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List the ophthalmic manifestations of the acquired immunodeficiency syndrome (AIDS)
Published in Nathaniel Knox Cartwright, Petros Carvounis, Short Answer Questions for the MRCOphth Part 1, 2018
Nathaniel Knox Cartwright, Petros Carvounis
Viral: – cytomegalovirus retinitis: unifocal or mulitfocal ‘pizza pie’ retinopathynecrotising retinitisretinal vasculitisrhegmatogenous retinal detachment following atrophic hole formation.
Cidofovir and Brincidofovir
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Graciela Andrei, Robert Snoeck
Cytomegalovirus retinitis is unusual in HIV-1 infected individuals unless the CD4 lymphocyte counts fall below 50 cells/ml. Because of the introduction of combination antiretroviral chemotherapy for HIV-1 infection, HCMV retinitis has become a rare condition in developed countries. However, detection of HCMV in blood in HIV-1-infected patients has been associated with a poor prognosis, even in the era of patients receiving effective antiretroviral therapy (Deayton et al., 2004).
Chorioretinal biopsy
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Freeman et al48 performed endoretinal biopsies on 13 eyes with infectious or inflammatory retinitis associated with retinal detachment: After pars plana vitrectomy, diathermy was applied contiguously along the posterior border of the intended biopsy site.A retinotomy site was created with the blade of the vertical scissors.If necessary, gentle irrigation of fluid through the retinotomy site was performed to ensure adequate separation between the retina and choroid to prevent inadvertent damage to the choroid.The specimen was excised with vertical scissors by initially making a 3–6 mm long cut along the posterior border.The incision was extended anteriorly for 2–4 mm. A rectangular piece was excised, leaving a small area attached to the remainder of the retina to prevent it from slipping into the subretinal space.The specimen was grasped with intraocular forceps and pulled toward the sclerotomy site to break its attachment to the retina.After the forceps were withdrawn, the intraocular pressure was elevated to float the tissue specimen into the sclerotomy, where it was gently grasped with fine-tissue forceps and withdrawn.Air–fluid exchange was performed using the biopsy site for internal drainage. Silicone oil was injected in nine eyes, sulfur hexafluoride in two eyes, and perfluoro-propane in two eyes.Macular reattachment was obtained in all eyes.Three eyes demonstrated acute retinal necrosis, nine had cytomegalovirus retinitis, and one had immune complex retinal vasculitis.Two eyes developed retinal detachment resulting from proliferative vitreoretinopathy; one retina was successfully reattached using silicone oil.
Application of iontophoresis in ophthalmic practice: an innovative strategy to deliver drugs into the eye
Published in Drug Delivery, 2023
Dong Wei, Ning Pu, Si-Yu Li, Yan-Ge Wang, Ye Tao
Cytomegalovirus retinitis (CMVR) is a disease of immunocompromised host, often associated with severe vision loss due to retinal atrophy, retinal detachment and/or optic nerve atrophy (Port et al., 2017; Suzuki et al., 2021). A patient with CMVR received intravitreal injection of foscarnet and oral valganciclovir for 2 months, and his CMVR retinitis was significantly improved (Chaudhry & Fung, 2021). Perhaps combining the therapeutic drugs of CMVR with iontophoresis is a promising strategy. In order to study the feasibility of delivering ganciclovir into the vitreous/retina with transscleral iontophoresis, Tim et al. measured the levels of ganciclovir in the vitreous/retina several times after a single application of transscleral iontophoresis in rabbits. They found there was still detectable level of ganciclovir in the vitreous/retina even 72 hours later. Therefore, ganciclovir can be successfully delivered into the vitreous for treatment of CMVR (Lam et al., 1994). Another study has also proved the effectiveness of iontophoresis in the treatment of CMVR. Marc et al. found that ocular iontophoresis can increase the concentration of foscarnet in vitreous obtained by intravenous injection (Yoshizumi et al., 1996). They propose that ocular iontophoresis may be an important and noninvasive local treatment technology for these patients who need intermittent ocular drug supplement and cannot tolerate higher dose of systemic antiviral drugs (Yoshizumi et al., 1996). Therefore, iontophoresis may be a good assistance scheme for local management of CMVR.
Potential therapeutic targets for Mpox: the evidence to date
Published in Expert Opinion on Therapeutic Targets, 2023
Siddappa N Byrareddy, Kalicharan Sharma, Shrikesh Sachdev, Athreya S. Reddy, Arpan Acharya, Kaylee M. Klaustermeier, Christian L Lorson, Kamal Singh
The FDA has not approved CDV for treating MPXV infections. Instead, it has been approved for cytomegalovirus retinitis in HIV-infected patients. However, CDV has shown antiviral activity against molluscum contagiosum in an HIV-infected patient [105]. BCV has been approved for smallpox treatment as an oral drug. The efficacy studies of these drugs against currently circulating MPXV viruses are limited. In a recent report, the efficacy of CDV, BCV and Tecovirimat was evaluated using 12 patient isolates in relevant cell models (human foreskin fibroblasts and human foreskin keratinocytes) [106]. The IC50 of Tecovirimat, cidofovir, and Brincidofovir was 4000 nmol, 80 μmol, and 600 nmol, respectively [106], and were reportedly within the range of therapeutic concentrations in plasma [106]. In another study, the plaque formation assay was used to evaluate the potency of Tecovirimat, and CDV using a patient isolate (MPXV/France/IRBA2211i/2022) [96]. The results showed that the IC50 of Tecovirimat was 12.7 nM, whereas the IC50 of the CDV was 30.4 µM, suggesting that Tecovirimat was ~ 2400-fold more potent than CDV. This difference in Mpox inhibition [92] does not corroborate with the results of Bojkova et al. [106], where CDV is only 80-fold less potent than Tecovirimat.
Ocular Manifestations in Patients of HIV(Human Immunodeficiency Virus) Infection on Combined Anti-Retroviral Therapy (CART)
Published in Ocular Immunology and Inflammation, 2022
Ritu Arora, Neha Sandhu, Pallavi Dokania, Anuradha Subramanian
The most common ocular manifestation was dry eye, observed in 56 eyes (prevalence 8.00%, SE 5%, CI 95%). The severity of dry eye was of moderate intensity with symptoms of discomfort, foreign body sensation and reversible signs in the form of punctate epitheliopathy and reduced TFBUT. The patients of dry eye were treated with tear substitutes without preservatives or/and lubricants in the form of ointment. The second most common ocular manifestation was CMV (Cytomegalovirus) retinitis in nine eyes (prevalence 1.43%, SE 5%, CI 95%). Six eyes of three patients had recurrent uveitis associated with complicated cataract. Dense cataract with 360° ring synechiae in 4 eyes precluded fundus view and in the remaining 2 eyes, no vitritis or cystoid macular edema was seen. After a complete and thorough investigative workup for uveitis including PPD (Purified Protein Derivative), serum ACE(Angiotensin-converting enzyme) levels, FTA-ABS (Fluorescent Treponemal Antibody Absorption) test, ANA (Anti-Nuclear Antibody), HLA B-27, no infectious or autoimmune cause could be found out. Three eyes of two patients had infective keratitis. One eye of a patient had non-resolving viral keratitis with superadded infection who developed Tubercular meningitis 2 weeks later. One patient with severe dry eye due to Steven-Johnson Syndrome, had bilateral microbial keratitis which responded to antimicrobials. Details of the ocular manifestations with symptoms, visual acuity, and CD4 count are presented in Table 2.