india j ophthalmol
TRANSCRIPT
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India J Ophthalmol. 2008 September-Oktober; 56 (5): 3-383.
!"#I$: !"#2636%33
Manifestasi segmen posterior human immunodeficiency virus / sindrom defisiensi imun
&la' S anker "S
!en*li+ in,orma+i atatan !a+al /ak #ipta dan i+en+i in,orma+i
&rtikel ini telah dik*tip oleh artikel lainn'a di !"#.
Abstrak
Seba1ai per ! diperoleh +indrom de,i+ien+i kekebalan (&I$S) 4 or1ani+a+i e+ehatan
$*nia (/O) 'an1 diperoleh +indrom de,i+ien+i im*n (&I$S) pembar*an epidemi $e+ember
2006 ada +ekitar 375 *ta (39%-9.%00.000) oran1 di +el*r*h d*nia hid*p den1an ir*+ h*man
imm*node,iien' (/I). % $ari ini +ekitar 52-500000 oran1 dari India. 2 "e+kip*n
mel*a+n'a pen11*naan terapi antiretroiral (&<=) hari ini mani,e+ta+i ok*lar &I$S di beberapa
titik mempen1ar*hi 50 +ampai 5> dari 'an1 terin,ek+i oran1 'an1 terlibat +e1men po+terior
adalah 'an1 palin1 *m*m. 3 J*1a +pektr*m mani,e+ta+i ok*lar &I$S di ne1ara berkemban1
berbeda dari ne1ara-ne1ara ma*. 9 =**an artikel ini adalah *nt*k menina* +em*a mani,e+ta+i
+e1men po+terior &I$S. "ani,e+ta+i +e1men po+terior pada pa+ien &I$S dapat diba1i menadi
empat kate1ori *tama: a+k*lopati in,ek+i oport*ni+tik ke1ana+an 'an1 tidak bia+a dan kelainan
ne*ro-o,talmolo1i.
?o to:
Vaskulopati
"iroa+*lopath' adalah mani,e+ta+i ok*lar 'an1 palin1 *m*m dari &I$S terlihat di +ekitar
90> +ampai 60> dari pa+ien /I-po+iti,. 5 klini+ it* bermani,e+ta+i +eba1ai bintik kapa+ terletak
di k*t*b po+terior dan dapat men+im*la+ikan path keil 'tome1aloir*+ (#") retiniti+
@ ?ambar % A. am*n tidak +eperti #" retiniti+ bintik-bintik kapa+ 'an1 tidak terkait den1an
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*mlah be+ar perdarahan iriti+ hal*+ ata* itriti+ po+terior rin1an. "ereka memiliki bata+ 'an1
lebih b*lat dan bia+an'a berorienta+i +epanan1 arade pemb*l*h darah dan mer*pakan daerah
,ok*+ i+kemia pada lapi+an +erat +ara,. eban'akan pa+ien den1an miroa+*lopath' retina
tidak men*n*kkan 1eala. !en1obatan tidak dit*n*kkan dalam ban'ak ka+*+.!realen+i
miroa+*lopath' berbandin1 terbalik den1an #$9 B o*nt.
?ambar %
"iroa+*lopath'
?o to:
Penyakit pembuluh besar
Okl*+i kapal be+ar terma+*k okl*+i ena p*+at dan aban1 retina dan aban1 okl*+i arteri retina
aran1 teradi dan bia+an'a teradi dalam h*b*n1an den1an retiniti+ ir*+ ne*ropati optik
in,iltrati, lim,omato*+ dan kelainan +eperti teri+ola+i. 6 - 8 Cro+ted aban1 a+k*liti+ telah
dikaitkan den1an retiniti+ #" di &I$S. 7
?o to:
Segmen posterior infeksi oportunistik
Se1men po+terior mata in,ek+i oport*ni+tik adalah mani,e+ta+i dari pen'akit di+ebarl*a+kan pada
pa+ien &I$S dan diak*i baik +eba1ai nerotiDin1 retiniti+ ata* +eba1ai *ni,oal ata* m*lti,okal
horoiditi+.<etiniti+ lebih *m*m daripada horoiditi+. <etiniti+ di mata tenan1 teradi pada pa+ien
den1an #$9 rendah B *mlah dan lebih *m*m karena #" dan pro1re+i, nekro+i+ retina l*ar
(!O<) +ementara retiniti+ di mata meradan1 bia+an'a teradi pada pa+ien den1an #$9 lebih
tin11i B *mlah dan lebih *m*m karena nekro+i+ retina ak*t ( &<) tok+opla+mo+i+ +i,ili+ ata*
tahap akhir dari kriptokok*+.
Cytomegalovirus retinitis
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#'tome1aloir*+ retiniti+ adalah in,ek+i oport*ni+tik ok*lar terkait &I$S 'an1 palin1 *m*m dan
dapat berkemban1 pada +ampai den1an 90 +ampai 50> dari pa+ien &I$S +ebel*m
&<=. 5 "e+kip*n in+iden telah men*r*n taam +eak m*n*ln'a &<= di d*nia barat ma+ih tetap
pen'ebab morbidita+ ok*lar terkem*ka di ne1ara-ne1ara berkemban1. %0 $i India #" retiniti+
ma+ih tetap mani,e+ta+i ok*lar *m*m dalam ka+*+-ka+*+ &I$S. %% %2 $alam +eri kami %286
ka+*+ keadian retiniti+ #" tetap tin11i bahkan di era &<= @ =abel % A. "*n1kin +epihak *nt*k
mem*lai den1an tetapi +ampai 52> akhirn'a akan men1emban1kan pen'akit
bilateral. #'tome1aloir*+ retiniti+ teradi hampir +eara ek+kl*+i, pada pa+ien 'an1 *mlah #$9
adalah E50 +el 4 ml. %3 am*n dia1no+i+ 'an1 tidak dapat dike*alikan berda+arkan #$9 B
men1hit*n1 +endiri pada pa+ien 'an1 memakai &<=. $alam ka+*+ 'an1 +an1at aran1 #"
retiniti+ dapat berkemban1 pada pa+ien den1an penin1katan *mlah #$9 +etelah m*lai &<=.
=abel %
"ani,e+ta+i ok*lar di %.286 aF*ired imm*node,iien' +'ndrome ka+*+
Temuan klinis: &da ti1a bent*k klini+ retiniti+ #". ent*k kla+ik (piDDa pie retinopati ata*
ke* otta1e den1an +a*+ tomat) ditandai den1an nekro+i+ retina kon,l*en den1an perdarahan
'an1 berkemban1 ter*tama di retina po+terior @ ?ambar 2& A. =he mema*kan tepi le+i ini
bia+an'a +an1at taam dan men'ebar onti1*o*+l'. ia+an'a +elama beberapa min11* le+i 'an1
tidak diobati berkemban1 menadi ,*ll-thikne++ nekro+i+ den1an 1lio+i+ retina 'an1 diha+ilkan
dan pi1men epitel atro,i. !a+ien +erin1 memiliki hilan1n'a lapan1an i+*al ata* ketaaman i+*al
dan +kotoma. Sebalikn'a bent*k mala+ diak*i +eba1ai le+i 1ran*lar di retina peri,er +erin1
den1an +edikit ata* tanpa perdarahan @ ?ambar 2 A. !a+ien m*n1kin melihat ,loater+ ata*
mereka m*n1kin a+imtomatik. !re+enta+i aran1 keti1a adalah b*ram aban1 an1iiti+ @ ?ambar
2# A.arena +ekitar %5> dari pa+ien den1an akti, retiniti+ #" tidak men*n*kkan 1eala
pemerik+aan r*tin den1an o,talmo+kopi lan1+*n1 melebar telah direkomenda+ikan pada interal
ti1a b*lan pada pa+ien den1an *mlah #$9 k*ran1 dari 50 +el 4 ml. %9 #'tome1aloir*+ retiniti+
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dapat men1akibatkan baik +ero*+ ata* rhe1mato1eno*+ retina deta+emen me+kip*n 'an1
terakhir ini a*h lebih *m*m. &bla+i retina <he1mato1eno*+ telah dilaporkan pada %3-27>
pa+ien den1an retiniti+ #" dan dapat teradi +elama ,a+e akti, ata* +emb*h dari
pen'akit. am*n +eak m*n*ln'a &<= keadian abla+i retina telah men*r*n +ekitar 60-> di
d*nia barat. %5 Sebalikn'a di +eri kami keadian abla+i retina-#" terkait ditem*kan telah
menin1kat @ =abel % A . /al ini m*n1kin karena *mlah 'an1 lebih tin11i dari pa+ien 'an1
memakai &<= 'an1 tidak panta+ ata* oran1 'an1 memakai &<= memiliki area 'an1 lebih be+ar
dari di+emb*hkan #" retiniti+ 'an1 akhirn'a men1emban1kan l*ban1 nekrotik men1arah ke
deta+emen. erba1ai pendekatan terma+*k par+ plana itretom' (!!) den1an 1a+ ata* +ilikon
tamponade min'ak (5000#S i+ko+ita+ lebih tin11i) +leral b*klin1 dan la+er demarka+i telah
e,ekti, dalam perbaikan deta+emen retina 'an1 berkaitan den1an retiniti+ #". %6
?ambar 2&
(&) la+ik #" retiniti+: piDDa-pie penampilan
?ambar 2
() berba1ai ?ran*lar retiniti+ #"
?ambar 2#(#) Cro+ted-aban1 an1iiti+ berba1ai #" retiniti+
Pengobatan: !en1obatan #" retiniti+ adalah indiid*al dan ter1ant*n1 pada loka+i retiniti+
akti, dan +tat*+ kekebalan pa+ien. Saat ini ter+edia a1en anti-#" terma+*k 1an+ikloir dan
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prodr*1 al1an+ikloir n'a ,o+karnet +ido,oir ,omiir+en 1an+ikloir implan dan
al1an+ikloir oral. Seb*ah rin1ka+an +in1kat dari obat ini diberikan dalam =abel 2 .
=abel 2
Obat *nt*k 'tome1aloir*+ retiniti+
Necrotizing retinopati herpes
erotiDin1 retinopati herpe+ (/<) adalah +pektr*m kontin* peradan1an +e1men po+terior
di+ebabkan oleh ir*+ herpe+ palin1 +erin1 ariella Do+ter ir*+ (G). It+ d*a pola klini+ 'an1
palin1 dikenal adalah &< @ ?ambar 3 A dan !O< @ ?ambar 9 A. ia+an'a mantan teradi pada
oran1 +ehat dan pa+ien &I$S den1an di+,*n1+i kekebalan t*b*h han'a rin1an dan #$9 tin11i B
*mlah +edan1kan 'an1 terakhir bia+an'a berkemban1 pada mereka 'an1 men1alami
im*no+*pre+i. % Selain ariella Do+ter ir*+ herpe+ +impleH ir*+ dan #" telah dii+ola+i di
pa+ien den1an &< dan herpe+ +impleH pada mata den1an !O<. %8Cit*r di,eren+ial antara
&< !O<O dan #" retiniti+ diberikan dalam =abel 3 .
?ambar 3
ekro+i+ retina ak*t
?ambar 9
ekro+i+ retina l*ar pro1re+i,
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=abel 3
"embedakan ,it*r dari ti1a eni+ retiniti+ ir*+ pada aF*ired imm*node,iien' +'ndrome
!eraatan medi+ a1re+i, den1an antiir*+ +i+temik 'an1 tepat dapat menin1katkan ha+il i+*al
an1ka panan1 pada pa+ien den1an /<. !en1obatan &< terma+*k a+ikloir intraena (%500
m1 4 +F meter 4 hari dalam ti1a do+i+ terba1i) +elama t**h +ampai %0 hari diik*ti den1an
a'loir oral (800 m1 lima kali +ehari) +elama enam min11*. %2 "en1ik*ti re+ol*+i retiniti+
a+er pro,ilak+i+ +eran1an adalah dian11ap berman,aat *nt*k mene1ah abla+i retina. am*n
kehilan1an pen1lihatan akibat in,ek+i pro1re+i, +el*b*n1 +ara, optik e,*+i ata* dalam ban'ak
ka+*+ abla+i retina teradi di hin11a 0 +ampai 85> dari pa+ien.&bla+i retina memb*t*hkan
itretom' intraitreal tamponade min'ak +ilikon dan endola+er ,otokoa1*la+i.
oksoplasmosis
$alam +eba1ian be+ar ka+*+ &I$S tok+opla+mo+i+ adalah in,ek+i primer daripada reaktia+i
a.=ok+opla+mo+i+ ok*lar di &I$S berbeda den1an tok+opla+mo+i+ pada indiid*im*nokompeten +erin1 bilateral m*lti,okal dan tidak terkait den1an beka+ l*ka
horioretinal. /al it* dapat men'ebabkan berba1ai kelainan ok*lar terma+*k iriti+ itriti+
horoiditi+ m*lti,okal ata* men'ebar nerotiDin1 retiniti+ @ ?ambar 5 A papilliti+ ata* ne*riti+
retrob*lbar ata* tok+opla+mo+i+ retina l*ar. %7 =oHopla+ma retiniti+ m*n1kin men'er*pai #"
retiniti+; am*n peradan1an intraok*lar bia+an'a lebih parah dan perdarahan 'an1 lebih
+edikit. !en1obatan den1an obat +tandar antipara+it (pirimetamin klindami+in +*l,onamid)
berha+il dalam men1endalikan tok+opla+mo+i+ ok*lar dalam ban'ak ka+*+.
?ambar 5
<etinohoroiditi+ tok+opla+ma
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Choroiditis
Pneumonia
"ani,e+ta+i ok*lar P. carinii terma+*k kon*n1tiiti+ ma++a orbital ne*ropati optik dan
horoiditi+. 20/al ini dilihat +eba1ai kla+ik bilateral dan m*lti,okal kek*nin1an baik berbata+
te1a+ le+i horoidal terletak di k*t*b po+terior tidak terkait den1an itriti+ iriti+ ata* a+k*liti+
@ ?ambar 6 A. 2% le+i mata mere+pon dalam ban'ak ka+*+ *nt*k ind*k+i dan terapi pemeliharaan
+elan*tn'a den1an pentamidin +i+temik trimetoprim dan +*l,ametok+aDol ata* dap+on.
?ambar 6
#horoiditi+ !ne*mo'+ti
Cryptococcus
#r'ptoo*+ menin1iti+ adalah pen'ebab palin1 *m*m dari le+i ne*ro-ophthalmol1i terkait
&I$S.#horoiditi+ kriptokok*+ m*n1kin m*lti,okal +oliter ata* kon,l*en dan m*n1kin terkait
den1an nod*l kelopak mata ma++a kon*n1tia iriti+ 1ran*lomato+a ma++a iri+ itriti+
nerotiDin1 retiniti+ endophthalmiti+ dan ne*riti+ optik @ ?ambar A. 22 Cl*konaDol terapi
pemeliharaan 200 m1 4 hari +aat ini dian*rkan pada +em*a pa+ien bahkan di era &<=.
?ambar
eterlibatan #r'ptoo*+ dari +ara, optik dan retina
?o to:
!C okular
"e+kip*n = par* adalah in,ek+i oport*ni+tik +i+temik *m*m terlihat pada ka+*+ &I$S di India
keadian = mata +an1at rendah. $alam penelitian kami %286 ka+*+ kami menem*kan han'a
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%> ka+*+ =# mata dian11ap. Ini bia+an'a men'aikan t*berkel horoidal +eba1ai m*lti,okal
den1an le+i k*nin1 di+krit ter*tama di k*t*b po+terior @ ?ambar 8 A. Ini m*n1kin berh*b*n1an
den1an abla+i retina ek+*dati, den1an peradan1an itreo*+ ariabel. adan1-kadan1
ba1aimanap*n dapat hadir +eba1ai po+terior +oliter tian1 1ran*loma-+eperti le+i be+ar ma++a
@ ?ambar 7 A. 23 !en1obatan den1an obat anti-= an1ka panan1 +i+temik e,ekti, dalam ban'ak
ka+*+. Spektr*m = mata ba1aimanap*n ber*bah di era +aat ini &<=.ar*-bar* ini telah ada
laporan dari memb*r*kn'a t*berk*lo+i+ mata pada pa+ien /I +etelah &<=. 29
?ambar 8
eberapa t*berkel horoidal karena =# mata
?ambar 7
e+i ma++a +oliter karena =# mata
?o to:
"eganasan yang tidak biasa
$ilaporkan +e1men mani,e+ta+i po+terior lim,oma non-/od1kin (/) terma+*k retiniti+
nerotiDin1 horoiditi+ m*lti,okal a+k*liti+ retina itriti+ ma++a +*bretinal dan p+e*do-
h'pop'on *eiti+. 25 !ilihan pen1obatan terma+*k radia+i dan kemoterapi.
?o to:
"elainan neuro#oftalmologi
elainan ne*ro-o,talmolo1i bia+an'a mer*pakan indika+i in,ek+i ata* lim,oma otak ata*
menin1e+ dan teradi han'a 6> dari pa+ien &I$S. elainan klini+ +ara, optik pada pa+ien den1an
&I$S dapat diak*i +eba1ai perine*riti+ edema papil papilliti+ ne*riti+ retrob*lbar dan atro,i
optik. 26
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?o to:
Sipilis
Si,ili+ mata di &I$S dapat hadir +eba1ai iriti+ itriti+ retrob*lbar ne*riti+ optik perine*riti+
papilliti+ ne*roretiniti+ a+k*liti+ retina +eb*ah retiniti+ nerotiDin1 'an1 m*n1kin +eara klini+
dibedakan dari #" dan abla+i retina ek+*dati,. 2 Si,ili+ di &I$S dapat berkemban1 ketika
*mlah #$9 'an1 lebih be+ar dari 200 +el 4 ml dan akibatn'a +i,ili+ terma+*k +i,ili+ mata
m*n1kin pen'akit men'aikan men1arah ke dia1no+i+ &I$S. =elah direkomenda+ikan baha %2-
29000000 *nit peni+ilin berair intraena diberikan +elama %0 hari pada pa+ien &I$S den1an
+i,ili+ mata.
?o to:
Manifestasi okular $%V di era A&
"*n*ln'a &<= telah memiliki dampak 'an1 mendalam pada mani,e+ta+i o,talmolo1i pa+ien
&I$S.Seba1ai obat ini men'ebabkan penin1katan ,*n1+i kekebalan t*b*h pa+ien memiliki
in,ek+i oport*ni+tik 'an1 lebih +edikit. &da laporan dari pen*r*nan dramati+ dalam ,rek*en+i
#" retiniti+ di daerah di mana ti1a dan empat-obat terapi kombina+i antiretroiral +eara r*tin
di1*nakan. Selain pen*r*nan keadian ada ha+il 'an1 lebih baik pada pa+ien den1an retiniti+
#" 'an1 menerima terapi antiretroiral bar* akti, +elain terapi anti-#". 28 !ada ban'ak
pa+ien den1an retiniti+ #" +emb*h 'an1 telah menan11api &<= terapi anti-#" telah
dihentikan tanpa reaktia+i retiniti+ ter+eb*t. $alam penelitian kami di mana kombina+i &<=
diberikan kepada %2 pa+ien den1an retiniti+ #" akti, +em*a-anti #" *mlah +el 'an1 %00 4
mm3 +elama ti1a b*lan. 27 =he #$9 median men1hit*n1 menin1kat dari 365 4 mm 3 (ki+aran 3
+ampai 9 4 mm 3) pada aal menadi %55 4 mm3 (ki+aran 7-9%0 4 mm 3) pada ti1a
b*lan. =idak ada pa+ien 'an1 memiliki reaktia+i #" retiniti+ ata* pen1emban1an #" di
l*ar +elama median tindak lan*t dari %6 b*lan. "e+kip*n +aat ini tidak ada kriteria +tandar *nt*k menent*kan apakah penin1katan kekebalan *k*p *nt*k mem*n1kinkan penarikan terapi
*mlah #$9 B minimal %00 +el 4 "# *nt*k +etidakn'a ti1a +ampai enam b*lan ata* naik
minimal 50 +el 4 "# telah direkomenda+ikan. 30 3% <eaktia+i #" retiniti+ telah dilaporkan
pada pa+ien 'an1 men1hentikan ata* menadi toleran terhadap &<=. etika terapi pemeliharaan
dihentikan pen1amatan dari dekat diperl*kan.
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%mmune pemulihan uveitis
Imm*ne pem*lihan *eiti+ (I<) adalah peradan1an intraok*lar men*lar 'an1 berkemban1 pada
pa+ien den1an retiniti+ #" akti, 'an1 memiliki ketin11ian +*b+tan+ial dalam #$9 B
men1hit*n1 den1an &<=.Imm*ne pem*lihan *eiti+ adalah pen'ebab *tama kehilan1an pen1lihatan bar* pada oran1 den1an &I$S terlihat di +ekitar %6-63> dari &<=
re+ponden. =in1kat keparahan in,lama+i ter1ant*n1 pada tin1kat pem*lihan kekebalan tin1kat
#" retiniti+ *mlah intraok*lar #" anti1en dan pen1obatan +ebel*mn'a.=em*an klini+
terma+*k r*an1 anterior ata* reak+i itreo*+ @ ?ambar %0 A pan*eiti+ den1an h'popon optik*+
dan edema mak*la '+toid pembent*kan membran epiretinal katarak itreoma*lar +indrom
trak+i dan itreoretinopath' proli,erati,. 32 33 !en1obatan den1an kortiko+teroid (+*btenon ata*
+i+temik ata* intraitreal ) e,ekti, dalam men1endalikan peradan1an dan menin1katkan i+i
dalam beberapa ka+*+.am*n opera+i m*n1kin diperl*kan pada pa+ien den1an +indrom
itreoma*lar trak+i pembent*kan membran epiretinal katarak dan itreoretinopath'
proli,erati,.
?ambar %0
itriti+ parah akibat *eiti+ pem*lihan kekebalan
?o to:
&ingkasan
#" retiniti+ a*h lebih *m*m di era &<= tetapi tetap +alah +at* komplika+i ok*lar palin1
*m*m &I$S di India. San1at terapi anti-retroiral akti, telah terb*kti men'ebabkan re1re+i
in,ek+i oport*ni+tik terma+*k #" retiniti+ menin1katkan akt* *nt*k kamb*h retiniti+ #"
men1*ran1i keadian lepa+n'a retina #" terkait dan memperpanan1 kelan1+*n1an hid*p
pa+ien. !a+ien den1an akti, retiniti+ #" 'an1 telah mere+pon &<= den1an *mlah #$9 B %00
+el 4 "# +elama lebih dari ti1a +ampai enam b*lan m*n1kin menadi kandidat *nt*k
pen1hentian terapi pemeliharaan #". =*t*p tindak lan*t *nt*k +etiap tanda-tanda reaktia+i
adalah aib. ekebalan pem*lihan *eiti+ telah dilaporkan pada pa+ien den1an retiniti+ #"
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+emb*h 'an1 telah menan11api &<=. erotiDin1 retinopati herpe+ dan t*berk*lo+i+ ok*lar
adalah 1an11*an +e1men po+terior *m*m lainn'a terlihat dalam ka+*+ &I$S.
?o to:
Catatan kaki
S*mber $*k*n1an: il
ent*ran epentin1an: =idak ada men'atakan
?o to:
&eferensi
%. &I$S &I$S epidemi *pdate: aporan h*+*+ tentan1 /I 4 &I$S: $e+ember
2006. @terakhir diak+e+ pada 3% Oktober 200A. =er+edia
dari: http:44data.*naid+.or14p*b4Kpi<eport4200642006LKpipdate en.pd, .
2. !en1endalian &I$S Or1ani+a+i a+ional $epartemen e+ehatan dan kel*ar1a *r*+an
!emerintah India./I 4 &I$S S*reillane epidemiolo1i dan laporan K+tima+i *nt*k tah*n
2005. tah*n 2006. @=erakhir diak+e+ pada 3% Oktober 200A. =er+edia
dari: http:44.naoonline.or14,nlapil06rprt.pd, .
3. e+tel'n !? #*nnin1ham Jr K=. /I 4 &I$S dan keb*taan 200%; 7:. 208-%3 @. !"# artikel
beba+ A@ !*b"ed A
9. rabe =<. !o+terior mani,e+ta+i +e1men /I-&I$S S*r Ophthalmol 2009; 97:... %3%-
5 @ !*b"ed A
5. ab+ $&. "ani,e+ta+i ok*lar in,ek+i /I =ran+ &m Ophthalmol So %775; 73:... 623-83@ !"#
artikel beba+ A @ !*b"ed A
6. #ona' "$ =on1 ! O <J. Okl*+i arteri retina aban1 (rao) dikombina+ikan den1anokl*+i ena retina aban1 (<O) dan optik di+ neoa+k*lari+a+i terkait den1an /I dan #"
retiniti+ Int Ophthalmol %776; %7:... 297-52 @ !*b"ed A
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. Criedman S" "ar1o #K. ilateral okl*+i ena retina +entral pada pa+ien den1an aF*ired
imm*node,iien' +'ndrome: korela+i patolo1i+ #linio- &rh Ophthalmol %775; %%3:... %%89-
8 @ !*b"ed A
8. =aman "arH J opeD !C <ao &. "en*lar aban1 okl*+i ena retina pada pa+ien /I- po+iti,<etina %77; %:... %62-9 @ !*b"ed A
7. "an+o*r &" i /. !eriphlebiti+ bek* retina di imm*node,iien' +'ndrome
diperolehOphthalmolo1ia %773; 20:... %82-6 @ !*b"ed A
%0. /olbrook J= ab+ $& einber1 $ ei+ <& $ai+ "$ Criedber1 $ et al. ehilan1an
pen1lihatan pada pa+ien den1an retiniti+ +itome1aloir*+ dan aF*ired imm*node,iien'
+'ndrome +ebel*m keter+ediaan l*a+ terapi antiretiroiral +an1at akti, &rh
Ophthalmol 2003; %2%:.. 77-%0 @. !*b"ed A
%%. i+a+ J "adhaan / ?eor1e &K *mara+am' le+i Solomon S. ok*ler terkait den1an
in,ek+i /I di India: Seran1kaian %00 pa+ien bert*r*t-t*r*t dieal*a+i pada p*+at r**kan &m J
Ophthalmol 2000;%27:.. 7-%5. @ !*b"ed A
%2. i+a+ J Co1la < ?opal ara'ana " anker &S *mar+am' et al. !endekatan
+aat ini *nt*k dia1no+i+ dan pen1elolaan le+i mata pada pa+ien po+iti, ir*+ h*man
imm*node,iien' India J Ophthalmol2002; 50:... 83-76 @ !*b"ed A
%3. *ppermann $ !ett' J? <ihman $$ "athe+ # C*llerton S# <ikman S et
al. orela+i antara *mlah #$9 dan prealen+i +itome1aloir*+ retiniti+ dan h*man
imm*node,iien' ir*+-terkait men*lar a+*lopath' retina pada pa+ien den1an aF*ired
imm*node,iien' +'ndrome &m J Ophthalmol%773; %%5:... 55-82 @ !*b"ed A
%9. alda++ano C $*nn J! Ceinber1 J ab+ $&. #'tome1aloir*+ retiniti+ dan #$9 rendah B
=-lim,o+it *mlah Kn1l J "ed %775; 333:... 60 @ !*b"ed A
%03%-9 @: 23; %5. #a++o*H oda1hi a*tier-Cra* " Cardea* # lehoan1 Stat*+ !. Saat
abla+i retina pada pa+ien &I$S J Cr Ophtalmol 2000... !*b"ed A
%6. Creeman < M*ieno JI #rapotta J& i+tha*+ & $ "*n1*ia &1*ilar "C. edah
perbaikan abla+i retina rhe1mato1eno*+ pada pa+ien im*no+*pre+i den1an 'tome1aloir*+
retiniti+ Ophthalmolo1' %772;77:.. 966-9 @. !*b"ed A
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%. ?*eH-OS# N <ohat # /erbort #!. erotiDin1 retinopathie+ herpe+: Seb*ah +pektr*m
pen'akit ir*+ 'an1 di+ebabkan herpe+ ditent*kan oleh keadaan kekebalan ho+t O*l Imm*nol
In,lamm %77; 5:... 257-65@ !*b"ed A
%8. Ormerod $ arkin J& "ar1o #& !aa !< "eno+k' " /ai1ht $O et al. !ro1re+i, epat herpe+ nekro+i+ retina: arakteri+tik pen'akit men'ila*kan ma* &I$S #lin "en1in,ek+i
$i+ %778; 26:.. 39-9@. !*b"ed A
%7. /olland ? Kn1+trom <K Jr ?la+1o J er1er $aniel+ S& Sidikaro N et
al.=ok+opla+mo+i+ ok*lar pada pa+ien den1an imm*node,iien' +'ndrome diperoleh &m J
Ophthalmol %788;%06:.. 653-6 @. !*b"ed A
20. Creeman < ?ro++ J? abelle J Oteken atD ile' #&. Pneumocystis
carinii horoidopath': Seb*ah entita+ klini+ bar* &rh Ophthalmol %787; %0:.. 863-
@. !*b"ed A
2%. Shami "J Creeman Criedber1 $ K Sideride+ i+tha*+ & &i K. Seb*ah +t*di m*ltienter
dari pne*monia horoidopath' &m J Ophthalmol %77%; %%2:.. %5-22 @. !*b"ed A
22. "*ioli # el,ort < < ee+ <ao . imbal dan in,ek+i #r'ptoo*+ horoidal di
imm*node,iien' +'ndrome diperoleh &m J Ophthalmol %775; %20:... 537-90 @ !*b"ed A
. 23. ab* < S*dhar+han S *mara+am' =here+e i+a+ J. ok*ler t*berk*lo+i+ di
aF*ired imm*node,iien' +'ndrome &m J Ophthalmol 2006; %92:.. 9%3-8 @ !*b"ed A
29. <athinam S< alitha !. paradok+ memb*r*kn'a t*berk*lo+i+ mata pada pa+ien /I +etelah
&<= K'e200; 2%:.. 66-8 @. !*b"ed A
25. <iero "K *ppermann $ ile' #& ?aria #< Smith "$ $reilin1er & et
al. im,oma aF*ired imm*node,iien' +'ndrome-terkait +el -intraok*lar &rh
Ophthalmol %777; %%:.. 6%6-22@. !*b"ed A
26. "an+o*r &". =em*an e*ro-mata di aF*ired imm*node,iien' +'ndrome J #lin
e*roophthalmol%770; %0:... %6-9 @ !*b"ed A
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2. "ei+h " !*lido JS elanda S #*lbert+on inard . "ani,e+ta+i ok*lar +i,ili+
di h*man imm*node,iien' ir*+ tipe ho+t %-terin,ek+i Ophthalmolo1' %770; 7:... %76-
203 @ !*b"ed A
28. <eed J Shab I< ?ordon J "or+e S. <e1re+i +itome1aloir*+ retiniti+ terkait den1an pen1obatan protea+e inhibitor pada pa+ien den1an &I$S &m J Ophthalmol %77; %29:... %77-
205 @ !*b"ed A
27. anker &S !atel &. !en1ar*h kombina+i terapi antiretroiral pada 'tome1aloir*+
retiniti+ India J Opthalmol 2002; 50:... 27-33 @ !*b"ed A
30. rabe =< alda++ano C hit*p S". !en1hentian terapi pemeliharaan pada pa+ien
den1an diam 'tome1aloir*+ retiniti+ dan penin1katan *mlah
#$9 Ophthalmolo1' %778; %05:... %257-%269 @ !*b"ed A
3%. =*ral # <ome* J Sirera ? &ndre* $ #oneero " <*iD S et al. =ahan lama pen1amp*nan
+itome1aloir*+ retiniti+ tanpa terapi pemeliharaan pada pa+ien 'an1 terin,ek+i ir*+ h*man
imm*node,iien' J In,et $i+ %778; %:... %080-3 @ !*b"ed A
32. araella+ "! &Den S! "a$onald J# Sh*,elt # oder #N !l*mmer $J et al. itriti+
kekebalan pem*lihan dan *eiti+ di &I$S: prediktor klini+ 1eala +i+a dan ha+il
pen1obatan <etina 200%;2%:.. %-7 @. !*b"ed A
33. araella+ "! a1* " "$onald J# Creeman <. Jan1ka panan1 po+terior dan anterior
+e1men komplika+i *eiti+ pem*lihan kekebalan terkait den1an 'tome1aloir*+ retiniti+ &m J
Ophthalmol 2000;%30:... 5-69 @ !*b"ed A
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Indian J Ophthalmol. 2008 Sep-Ot; 56(5): 3383.
!"#I$: !"#2636%33
Posterior segment manifestations of human immunodeciency virus/
acquired immune deciency syndrome
&la' S anker "S
&*thor in,ormation &rtile note+ #op'ri1ht and ien+e in,ormation
=hi+ artile ha+ been ited b' other artile+ in !"#.
Abstract
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&+ per the nited ation+ aF*ired imm*ne de,iien' +'ndrome (&I$S)4orld /ealth
or1aniDation (/O) aF*ired imm*ne de,iien' +'ndrome (&I$S) epidemi *pdate $eember
2006 there are abo*t 37.5 million (39.%-9.% million) people 1loball' liin1 ith h*man
imm*node,iien' ir*+ (/I).% O*t o, the+e abo*t 5.2-5. million people are ,rom India.2 In
+pite o, the ide+pread *+e o, hi1hl' atie antiretroiral therap' (/&&<=) toda' o*lar
mani,e+tation+ o, &I$S at +ome point a,,et 50 to 5> o, in,eted per+on+ o, hih po+terior
+e1ment inolement i+ the mo+t ommon.3 &l+o the +petr*m o, o*lar mani,e+tation+ o, &I$S
in the deelopin1 orld di,,er+ ,rom that o, deeloped nation+.9 =he p*rpo+e o, thi+ artile i+ to
reie all po+terior +e1ment mani,e+tation+ o, &I$S. =he po+terior +e1ment mani,e+tation+ in
&I$S patient+ an be diided into ,o*r main ate1orie+: a+*lopath' opport*ni+ti in,etion+
*n*+*al mali1nanie+ and ne*ro-ophthalmolo1i abnormalitie+.
?o to:
Vasculopathy
"iroa+*lopath' i+ the mo+t ommon o*lar mani,e+tation o, &I$S +een in abo*t 90> to
60> o, /I-po+itie patient+.5 #liniall' it mani,e+t+ a+ otton-ool +pot+ loated in the
po+terior pole and ma' +im*late +mall pathe+ o, 'tome1aloir*+ (#") retiniti+ @Ci1*re %A.
/oeer *nlike #" retiniti+ otton-ool +pot+ are not a++oiated ith lar1e amo*nt+ o, hemorrha1e+ +*btle iriti+ or mild po+terior itriti+. =he' hae more ro*nded border+ and are
*+*all' oriented alon1 the a+*lar arade+ and repre+ent ,oal area+ o, i+hemia in the nere
,iber la'er. "o+t patient+ ith retinal miroa+*lopath' are a+'mptomati. =reatment i+ not
indiated in mo+t a+e+. =he prealene o, miroa+*lopath' i+ iner+el' proportional to #$9B
o*nt.
Ci1*re %
"iroa+*lopath'
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?o to:
Large vessel disease
ar1e e++el ol*+ion+ inl*din1 entral and branh retinal ein ol*+ion+ and branh retinalarter' ol*+ion+ are *nommon and *+*all' o*r in a++oiation ith iral retiniti+ in,iltratie
l'mphomato*+ opti ne*ropath' and a+ i+olated abnormalitie+.6-8 Cro+ted branh a+*liti+ ha+
been a++oiated ith #" retiniti+ in &I$S.7
?o to:
Posterior segment opportunistic infections
O*lar po+terior +e1ment opport*ni+ti in,etion+ are mani,e+tation+ o, di++eminated di+ea+e in
&I$S patient+ and are reo1niDed either a+ nerotiDin1 retiniti+ or a+ *ni,oal or m*lti,oal
horoiditi+. <etiniti+ i+ more ommon than horoiditi+. <etiniti+ in F*iet e'e+ o*r+ in patient+
ith loer #$9B o*nt+ and i+ more ommonl' d*e to #" and pro1re++ie o*ter retinal
nero+i+ (!O<) hile retiniti+ in in,lamed e'e+ *+*all' o*r in patient+ ith hi1her #$9B
o*nt+ and i+ more ommonl' d*e to a*te retinal nero+i+ (&<) toHopla+mo+i+ +'phili+ or
late +ta1e+ o, r'ptoo*+.
Cytomegalovirus retinitis
#'tome1aloir*+ retiniti+ i+ the mo+t ommon &I$S-related o*lar opport*ni+ti in,etion and
an deelop in *p to 90 to 50> o, &I$S patient+ prior to /&&<=.5 <ho*1h it+ inidene ha+
delined markedl' +ine the adent o, /&&<= in the e+tern orld it +till remain+ the leadin1
a*+e o, o*lar morbidit' in the deelopin1 o*ntrie+.%0 In India #" retiniti+ +till remain+ the
ommone+t o*lar mani,e+tation in &I$S a+e+.%%%2 In o*r +erie+ o, %286 a+e+ the inidene o,
#" retiniti+ remain+ hi1h een in the era o, /&&<= @=able %A. It ma' be *nilateral to +tart
ith b*t *p to 52> ill eent*all' deelop bilateral di+ea+e. #'tome1aloir*+ retiniti+ o*r+
almo+t eHl*+iel' in patient+ ho+e #$9B o*nt+ are E50 ell+4Pl. %3/oeer it+ dia1no+i+
annot be eHl*ded ba+ed on #$9B o*nt alone in patient+ takin1 /&&<=. In eHeptionall' rare
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in+tane+ #" retiniti+ ma' deelop in patient+ ith eleated #$9B o*nt+ +hortl' a,ter the
initiation o, /&&<=.
=able %
O*lar mani,e+tation+ in %286 aF*ired imm*node,iien' +'ndrome a+e+
Clinical findings: =here are three linial ,orm+ o, #" retiniti+. =he la++ial ,orm (piDDa pie
retinopath' or otta1e hee+e ith keth*p) i+ harateriDed b' on,l*ent retinal nero+i+ ith
hemorrha1e that deelop+ mo+tl' in the po+terior retina @Ci1*re 2&A. =he adanin1 ed1e o,
the+e le+ion+ i+ *+*all' er' +harp and +pread+ onti1*o*+l'. ='piall' oer +eeral eek+
*ntreated le+ion+ pro1re++ to ,*ll-thikne++ nero+i+ ith re+*ltant retinal 1lio+i+ and pi1ment
epithelial atroph'. !atient+ o,ten hae lo++ o, i+*al ,ield or i+*al a*it' and +otoma. In
ontra+t the indolent ,orm i+ reo1niDed a+ a 1ran*lar le+ion in the peripheral retina o,ten ith
little or no hemorrha1e @Ci1*re 2A. !atient+ ma' notie ,loater+ or the' ma' be a+'mptomati.
& third *nommon pre+entation i+ ,ro+ted branh an1iiti+ @Ci1*re 2#A. ea*+e approHimatel'
%5> o, patient+ ith atie #" retiniti+ are a+'mptomati ro*tine +reenin1 ith dilated
indiret ophthalmo+op' ha+ been reommended at three-month interal+ in patient+ ith #$9B
o*nt+ le++ than 50 ell+4Pl.%9 #'tome1aloir*+ retiniti+ ma' re+*lt in either +ero*+ or
rhe1mato1eno*+ retinal detahment altho*1h the latter i+ m*h more ommon. <he1mato1eno*+
retinal detahment ha+ been reported in %3 to 27> o, patient+ ith #" retiniti+ and ma' o*r
d*rin1 the atie or healed pha+e o, the di+ea+e. /oeer +ine the adent o, /&&<= inideneo, retinal detahment ha+ derea+ed b' approHimatel' 60 to > in the e+tern orld. %5 In
ontra+t in o*r +erie+ the inidene o, #"-related retinal detahment a+ ,o*nd to hae
inrea+ed @=able %A. =hi+ ma' be d*e to hi1her n*mber o, patient+ takin1 inappropriate /&&<=
or people takin1 /&&<= hae lar1er area+ o, healed #" retiniti+ hih eent*all' deelop
neroti hole+ leadin1 to detahment. ario*+ approahe+ inl*din1 par+ plana itretom' (!!)
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ith 1a+ or +ilione oil tamponade (pre,erabl' hi1h i+o+it' 5000#S) +leral b*klin1 and la+er
demaration hae been e,,etie in the repair o, retinal detahment+ related to #" retiniti+.%6
Ci1*re 2&
(&) #la++i #" retiniti+: piDDa-pie appearane
Ci1*re 2
() ?ran*lar ariet' o, #" retiniti+
Ci1*re 2#
(#) Cro+ted-branh an1iiti+ ariet' o, #" retiniti+
Treatment : =reatment o, #" retiniti+ i+ indiid*aliDed and depend+ *pon the loation o, the
atie retiniti+ and the imm*ne +tat*+ o, the patient. #*rrentl' aailable anti-#" a1ent+ inl*de
1aniloir and it+ prodr*1 al1aniloir ,o+arnet ido,oir ,omiir+en 1aniloir implant
and oral al1aniloir. & brie, +*mmar' o, the+e dr*1+ i+ proided in =able 2.
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=able 2
"ediation+ ,or 'tome1aloir*+ retiniti+
Necrotizing herpetic retinopathy
erotiDin1 herpeti retinopath' (/<) i+ a ontin*o*+ +petr*m o, po+terior +e1ment
in,lammation ind*ed b' herpe+ ir*+e+ mo+t ommonl' ariella Do+ter ir*+ (G). It+ to
mo+t reo1niDable linial pattern+ are &< @Ci1*re 3A and !O< @Ci1*re 9A. +*all' the
,ormer o*r+ in health' per+on+ and &I$S patient+ ith onl' mild imm*ne d'+,*ntion and
eleated #$9B o*nt+ herea+ the latter *+*all' deelop+ in tho+e ho are +eerel'
imm*no+*ppre++ed.% In addition to ariella Do+ter ir*+ herpe+ +impleH ir*+ and #" hae
been i+olated in patient+ ith &< and herpe+ +impleH in e'e+ ith !O<.%8 =he di,,erential
,eat*re+ beteen &< !O< and #" retiniti+ are 1ien in =able 3.
Ci1*re 3
&*te retinal nero+i+
Ci1*re 9
!ro1re++ie o*ter retinal nero+i+
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=able 3
$i,,erentiatin1 ,eat*re+ o, three t'pe+ o, iral retiniti+ in aF*ired imm*node,iien' +'ndrome
&11re++ie medial treatment ith appropriate +'+temi antiiral+ ma' improe lon1-term i+*al
o*tome in patient+ ith /<. =reatment o, &< inl*de+ intraeno*+ a'loir (%500 m14+F
meter4da' in three diided do+e+) ,or +een to %0 da'+ ,olloed b' oral a'loir (800 m1 ,ie
time+ dail') ,or +iH eek+.%2Colloin1 re+ol*tion o, retiniti+ proph'lati la+er barra1e i+
on+idered bene,iial to preent retinal detahment. /oeer i+*al lo++ d*e to pro1re++ie
in,etion opti nere +heath e,,*+ion or in mo+t a+e+ retinal detahment o*r+ in *p to 0 to
85> o, patient+. <etinal detahment reF*ire+ itretom' intraitreal +ilione oil tamponade and
endola+er photooa1*lation.
o!oplasmosis
In the maorit' o, &I$S a+e+ toHopla+mo+i+ i+ a primar' in,etion rather than a reatiation.
O*lar toHopla+mo+i+ in &I$S in ontra+t to toHopla+mo+i+ in imm*noompetent indiid*al+ i+
o,ten bilateral m*lti,oal and not a++oiated ith horioretinal +ar+. It ma' a*+e a ariet' o,
o*lar abnormalitie+ inl*din1 iriti+ itriti+ horoiditi+ m*lti,oal or di,,*+e nerotiDin1 retiniti+
@Ci1*re 5A papilliti+ or retrob*lbar ne*riti+ or o*ter retinal toHopla+mo+i+. %7 =oHopla+ma retiniti+
ma' re+emble #" retiniti+; hoeer intrao*lar in,lammation i+ *+*all' more +eere and
hemorrha1e+ are ,eer. =reatment ith +tandard antipara+iti dr*1+ (p'rimethamine
lindam'in +*l,onamide+) i+ +*e++,*l in ontrollin1 o*lar toHopla+mo+i+ in mo+t a+e+.
Ci1*re 5
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=oHopla+mi retinohoroiditi+
Choroiditis
Pneumocystis
O*lar mani,e+tation+ o, P. carinii inl*de on*ntiiti+ orbital ma++ opti ne*ropath' and
horoiditi+.20 It i+ +een a+ la++iall' bilateral and m*lti,oal 'elloi+h ell-demarated
horoidal le+ion+ loated in the po+terior pole not a++oiated ith itriti+ iriti+ or a+*liti+
@Ci1*re 6A.2% O*lar le+ion+ re+pond in mo+t a+e+ to ind*tion and +*b+eF*ent maintenane
treatment ith +'+temi pentamidine trimethoprim and +*l,amethoHaDole or dap+one.
Ci1*re 6
!ne*mo'+ti horoiditi+
Cryptococcus
#r'ptoo*+ menin1iti+ i+ the mo+t ommon a*+e o, &I$S- related ne*ro-ophthalmol1i
le+ion+. #r'ptooal horoiditi+ ma' be m*lti,oal +olitar' or on,l*ent and ma' be a++oiated
ith e'elid nod*le on*ntial ma++ 1ran*lomato*+ iriti+ iri+ ma++ itriti+ nerotiDin1
retiniti+ endophthalmiti+ and opti ne*riti+ @Ci1*re A.22 Cl*onaDole maintenane therap' 200
m14da' i+ *rrentl' reommended in all patient+ een in the era o, /&&<=.
Ci1*re
#r'ptoo*+ inolement o, opti nere and retina
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?o to:
"cular tuberculosis
=ho*1h p*lmonar' t*ber*lo+i+ i+ the ommone+t +'+temi opport*ni+ti in,etion +een in &I$Sa+e+ in India the inidene o, o*lar t*ber*lo+i+ i+ er' lo. In o*r +t*d' o, %286 a+e+ e
,o*nd onl' %> a+e+ ith pre+*med o*lar t*ber*lo+i+. It *+*all' pre+ent+ a+ m*lti,oal
horoidal t*berle+ ith di+rete 'ello le+ion+ mainl' at the po+terior pole @Ci1*re 8A. It ma' be
a++oiated ith an eH*datie retinal detahment ith ariable itreo*+ in,lammation.
Oa+ionall' hoeer it ma' pre+ent a+ a bi1 +olitar' po+terior pole 1ran*loma-like ma++ le+ion
@Ci1*re 7A.23 =reatment ith lon1-term +'+temi anti-t*ber*lo*+ dr*1+ i+ e,,etie in mo+t a+e+.
=he +petr*m o, o*lar t*ber*lo+i+ hoeer i+ han1in1 in toda'Q+ era o, /&&<=. <eentl'
there ha+ been a report o, or+enin1 o, o*lar t*ber*lo+i+ in /I patient+ a,ter antiretroiral
therap'.29
Ci1*re 8
"*ltiple horoidal t*berle+ d*e to o*lar t*ber*lo+i+
Ci1*re 7
Solitar' ma++ le+ion d*e to o*lar t*ber*lo+i+
?o to:
#nusual malignancies
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<eported po+terior +e1ment mani,e+tation+ o, non-/od1kinQ+ l'mphoma (/) inl*de
nerotiDin1 retiniti+ m*lti,oal horoiditi+ retinal a+*liti+ itriti+ +*bretinal ma++ and
p+e*do-h'pop'on *eiti+.25 =reatment option+ inl*de radiation and hemotherap'.
?o to:
Neuro$ophthalmologic abnormalities
e*ro-ophthalmolo1i abnormalitie+ *+*all' are an indiation o, in,etion or l'mphoma o, the
brain or menin1e+ and o*r in onl' 6> o, &I$S patient+. #linial abnormalitie+ o, the opti
nere in a patient ith &I$S ma' be reo1niDed a+ perine*riti+ papilledema papilliti+
retrob*lbar ne*riti+ and opti atroph'.26
?o to:
%yphilis
O*lar +'phili+ in &I$S ma' pre+ent a+ iriti+ itriti+ retrob*lbar opti ne*riti+ perine*riti+
papilliti+ ne*roretiniti+ retinal a+*liti+ a nerotiDin1 retiniti+ hih ma' be liniall'
indi+tin1*i+hable ,rom #" and eH*datie retinal detahment. 2 S'phili+ in &I$S ma' deelop
hen #$9B o*nt+ are 1reater than 200 ell+4Pl and on+eF*entl' +'phili+ inl*din1 o*lar +'phili+ ma' be the pre+entin1 illne++ leadin1 to the dia1no+i+ o, &I$S. It ha+ been
reommended that %2 to 29 million *nit+ o, intraeno*+ aF*eo*+ peniillin be admini+tered ,or
%0 da'+ in &I$S patient+ ith o*lar +'phili+.
?o to:
"cular manifestations of &'V in the era of &AA(
=he adent o, potent antiretroiral therap' ha+ had a pro,o*nd impat on the ophthalmolo1ial
mani,e+tation+ o, &I$S patient+. &+ the+e dr*1+ lead to improed imm*ne ,*ntion patient+
hae ,eer opport*ni+ti in,etion+. =here hae been report+ o, dramati derea+e+ in the
,reF*en' o, #" retiniti+ in area+ here three- and ,o*r-dr*1 antiretroiral ombination
therapie+ are ro*tinel' bein1 *+ed. In addition to derea+ed inidene there are improed
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o*tome+ in patient+ ith #" retiniti+ ho reeied ne atie antiretroiral therap' in
addition to anti-#" therap'.28 In man' patient+ ith healed #" retiniti+ ho hae re+ponded
to /&&<= anti-#" therap' ha+ been di+ontin*ed itho*t reatiation o, the retiniti+. In o*r
+t*d' here ombination antiretroiral treatment a+ 1ien to %2 patient+ ith atie #"
retiniti+ all anti-#" ell o*nt+ ere %004mm3 ,or three month+.27 =he median #$9 ell
o*nt inrea+ed ,rom 36.54mm3 (ran1e 3 to 94mm3) at ba+eline to %5.54mm3 (ran1e 7 to
9%04mm3) at three month+. o patient had reatiation o, #" retiniti+ or deelopment o,
eHtrao*lar #" d*rin1 median ,ollo-*p o, %6. month+. <ho*1h at pre+ent there are no
+tandardiDed riteria ,or determinin1 hether imm*nolo1i improement i+ +*,,iient to allo
ithdraal o, therap' a #$9B ell o*nt o, at lea+t %00 ell+4m ,or at lea+t three to +iH
month+ or a ri+e o, at lea+t 50 ell+4m ha+ been reommended. 303% <eatiation o, #"
retiniti+ ha+ been reported in patient+ ho di+ontin*e or beome intolerant to /&&<=. hen
maintenane therap' i+ di+ontin*ed lo+e ob+eration i+ reF*ired.
'mmune recovery uveitis
Imm*ne reoer' *eiti+ (I<) i+ a nonin,etio*+ intrao*lar in,lammation hih deelop+ in
patient+ ith inatie #" retiniti+ ho hae had a +*b+tantial eleation in #$9B o*nt ith
/&&<=. Imm*ne reoer' *eiti+ i+ the leadin1 a*+e o, ne i+*al lo++ in per+on+ ith &I$S
+een in abo*t %6 to 63> o, /&&<= re+ponder+. =he +eerit' o, the in,lammation depend+ on the
de1ree o, imm*ne reon+tit*tion eHtent o, #" retiniti+ amo*nt o, intrao*lar #" anti1en
and preio*+ treatment. #linial ,indin1+ inl*de anterior hamber or itreo*+ reation @Ci1*re
%0A pan*eiti+ ith h'popon opti di+k and '+toid ma*lar edema epiretinal membrane
,ormation atarat itreoma*lar tration +'ndrome and proli,eratie
itreoretinopath'.3233 =reatment ith ortio+teroid+ (+*btenon or +'+temi or intraitreal) i+
e,,etie in ontrollin1 in,lammation and improin1 i+ion in +ome a+e+. /oeer +*r1er' ma'
be reF*ired in patient+ ith itreoma*lar tration +'ndrome epiretinal membrane ,ormation
atarat and proli,eratie itreoretinopath'.
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Ci1*re %0
Seere itriti+ d*e to imm*ne reoer' *eiti+
?o to:
%ummary
#" retiniti+ i+ m*h le++ ommon in the era o, /&&<= b*t remain+ one o, the ommone+t
o*lar ompliation+ o, &I$S in India. /i1hl' atie anti-retroiral therap' ha+ been +hon to
a*+e re1re++ion o, opport*ni+ti in,etion+ inl*din1 #" retiniti+ inrea+e time to relap+e o,
#" retiniti+ red*e the inidene o, #"-related retinal detahment+ and prolon1 patient
+*rial. !atient+ ith inatie #" retiniti+ ho hae re+ponded to /&&<= ith a #$9B ell
o*nt %00 ell+4 m ,or more than three to +iH month+ ma' be andidate+ ,or di+ontin*ation
o, #" maintenane therap'. #lo+e ,ollo-*p ,or an' +i1n+ o, reatiation i+ mandator'.
Imm*ne reoer' *eiti+ ha+ been reported in patient+ ith healed #" retiniti+ ho hae
re+ponded to /&&<=. erotiDin1 herpeti retinopath' and o*lar t*ber*lo+i+ are other
ommon po+terior +e1ment di+order+ +een in &I$S a+e+.
?o to:
)ootnotes
So*re o, S*pport: il
#on,lit o, Intere+t: one delared
?o to:
(eferences
%. &I$S &I$S epidemi *pdate: Speial report on /I4&I$S: $eember 2006. @la+t
ae++ed on 200 Ot 3%A. &ailable
,rom: http:44data.*naid+.or14p*b4Kpi<eport4200642006LKpipdate en.pd, .
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2. ational &I$S #ontrol Or1aniDation "ini+tr' o, /ealth and ,amil' a,,air+ ?oernment o,
India. /I4&I$S epidemiolo1ial S*reillane and K+timation report ,or the 'ear 2005. 2006.
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3. e+tel'n !? #*nnin1ham Jr K=. /I4&I$S and blindne++. 200%;7:208%3. @!"# ,ree
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%0. /olbrook J= Jab+ $& einber1 $ ei+ <& $ai+ "$ Criedber1 $ et al. i+*al lo++ in
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#orrelation beteen #$9B o*nt+ and prealene o, 'tome1aloir*+ retiniti+ and h*man
imm*node,iien' ir*+-related nonin,etio*+ retinal a+*lopath' in patient+ ith aF*ired
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%6. Creeman < M*ieno JI #rapotta J& i+tha*+ & "*n1*ia $ &1*ilar "C. S*r1ial repair
o, rhe1mato1eno*+ retinal detahment in imm*no+*ppre++ed patient+ ith 'tome1aloir*+
retiniti+.Ophthalmolo1'. %772;77:9669. @!*b"edA
%. ?*eH-#ro+ier N <ohat # /erbort #!. erotiDin1 herpeti retinopathie+: & +petr*m o,
herpe+ ir*+-ind*ed di+ea+e+ determined b' the imm*ne +tate o, the ho+t. O*l Imm*nol
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%8. Ormerod $ arkin J& "ar1o #& !aa !< "eno+k' " /ai1ht $O et al. <apidl'
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22. "*ioli # el,ort < ee+ < <ao . imbal and horoidal #r'ptoo*+ in,etion in the
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25. <iero "K *ppermann $ ile' #& ?aria #< Smith "$ $reilin1er & et al.
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o*nt+. Ophthalmolo1'. %778;%05:%25769.@!*b"edA
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32. araella+ "! &Den S! "a$onald J# Sh*,elt # oder #N !l*mmer $J et al.
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o*tome+. <etina. 200%;2%:%7.@!*b"edA
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+e1ment ompliation+ o, imm*ne reoer' *eiti+ a++oiated ith 'tome1aloir*+
retiniti+. &m J Ophthalmol.2000;%30:569. @!*b"edA