Clinical manifestation and treatment of ocular immune reconstitution inflammatory response syndrome in acquired immunodeficiency syndrome patients with cytomegalovirus retinitis

Authors: Kong Wenjun,  Wei Wenbin,  Xie Lianyong,  Chen Chao,  Du Kuifang
DOI: 10.3760/cma.j.cn115989-20200317-00179
Published 2021-07-10
Cite asChin J Exp Ophthalmol, 2021, 39(7): 626-631.

Abstract

Objective

To investigate the ocular characteristics and treatment prognosis of ocular immune reconstruction inflammatory syndrome (IRIS) in patients with cytomegalovirus retinitis (CMVR) complicated with acquired immunodeficiency syndrome (AIDS).

Methods

A serial case-observational study was conducted.Seventeen eyes from 15 male 21-to 43-year-old AIDS patients combined with CMVR, who were diagnosed with IRIS at Beijing You’an Hospital, Capital Medical University from February 2016 to December 2018 were included.The best corrected visual acuity (BCVA) of patients was recorded, and the intraocular pressure and anterior segment was measured with a non-contact tonometer and a slit-lamp microscope, respectively.The ocular fundus was observed by fundus photography and optical coherence tomography (OCT). Reverse transcription polymerase chain reaction was used to measure the cytomegalovirus deoxyribonucleic acid (CMV-DNA) content in the aqueous humor during the occurrence of IRIS.The flow cytometry was employed to determine the peripheral blood CD4+ T lymphocyte count before highly active antiretroviral therapy (HAART) and during the occurrence of IRIS.All patients were followed for 3 to 25 months, with an average of 15 months.The HAART time of patients was 17 to 104 days, with an average of (66.1±27.4) days.Patients with anterior segment inflammatory reactions were given the anti-inflammatory and mydriatic treatment.Patients with severe vitreous opacity were intravitreally injected with 4 mg of triamcinolone.Patients with macular edema were given 0.5 mg intravitreal injection of conbercept.The study adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Beijing You’an Hospital, Capital Medical University (No.[2017]11). Written informed consent was obtained from each patient prior to any examination.

Results

Anterior segment inflammation (Tyndall effect, KP, post-iris adhesion) was found in 9 eyes, vitreous opacities to varying degrees in 11 eyes, and macular edema in 2 eyes.The CMV-DNA content was negative (<500 copies/ml) in 15 eyes.The CD4+ T lymphocyte count in peripheral blood during IRIS was 67 (51, 99) cells/μl, which was significantly higher than 17(6, 20) cells/μl before HAART treatment (Z=-4.48, P<0.01). Two of the 15 AIDS patients had tuberculosis.The BCVA of the patients was improved from 0.30 (0.10, 0.55) before treatment to 0.50 (0.35, 0.60) after treatment, and the difference was statistically significant (Z=-2.34, P=0.019).

Conclusions

The anterior and posterior segment may be involved in IRIS patients with AIDS and CMVR, and the corresponding ocular treatment is effective.

Key words:

Acquired immune deficiency syndrome/treatment; Ocular immune reconstitution inflammatory syndrome/treatment; Clinical manifestation; Treatment effectiveness

Contributor Information

Kong Wenjun

Department of Ophthalmology, Beijing You’an Hospital, Capital Medical University, Beijing Infectious Eye Disease Diagnosis And Treatment Center, Beijing 100069, China

Wei Wenbin

Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Infectious Eye Disease Diagnosis And Treatment Center, Beijing 100730, China

Xie Lianyong

Department of Ophthalmology, Beijing You’an Hospital, Capital Medical University, Beijing Infectious Eye Disease Diagnosis And Treatment Center, Beijing 100069, China

Chen Chao

Department of Ophthalmology, Beijing You’an Hospital, Capital Medical University, Beijing Infectious Eye Disease Diagnosis And Treatment Center, Beijing 100069, China

Du Kuifang

Department of Ophthalmology, Beijing You’an Hospital, Capital Medical University, Beijing Infectious Eye Disease Diagnosis And Treatment Center, Beijing 100069, China

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Updated: July 27, 2021 — 1:15 am