Long-term Visual Morbidity of Cytomegalovirus Retinitis in Patients with Acquired Immune Deficiency Syndrome

Background: Patient survival with the acquired immune deficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis is increasing because of earlier diagnosis and improved medical therapy. Visual morbidity that occurs with prolonged survival has not been well described. Methods: To evaluate the progression of retinitis, ocular complications, and visual morbidity, the authors retrospectively reviewed the records of 22 patients who had tested positive for human immunodeficiency virus since December 31, 1987. Each patient had an ophthalmologic diagnosis of CMV retinitis and had survived for a minimum of 6 months after diagnosis of retinitis. Patients were treated with intravenous ganciclovir alone, ganciclovir followed by foscarnet, or foscarnet alone (1 patient). Results: Mean survival was 16.7 months after the diagnosis of retinitis. The retinitis progressed in 74% of eyes during therapy. Visual acuity of 20/70 or worse occurred in 79% of eyes at a mean of 7.6 months from diagnosis of CMV retinitis. No light perception occurred in 49% of eyes after a mean of 15 months patient survival. Eleven patients with visual acuity of 20/70 or worse in both eyes survived a mean of 11 months. In 39 eyes with CMV retinitis, the following complications occurred: retinal detachment (33%), papillitis (32%), branch retinal artery occlusion (10%), persistent iritis (5%), and cataract (2.5%). Conclusion: Improved modalities of therapy will continue to increase the survival of patients with AIDS and CMV retinitis. Progression of the retinitis occurs with current therapeutic regimens in the majority of patients. As survival increases, significant visual loss and ocular complications may compromise patient care and quality of life.