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目的探讨获得性免疫缺陷综合征(acquiredimmunodeficiencysyndrome,AIDS)并发巨细胞病毒(cytomegalovirus,CMV)性视网膜炎的眼底表现特点、全身症状及治疗预后。方法观察8例(15只眼)AIDS并发CMV性视网膜炎的临床表现,分析其眼底、视力、荧光素眼底血管造影及CD4+T淋巴细胞检测结果,并对其中2例(4只眼)行更昔洛韦玻璃体腔注药治疗。随访时间2～34个月,平均16个月。结果初诊视力≤0.2者10只眼(66.7%),其中无光感者2只眼,眼前光感者2只眼,0.04～0.20者6只眼;0.8和0.9者各1只眼(13.3%);≥1.0者3只眼(20.0%)。12只眼的眼底表现为视网膜血管炎特点,呈沿血管分布的浓厚黄白色病损,其上有片状出血,边缘为不规则的黄白色颗粒,可形象描述为“奶酪加番茄酱样视网膜炎”;玻璃体透明或反应轻微。2只眼的眼底呈晚期表现,视网膜萎缩呈灰色,视网膜血管硬化、狭窄,视网膜色素上皮萎缩,可透见脉络膜血管及视神经萎缩。1只眼视网膜脱离。8例患者的CD4+T淋巴细胞计数在0～36个/mm3之间,平均(15.0±12.9)个/mm3。4只眼玻璃体注药后视力均显著提高。眼底病变明显消退,出血吸收。结论CMV性视网膜炎是AIDS最常见、最严重的眼部并发症。眼底表现特点为进行性、坏死性视网膜炎伴出血,同时合并有视网膜血管炎。但玻璃体反应无或轻微。对原因不明的黄白色病损、视网膜出血及视网膜血管炎应行血清人类免疫缺陷病毒(humanimmunodeficiencyvirus,HIV)抗体检测。反之,HIV阳性者应常规进行眼底检查。(中华眼科杂志,2005,41:803806)
Objective To investigate the fundus characteristics, systemic symptoms and prognosis of acquired immunodeficiency syndrome (AIDS) complicated with cytomegalovirus (CMV) retinitis. Methods The clinical manifestations of 8 cases (15 eyes) with CMV retinitis were observed. The fundus, visual acuity, fundus fluorescein angiography and CD4 + T lymphocyte test results were analyzed. Two of them (4 eyes) Ganciclovir intravitreal injection therapy. Follow-up time of 2 to 34 months, an average of 16 months. Results There were 10 eyes (66.7%) with visual acuity ≤0.2, including 2 eyes without light perception, 2 eyes with light perception before eyes, 6 eyes with 0.04 ~ 0.20 eyes, and 1 eyes with eyesight 0.8 and 0.9 (13.3% ); 3 eyes ≥1.0 (20.0%). Twelve eyes showed retinal vasculitis with thick yellow-white lesions along the blood vessels with flaky hemorrhage on the edges and irregular yellowish-white particles on the edges. The image was described as “cheese with tomato-like retinal Inflammation ”; vitreous transparent or mild reaction. The fundus of 2 eyes showed advanced manifestation, the atrophy of the retina was gray, retinal sclerosis, stenosis and retinal pigment epithelial atrophy were found in choroidal vessels and optic atrophy. Retinal detachment in 1 eye. Eight patients had a CD4 + T lymphocyte count of 0-36 cells / mm3, with an average of (15.0 +/- 12.9) / mm3.4 eyes with significant improvement of visual acuity after vitreous injection. Fundus lesions significantly subsided, bleeding absorption. Conclusion CMV retinitis is the most common and serious ocular complication of AIDS. Fundus characterized by progressive, necrotizing retinitis associated with bleeding, combined with retinal vasculitis. However, the vitreous reaction with no or minor. For unexplained yellowish white lesions, retinal hemorrhage and retinal vasculitis serum HIV should be detected. Conversely, HIV-positive patients should be routine examination of the fundus. (Chinese Journal of Ophthalmology, 2005,41: 803,806)