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Surgical treatment of hiv-associated retinal detachment

Session Details

Session Title: Vitreoretinal Surgery III

Session Date/Time: Friday 18/09/2015 | 14:30-16:00

Paper Time: 14:54

Venue: Athena

First Author: : A.Rapoport RUSSIAN FEDERATION

Co Author(s): :    S. Bersenev              

Abstract Details

PURPOSE:HIV-infection leading to AIDS is a life-threatening disease. Up to 20% of patients with AIDS lose vision due to CMV retinitis which develops in up to 70% of HIV-infected. Aim of this paper is to present the authors’ results of surgical treatment of retinal detachment due to CMV retinitis in HIV-infected patients.

Setting:

IRTC Eye Microsurgery Ekaterinburg Center, Ekaterinburg, Russia

Methods:

From September, 2012 to May, 2014 in our center 3 patients (4 eyes) have been operated for HIV-associated retinal detachment – 1 male and 2 females. All the patients had 4B AIDS and were on specific anti-retrovirus therapy. Mean age vas 37 ±1 year. Follow-up period was from six months to 2 years (mean, 19 ±4 months). At admittance all the patients had transparent lens, IOP was normal (16±2 mm Hg). Visual acuity varied from wrong light perception to 0.4. In 2 patient the process was bilateral. Terms from detachment to operation were from 2 weeks to 6 months (mean, 3 ±1 months). In 3 of 4 cases retinal detachment was total. In all the cases there were characteristic sighs: high bullous retinal detachment with ischemic foci and intraretinal hemorrhages, giant retinal tears on ischemic background, rather slow progression of PVR. In all the patients 3-port 25G vitrectomy was performed under regional anesthesia. After separation of the posterior hyaloid the retina was unfolded with PFCL. If necessary wide relaxing retinotomy was performed to achieve complete mobilization of the retina. The operation was finished with endolaser coagulation and PFCL exchange for high viscosity silicone oil with sutures on all the ports.

Results:

The operation did not worsen general status of the patients. Retina was attached during follow-up. In all the cases silicone tamponade resulted in lens opacification in terms of 5 to 12 (mean, 10±2) months. In one case lens opacification was accompanied by swelling with IOP increase up to 41 mm Hg. All the patients underwent phaco with IOL implantation. In case of phacomorphic glaucoma IOP was normal after phaco. In two cases phaco was accompanied by posterior capsulorhexis due to rough fibrosis; in 2 other cases dissection of secondary cataract was performed in 2 and 7 months. All the operations were performed under local anesthesia and were uneventful. Postoperative visual acuity was higher than preoperative in all cases. Optical coherence tomography has disclosed persisting macular edema in all cases. Other specific feature of these patients is significant narrowing of retinal vessels. IOP was normal without hypotensive therapy. Silicone oil removal is not planned due to high risk of redetachment and good tolerability of silicone tamponade.

Conclusions:

Three-port vitrectomy with high viscosity silicone oil tamponade is an effective method of HIV-associated retinal detachment treatment and provides rather high and stable visual acuity in HIV-infected patients.

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