity in the group of patients with operated retinal detachment became significantly lower after complex treatment. Conclusions. CMV-uveitis has a chronic sluggish course, despite multicomponent treatment. Key words: cytomegalovirus, uveitis, HIV, HIV-infection, AIDS, retinal detachment.

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Retinal detachment in cytomegalovirus uveitis in HIV-infected patients: treatment outcomes

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-3-154-158 ◽

2021 ◽

pp. 154-158

Author(s):

T.D. Sizova ◽

◽

V.M. Khokkanen ◽

F.O. Kasуmov ◽

E.V. Boiko ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Hiv Infection ◽

Treatment Outcomes ◽

Clinical Features ◽

Acute Retinal Necrosis ◽

Study Group ◽

Ophthalmological Examination ◽

Complex Treatment ◽

Secondary Diseases

Cytomegalovirus (CMV) uveitis in HIV infection is one of the most dangerous secondary diseases of the visual organ, leading to blindness in the absence of treatment. The aim is to characterize the clinical features of the course of retinal detachment in HIV infection. Materials and methods. The study group included 29 patients, 34 eyes (9 men and 20 women). All patients underwent a standard routine ophthalmological examination. To confirm the diagnosis, an ultrasound of the eyeball was performed. Results. Retinal detachment was detected in 29 patients (34 eyes) out of 72 (94 eyes) and was 40.3% (95% CI=29.3-51.79%). According to the mechanism of retinal detachment, the following forms were identified: acute retinal necrosis, regmatogenic and traction detachment. In 50% of cases, the disease occurred as acute retinal necrosis of CMV-etiology. Visual acuity in the group of patients with operated retinal detachment became significantly lower after complex treatment. Conclusions. CMV-uveitis has a chronic sluggish course, despite multicomponent treatment. Retinal detachment is detected in 40% of HIV-infected patients with CMV-uveitis and in half of cases has the character of acute retinal necrosis. Keywords: cytomegalovirus, uveitis, HIV, HIV-infection, AIDS, retinal detachment.

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Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study

Journal of Ophthalmology ◽

10.1155/2015/821864 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Salvatore Di Lauro ◽

Melissa Castrejón ◽

Itziar Fernández ◽

Jimena Rojas ◽

Rosa M. Coco ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Visual Loss ◽

Vision Loss ◽

Multicentric Study ◽

Prospective Multicentre Study ◽

Snellen Chart ◽

Pars Plana ◽

Phakic Eyes

Purpose. To quantify the frequency of visual loss after successful retinal detachment (RD) surgery in macula-on patients in a multicentric, prospective series of RD.Methods. Clinical variables from consecutive macula-on RD patients were collected in a prospective multicentric study. Visual loss was defined as at least a reduction in one line in best corrected visual acuity (VA) with Snellen chart. The series were divided into 4 subgroups: (1) all macula-on eyes (n=357); (2) macula-on patients with visual loss at the third month of follow-up (n=53) which were further subdivided in (3) phakic eyes (n=39); and (4) pseudophakic eyes (n=14).Results. Fifty-three eyes (14.9%) had visual loss three months after surgery (n=39phakic eyes;n=14pseudophakic eyes). There were no statistically significant differences between them regarding their clinical characteristics. Pars plana vitrectomy (PPV) was used in 67.2% of cases, scleral buckle in 57.7%, and scleral explant in 11.9% (36.1% were combined procedures).Conclusions. Around 15% of macula-on RD eyes lose VA after successful surgery. Development of cataracts may be one cause in phakic eyes, but vision loss in pseudophakic eyes could have other explanations such as the effect of released factors produced by retinal ischemia on the macula area. Further investigations are necessary to elucidate this hypothesis.

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Surgical Management of a Patient with Anterior Megalophthalmos, Lens Subluxation, and a High Risk of Retinal Detachment

Case Reports in Ophthalmology ◽

10.1159/000456068 ◽

2017 ◽

Vol 8 (1) ◽

pp. 61-66 ◽

Cited By ~ 3

Author(s):

María Carmen Guixeres Esteve ◽

Augusto Octavio Pardo Saiz ◽

Lucía Martínez-Costa ◽

Samuel González-Ocampo Dorta ◽

Pedro Sanz Solana

Keyword(s):

Retinal Detachment ◽

Vision Loss ◽

Lens Subluxation ◽

Intraocular Lens Dislocation ◽

Common Causes ◽

History Of ◽

Anterior Megalophthalmos ◽

The Right ◽

Iris Claw

The early development of lens opacities and lens subluxation are the most common causes of vision loss in patients with anterior megalophthalmos (AM). Cataract surgery in such patients is challenging, however, because of anatomical abnormalities. Intraocular lens dislocation is the most common postoperative complication. Patients with AM also seem to be affected by a type of vitreoretinopathy that predisposes them to retinal detachment. We here present the case of a 36-year-old man with bilateral AM misdiagnosed as simple megalocornea. He had a history of amaurosis in the right eye due to retinal detachment. He presented with vision loss in the left eye due to lens subluxation. Following the removal of the subluxated lens, it was deemed necessary to perform a vitrectomy in order to prevent retinal detachment. Seven months after surgery, an Artisan® Aphakia iris-claw lens was implanted in the anterior chamber. Fifteen months of follow-up data are provided.

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Retinal Detachment After Cataract Surgery and Posterior Laser Capsulotomy in a Young Healthy Male Patient: Case Report

Surgical Case Reports ◽

10.31487/j.scr.2020.03.10 ◽

2020 ◽

pp. 1-3

Author(s):

Marco Zeppieri ◽

Marco Zeppieri

Keyword(s):

Risk Factors ◽

Visual Acuity ◽

Retinal Detachment ◽

Cataract Surgery ◽

Intraocular Lens ◽

Vision Loss ◽

Nuclear Cataract ◽

Cataract Formation ◽

Laser Treatments ◽

Visual Acuity Loss

Background: The onset of cataract formation is normally experienced in senile age. The process of lens opacification can also be influenced by other factors, including systemic diseases, infection, trauma, medication, ultraviolet light exposure, genetic predisposition and environmental sources. Gradual vision loss accompanied by a myopic refractive shift can be caused by nuclear cataract formation, even in young patients. Phacoemulsification cataract removal and intraocular lens insertion surgery is indicated when visual acuity loss and/or myopic anisometropia becomes a problem. Surgical and laser treatments are risk factors in developing retinal detachment, especially in myopic patients. Case Presentation: This is a case of an early onset nuclear cataract in a young male. A 44-year-old man visited the hospital complaining of gradual vision loss in his right eye. History study revealed no systemic or ophthalmic diseases or trauma. The patient underwent phacoemulsification nuclear cataract removal and intraocular lens insertion surgery in his right eye, followed by Nd:YAG laser posterior capsulotomy 3 years later. He underwent phacoemulsification nuclear cataract surgery in his left eye at the age of 48 years, followed by laser capsulotomy treatment 2 years later. At the age 50, a routine eye examination revealed retinal detachment in his right eye. He underwent vitrectomy surgery twice. Conclusion: Nuclear lens opacification is seldom of clinical importance in young healthy adult patients; however, it can be the cause of progressive visual acuity loss, especially in the presence of a myopic refractive shift. Surgery, laser treatment and myopia are all risk factors in retinal detachment. This case shows that thorough and periodic routine eye examinations are a must when dealing with patients with unexpected and atypical signs and symptoms, especially having underwent surgery and laser treatments.

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Myosin 1f-mediated activation of microglia contributes to the photoreceptor degeneration in a mouse model of retinal detachment

Cell Death and Disease ◽

10.1038/s41419-021-03983-3 ◽

2021 ◽

Vol 12 (10) ◽

Author(s):

Yimin Wang ◽

Xiaohuan Zhao ◽

Min Gao ◽

Xiaoling Wan ◽

Yinong Guo ◽

...

Keyword(s):

Immune Response ◽

Cell Death ◽

Visual Acuity ◽

Retinal Detachment ◽

Inflammatory Response ◽

Mouse Model ◽

Vision Loss ◽

Photoreceptor Degeneration ◽

Retinal Injury ◽

Photoreceptor Death

AbstractPhotoreceptor death and neurodegeneration is the leading cause of irreversible vision loss. The inflammatory response of microglia plays an important role in the process of neurodegeneration. In this study, we chose retinal detachment as the model of photoreceptor degeneration. We found Myosin 1f was upregulated after retinal detachment, and it was specifically expressed in microglia. Deficiency of myosin 1f protected against photoreceptor apoptosis by inhibiting microglia activation. The elimination of microglia can abolish the protective effect of myosin 1f deficiency. After stimulation by LPS, microglia with myosin 1f deficiency showed downregulation of the MAPK and AKT pathways. Our results demonstrated that myosin 1f plays a crucial role in microglia-induced neuroinflammation after retinal injury and photoreceptor degeneration by regulating two classic inflammatory pathways and thereby decreasing the expression of inflammatory cytokines. Knockout of myosin 1f reduces the intensity of the immune response and prevents cell death of photoreceptor, suggesting that myosin 1f can be inhibited to prevent a decline in visual acuity after retinal detachment.

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Reactivation of Acute Retinal Necrosis following SARS-CoV-2 Infection

Case Reports in Ophthalmological Medicine ◽

10.1155/2021/7336488 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Monica P. Gonzalez ◽

Radames Rios ◽

Mariella Pappaterra ◽

Miguel Hernandez ◽

Allison Toledo ◽

...

Keyword(s):

Vision Loss ◽

Acute Retinal Necrosis ◽

Pcr Analysis ◽

Prior History ◽

Ophthalmological Examination ◽

History Of ◽

Polymerase Chain ◽

Simplex Virus ◽

The Right

Purpose. To report on a case of reactivation of acute retinal necrosis following SARS-CoV-2 infection. Methods. Observational case report. Observations. A 32-year-old female with a distant history of left retinal detachment secondary to necrotizing herpetic retinitis complained of right-eye vision loss, pain, redness, and photophobia. An ophthalmological examination revealed findings consistent with acute retinal necrosis of the right eye. A polymerase chain reaction (PCR) analysis of the right vitreous was positive for herpes simplex virus type 2 (HSV-2). A coronavirus disease 2019 (COVID-19) screening test using reverse transcriptase- (RT-) PCR was positive for SARS-CoV-2 RNA. Conclusions. Our case suggests that COVID-19 may cause a latent HSV infection to reactivate, causing contralateral involvement in patients with a prior history of HSV-associated acute retinal necrosis.

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Cyclotherapy as a Technique to Expedite the Treatment of Hyperopic Amblyopia

Vision Development & Rehabilitation ◽

10.31707/vdr2016.2.2.p115 ◽

2016 ◽

pp. 115-121

Keyword(s):

Visual Acuity ◽

Vision Loss ◽

Corrected Visual Acuity ◽

Manifest Refraction ◽

Common Causes ◽

Best Corrected Visual Acuity ◽

Spectacle Correction

Amblyopia is one of the most common causes of vision loss in children. This paper shows the efficacy of cyclotherapy in facilitating plus acceptance to expedite the treatment of refractive amblyopia. Three cases of hyperopic amblyopia underwent cyclotherapy. Best corrected visual acuity improved by at least one visual acuity line after cycloplegic refraction for all three patients as compared to dry manifest refraction. After treatment with cyclotherapy, acuities were equal to the initial cycloplegic refraction at the first followup visit with full spectacle correction. The full plus acceptance allowed for quicker resolution of refraction correction in the treatment of amblyopia. The use of cyclotherapy is effective in facilitating plus acceptance in hyperopic amblyopic eyes, and it expedites the resolution of amblyopia.

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Foveal bulge as a predictor of high visual function in rhegmatogenous retinal detachment

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-1-234-238 ◽

2021 ◽

pp. 234-238

Author(s):

R.R. Fayzrakhmanov ◽

◽

A.V. Sukhanova ◽

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Outer Segment ◽

Rhegmatogenous Retinal Detachment ◽

Silicone Oil ◽

Outer Nuclear Layer ◽

Control Group ◽

Ophthalmological Examination ◽

Outer Segments ◽

Group 2

Introduction. The integrity of photoreceptor's inner segment/outer segment connection plays great importance in predicting visual acuity in eyes with retinal pathology. However, even optical coherence tomographic study showed the intact of retinal layers, including photoreceptor's inner segment/outer segment line, after surgery due to rhegmatogenous retinal detachment (RRD), low visual acuity is observed. Purpose. to identify predictors of high visual acuity in the foveolar zone in patients after successful RRD repair according to SD-OCT. Material and methods. Group 1 consisted of 20 cases – eyes after successful primary RRD repair performed through pars plana vitrectomy using silicone oil tamponade (1300 cSt), followed by removal of silicone oil with a replacement for sterile air. Group 2 – control, followed eyes without ophthalmopathology and visualisation of foveolar bulge according to OCT. All patients underwent a standard ophthalmological examination and OCT on the 30th day after silicone oil removal. OCT examination was performed by Retina Map and Cross Line modes. The lengths of the outer segments of photoreceptors, inner segments of photoreceptors and the outer nuclear layer of the layer were measured in manual mode. Retina Map was used to measure retinal foveolar thickness. Results. During the study, the data of the foveolar thickness of the retina, the outer nuclear layer and the length of the outer segment of photoreceptors in the main group showed a significant decrease in comparison with the control group (p=0.002, p=0.006, p=0.02, respectively). In this case, a strong correlation was obtained only between the length of the outer segments of photoreceptors and visual acuity (r=0.68). Conclusion. The length of the outer segments of the cones in the central retinal area, or foveolar bulge, should considers a predictor of high visual acuity twostage surgical treatment of primary RRD using silicone oil. Key words: retinal detachment, foveolar bulge, ellipsoid zone, vitrectomy, OCT.

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An algorithm for managing surgical patients with acute retinal necrosis

Russian Ophthalmological Journal ◽

10.21516/2072-0076-2018-11-4-29-35 ◽

2018 ◽

Vol 11 (4) ◽

pp. 29-35

Author(s):

V. V. Neroev ◽

P. A. Ilyukhin ◽

V. E. Tankovsky ◽

R. A. Fedotov

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Retinal Detachment ◽

Comparison Group ◽

Silicone Oil ◽

Clinical Manifestations ◽

Main Group ◽

Acute Retinal Necrosis ◽

Surgical Patients ◽

Irreversible Damage

Purpose. To increase the efficiency of surgical treatment and develop an algorithm for managing patients with the consequences of acute retinal necrosis (ARN).Material and methods. The study included 35 patients (42 eyes) aged 18 to 74 with acute retinal necrosis. All patients underwent a microinvasive (23 Ga) vitrectomy with membrane peel, endolaser coagulation of the retina and endotamponade of the vitreal cavity with silicone oil. The operated eyes were divided into 2 groups. The main group consisted of 17 eyes with a clinical picture of fibrosis of the vitreous without retinal detachment (10 eyes) and retinal detachment without pronounced fibrosis of the vitreous (7 eyes). The comparison group included 25 eyes which had retinal detachment and fibrosis of the vitreous at the time of surgery. The visual acuity varied between incorrect light projection and 0.15 with correction.Results. A stable anatomical and optical result was achieved in all cases. Complete adhesion of the detached retina was achieved in 94.1 %, which is explained by the fact that surgical treatment was in most cases performed in the absence of pronounced stages of proliferative vitreoretinopaty. In all cases of the main group, an increase in visual acuity was noted. In 53 % of cases, visual acuity achieved 0.1 to 0.3 and in the remaining 47 % it was 0.3 % or above. This can be accounted for by the prevalence of peripheral necrotic lesions, as well as a lower incidence of macular edema and optic neuropathy. However, in the comparison group, an increase in visual acuity was only observed in 56 % cases, with visual acuity reaching 0.1 or higher only in 24 % of the eyes. A high frequency (72 %) of necrosis expansion to the posterior eye pole with an irreversible damage to the optic nerve and the macular region was revealed.Conclusion. Active dynamic observation of patients with ARN helps detect changes requiring surgical treatment, which leads to higher functional and anatomical outcomes, as well helps avoid the disability of the patients. Surgical treatment prior to the formation of retinal detachment in severe traction syndrome with or without retinal tears is advisable. An algorithm was proposed for managing surgical patients, depending on the clinical manifestations of ARN effects.

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Cytomegalovirus uveitis in HIV-infected patients: course and outcomes

Journal Infectology ◽

10.22625/2072-6732-2020-12-4-45-50 ◽

2020 ◽

Vol 12 (4) ◽

pp. 45-50

Author(s):

T. D. Sizova ◽

V. M. Khokkanen ◽

D. A. Gusev ◽

E. V. Boyko

Keyword(s):

Antiretroviral Therapy ◽

Retinal Detachment ◽

Hiv Infection ◽

Linear Relationship ◽

Vision Loss ◽

Number Of Patients ◽

Department Of Ophthalmology ◽

Eye Damage ◽

Medical University ◽

And Control

Cytomegalovirus uveitis is one of the AIDS marker diseases, develops with severe immunodeficiency and is the main cause of blindness in HIV-infected patients.The aim of our work is to study the course and outcomes of CMV uveitis in patients with HIV infection over the past 10 years.Materials and methods. The study was conducted at the St. Petersburg Center for the Prevention and Control of AIDS and Infectious Diseases and at the Department of Ophthalmology of North-Western State Medical University named after I.I. Mechnikov. The analysis of statistical data of HIV Newsletters in St. Petersburg for 2009-2019 was carried out, as well as the Journal of Ophthalmologist Examination of the AIDS Center to assess the long-term dynamics of detection of CMV uveitis, CMV associated retinal detachment, and cases of vision loss.Results. On average, CMV eye damage occurred in 1.65% of patients. In most cases, the involvement of the retina was predominantly peripheral (50-89%). Neuritis, panuveitis, cystic macular edema and retinal detachment were also registered. A positive strong linear relationship was found between the number of new cases of HIV infection already detected in the AIDS stage and new cases of cytomegalovirus damage to the organ of vision. There is a very strong inverse linear relationship between the frequency of detection of CMV uveitis and the amount of antiretroviral therapy provided.Conclusion. Conducting antiretroviral therapy and providing it to an increasing number of patients helps to reduce the incidence of HIV infection in St. Petersburg and probably secondary CMV infection with damage to the organ of vision.

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