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William R. Freeman - One of the best experts on this subject based on the ideXlab platform.
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Immune Recovery Vitritis Associated With Inactive Cytomegalovirus Retinitis
2017Co-Authors: Marietta P. Karavellas, Careen Y. Lowder, J. Christopher Macdonald, Cesar P. Avila, William R. FreemanAbstract:Objective: To describe a syndrome of posterior segment intraocular inflammation that causes visual loss in patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis. This syndrome was associated with immune recovery mediated by combination antiretroviral treatment including protease inhibitors. Design: A case-control study at 2 university medical centers. Participants: One hundred thirty patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis were examined at 2 medical centers for 15 months. In addition, the medical records of 509 patients examined at 1 center for 11 years before the initiation of protease inhibitor therapy were analyzed retrospectively. Results: Five patients with symptomatic Vitritis and papillitis with cystoid macular edema or epiretinal membrane formation were documented. In each patient there was inactive cytomegalovirus retinitis that had not caused visual decrease before the onset of inflammation. All patients had elevated CD4 + T lymphocyte levels (median increase, 86310 6 /L [86 cells/mm 3 ]) after combination treatment including protease inhibitors. Two patients with cystoid macular edema were treated with corticosteroids and had resolution of the cystoid macular edema and an increase in visual acuity without reactivation of the retinitis. Retrospective analysis failed to disclose similar patients with intraocular inflammation in the era before the introduction of protease inhibitors. Conclusions: This newly described syndrome of posterior segment inflammation related to cytomegalovirus retinitis is a cause of visual morbidity in patients with acquired immunodeficiency syndrome. It is associated with increased immune competence as a result of combined antiretroviral treatment with protease inhibitors and may be amenable to corticosteroid therapy without reactivation of retinitis. Arch Ophthalmol. 1998;116:169-175
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intraocular viral and immune pathogenesis of immune recovery uveitis in patients with healed cytomegalovirus retinitis
Retina-the Journal of Retinal and Vitreous Diseases, 2006Co-Authors: Rachel D Schrier, Marietta P. Karavellas, Mikyoung Song, Irene L Smith, Dirkuwe Bartsch, Francesca J Torriani, Claudio R Garcia, William R. FreemanAbstract:Purpose:To investigate immune and viral contributions to the pathogenesis of immune recovery uveitis (IRU), which presents as Vitritis, macular edema, or formation of epiretinal membranes, and develops in patients with acquired immunodeficiency syndrome (AIDS) who experienced cytomegalovirus (CMV) r
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immune recovery Vitritis and uveitis in aids clinical predictors sequelae and treatment outcomes
Retina-the Journal of Retinal and Vitreous Diseases, 2001Co-Authors: Marietta P. Karavellas, Careen Y. Lowder, Francesca J Torriani, Daniel J Plummer, Chrisandra Shufelt, Stanley P Azen, James E Macdonald, Ben J Glasgow, William R. FreemanAbstract:PurposeTo determine 1) clinical predictors of an inflammatory syndrome associated with cytomegalovirus (CMV) retinitis (immune recovery Vitritis or uveitis [IRV or IRU]); 2) clinical sequelae of IRV; and 3) the effect of corticosteroid treatment on visual acuity.MethodsA cohort study from the AIDS O
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incidence of immune recovery Vitritis in cytomegalovirus retinitis patients following institution of successful highly active antiretroviral therapy
The Journal of Infectious Diseases, 1999Co-Authors: Marietta P. Karavellas, Francesca J Torriani, Daniel J Plummer, Christopher J Macdonald, Chrisandra Shufelt, Stanley P Azen, William R. FreemanAbstract:This study was conducted to determine the likelihood of the development of a new ocular inflammatory syndrome (immune recovery Vitritis, IRV), which causes vision loss in AIDS patients with cytomegalovirus (CMV) retinitis, who respond to highly active antiretroviral therapy (HAART). We followed 30 HAART-responders with CD4 cell counts of >/=60 cells/mm3. Patients were diagnosed with IRV if they developed symptomatic Vitritis of >/=1+ severity associated with inactive CMV retinitis. Symptomatic IRV developed in 19 (63%) of 30 patients and in 26 (59%) of 44 eyes over a median follow-up from HAART response of 13.5 months. The annual incidence of IRV was 83/100 person-years. Excluding patients with previous cidofovir therapy did not significantly alter the time course of IRV (P=.79). These data suggest that IRV develops in a significant number of HAART-responders with CMV retinitis and is unrelated to previous cidofovir therapy.
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Immune Recovery Vitritis Associated With Inactive Cytomegalovirus Retinitis: A New Syndrome
Archives of Ophthalmology, 1998Co-Authors: Marietta P. Karavellas, Careen Y. Lowder, J. Christopher Macdonald, Cesar P. Avila, William R. FreemanAbstract:Objective To describe a syndrome of posterior segment intraocular inflammation that causes visual loss in patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis. This syndrome was associated with immune recovery mediated by combination antiretroviral treatment including protease inhibitors. Design A case-control study at 2 university medical centers. Participants One hundred thirty patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis were examined at 2 medical centers for 15 months. In addition, the medical records of 509 patients examined at 1 center for 11 years before the initiation of protease inhibitor therapy were analyzed retrospectively. Results Five patients with symptomatic Vitritis and papillitis with cystoid macular edema or epiretinal membrane formation were documented. In each patient there was inactive cytomegalovirus retinitis that had not caused visual decrease before the onset of inflammation. All patients had elevated CD4 + T lymphocyte levels (median increase, 86×10 6 /L [86 cells/mm 3 ]) after combination treatment including protease inhibitors. Two patients with cystoid macular edema were treated with corticosteroids and had resolution of the cystoid macular edema and an increase in visual acuity without reactivation of the retinitis. Retrospective analysis failed to disclose similar patients with intraocular inflammation in the era before the introduction of protease inhibitors. Conclusions This newly described syndrome of posterior segment inflammation related to cytomegalovirus retinitis is a cause of visual morbidity in patients with acquired immunodeficiency syndrome. It is associated with increased immune competence as a result of combined antiretroviral treatment with protease inhibitors and may be amenable to corticosteroid therapy without reactivation of retinitis.
Narsing A. Rao - One of the best experts on this subject based on the ideXlab platform.
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clinical features of tuberculous serpiginouslike choroiditis in contrast to classic serpiginous choroiditis
Archives of Ophthalmology, 2010Co-Authors: Daniel Vitor Vasconcelossantos, Kumar P Rao, John B Davies, Elliott H Sohn, Narsing A. RaoAbstract:Objective To compare distinctive clinical features of presumed tuberculous serpiginouslike choroiditis (Tb-SLC) with classic serpiginous choroiditis (SC) in patients living in a region that is nonendemic for tuberculosis. Methods Retrospective comparative analysis of clinical features of 5 patients with recurrent Tb-SLC and 5 with SC. Results All patients with recurrent Tb-SLC primarily emigrated from areas highly endemic for tuberculosis and had been unsuccessfully treated with steroids/immunosuppressive agents. Results of uveitis investigations were negative except for positive tuberculin skin test results. These patients received oral tuberculostatic drugs, without recurrences (follow-up, 6-91 months). The ocular involvement in Tb-SLC was mostly unilateral, with multiple irregular serpiginoid lesions involving the posterior pole and periphery but usually sparing the juxtapapillary area. All 5 cases had inflammatory cells in the vitreous. Patients with SC were from areas nonendemic for tuberculosis, had negative uveitis workup findings (including tuberculin skin test results), and were successfully managed with steroids/immunosuppressive agents (follow-up, 6-72 months) with no recurrence. Ocular involvement in SC was usually bilateral, rarely multifocal, and primarily involved the posterior pole, especially around the optic disc and extending contiguously to the macula. No patient with SC presented with Vitritis. Conclusion In areas nonendemic for tuberculosis, SC can be clinically differentiated from Tb-SLC. Patients with Tb-SLC come from highly endemic regions, show significant Vitritis, and often present with multifocal lesions in the posterior pole and periphery. Cases of SC, in contrast, reveal minimal or no Vitritis and frequently show bilateral involvement with larger solitary lesions extending primarily from the juxtapapillary area and sparing the periphery.
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rifabutin associated hypopyon uveitis in human immunodeficiency virus negative immunocompetent individuals
Ophthalmology, 2001Co-Authors: Neelakshi Bhagat, Narsing A. Rao, Russell W Read, Ronald E Smith, Lawrence P ChongAbstract:Abstract Objective To report the occurrence of rifabutin-associated hypopyon uveitis in human immunodeficiency virus (HIV)–negative immunocompetent individuals. Design Retrospective case series. Participants Three HIV-negative subjects on rifabutin and clarithromycin for Mycobacterium avium complex infections with hypopyon uveitis are described. One subject was iatrogenically immunosuppressed because of a prior lung transplant. Two subjects had no known immunosuppressive conditions. Intervention Topical and regional steroid therapy. Discontinuation of rifabutin was required in two subjects. Main outcome measures Visual acuity, resolution of hypopyon, anterior uveitis, and vitreitis. Results All subjects had resolution of hypopyon after therapy, two within 24 hours of beginning topical steroids. Vitreitis resolved with the discontinuation of rifabutin in two subjects. Chronic low-grade anterior uveitis and vitreitis were observed in the remaining subject, whose rifabutin dose was lowered but not discontinued because of active Mycobacterium avium complex osteomyelitis. Conclusions Rifabutin-associated uveitis is well described in HIV-positive individuals, but it has been reported only once in an HIV-negative individual. We report two cases of hypopyon uveitis in immunocompetent individuals and one case in an immunosuppressed HIV-negative individual. All three subjects were receiving concurrent rifabutin and clarithromycin. Awareness that this entity can occur in HIV negative and nonimmunosuppressed individuals and that it can mimic infectious endophthalmitis may spare the subject from an invasive workup of systemic infection.
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Vitritis as the primary manifestation of ocular syphilis in patients with hiv infection
American Journal of Ophthalmology, 1998Co-Authors: Irene C Kuo, Michael A Kapusta, Narsing A. RaoAbstract:Purpose To describe dense Vitritis as the primary manifestation of ocular syphilis in three human immunodeficiency virus (HIV)-positive patients and to determine the response of these patients to the established regimen for neurosyphilis. Methods Anti-Toxoplasma gondii IgM and IgG antibody titers, tuberculin skin test, chest radiograph, and serum angiotensin-converting enzyme level were obtained because tuberculosis, sarcoidosis, and toxoplasmosis were in the differential diagnosis. Two of the three patients were not known to have HIV infection at the time of initial examination and consented to HIV testing. Treponemal and nontreponemal tests were performed on serum and cerebrospinal fluid to establish a definitive diagnosis. Treatment for neurosyphilis was initiated, and daily ophthalmic examinations were performed, with careful attention to signs commonly associated with syphilitic eye disease. Results All three patients exhibited improvement in visual acuity and resolution of vitreous haze. There was no evidence of other signs of posterior uveitis. The one patient for whom there has been a 6-month follow-up showed no sequelae of his eye disease. Conclusions Human immunodeficiency virus-positive patients with syphilis may present atypically dense Vitritis. In these patients, Vitritis may be the first manifestation of syphilis. The regimen for neurosyphilis provides effective therapy. Moreover, in some patients, syphilitic Vitritis may be the initial manifestation of HIV disease.
Marietta P. Karavellas - One of the best experts on this subject based on the ideXlab platform.
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Immune Recovery Vitritis Associated With Inactive Cytomegalovirus Retinitis
2017Co-Authors: Marietta P. Karavellas, Careen Y. Lowder, J. Christopher Macdonald, Cesar P. Avila, William R. FreemanAbstract:Objective: To describe a syndrome of posterior segment intraocular inflammation that causes visual loss in patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis. This syndrome was associated with immune recovery mediated by combination antiretroviral treatment including protease inhibitors. Design: A case-control study at 2 university medical centers. Participants: One hundred thirty patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis were examined at 2 medical centers for 15 months. In addition, the medical records of 509 patients examined at 1 center for 11 years before the initiation of protease inhibitor therapy were analyzed retrospectively. Results: Five patients with symptomatic Vitritis and papillitis with cystoid macular edema or epiretinal membrane formation were documented. In each patient there was inactive cytomegalovirus retinitis that had not caused visual decrease before the onset of inflammation. All patients had elevated CD4 + T lymphocyte levels (median increase, 86310 6 /L [86 cells/mm 3 ]) after combination treatment including protease inhibitors. Two patients with cystoid macular edema were treated with corticosteroids and had resolution of the cystoid macular edema and an increase in visual acuity without reactivation of the retinitis. Retrospective analysis failed to disclose similar patients with intraocular inflammation in the era before the introduction of protease inhibitors. Conclusions: This newly described syndrome of posterior segment inflammation related to cytomegalovirus retinitis is a cause of visual morbidity in patients with acquired immunodeficiency syndrome. It is associated with increased immune competence as a result of combined antiretroviral treatment with protease inhibitors and may be amenable to corticosteroid therapy without reactivation of retinitis. Arch Ophthalmol. 1998;116:169-175
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intraocular viral and immune pathogenesis of immune recovery uveitis in patients with healed cytomegalovirus retinitis
Retina-the Journal of Retinal and Vitreous Diseases, 2006Co-Authors: Rachel D Schrier, Marietta P. Karavellas, Mikyoung Song, Irene L Smith, Dirkuwe Bartsch, Francesca J Torriani, Claudio R Garcia, William R. FreemanAbstract:Purpose:To investigate immune and viral contributions to the pathogenesis of immune recovery uveitis (IRU), which presents as Vitritis, macular edema, or formation of epiretinal membranes, and develops in patients with acquired immunodeficiency syndrome (AIDS) who experienced cytomegalovirus (CMV) r
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immune recovery Vitritis and uveitis in aids clinical predictors sequelae and treatment outcomes
Retina-the Journal of Retinal and Vitreous Diseases, 2001Co-Authors: Marietta P. Karavellas, Careen Y. Lowder, Francesca J Torriani, Daniel J Plummer, Chrisandra Shufelt, Stanley P Azen, James E Macdonald, Ben J Glasgow, William R. FreemanAbstract:PurposeTo determine 1) clinical predictors of an inflammatory syndrome associated with cytomegalovirus (CMV) retinitis (immune recovery Vitritis or uveitis [IRV or IRU]); 2) clinical sequelae of IRV; and 3) the effect of corticosteroid treatment on visual acuity.MethodsA cohort study from the AIDS O
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incidence of immune recovery Vitritis in cytomegalovirus retinitis patients following institution of successful highly active antiretroviral therapy
The Journal of Infectious Diseases, 1999Co-Authors: Marietta P. Karavellas, Francesca J Torriani, Daniel J Plummer, Christopher J Macdonald, Chrisandra Shufelt, Stanley P Azen, William R. FreemanAbstract:This study was conducted to determine the likelihood of the development of a new ocular inflammatory syndrome (immune recovery Vitritis, IRV), which causes vision loss in AIDS patients with cytomegalovirus (CMV) retinitis, who respond to highly active antiretroviral therapy (HAART). We followed 30 HAART-responders with CD4 cell counts of >/=60 cells/mm3. Patients were diagnosed with IRV if they developed symptomatic Vitritis of >/=1+ severity associated with inactive CMV retinitis. Symptomatic IRV developed in 19 (63%) of 30 patients and in 26 (59%) of 44 eyes over a median follow-up from HAART response of 13.5 months. The annual incidence of IRV was 83/100 person-years. Excluding patients with previous cidofovir therapy did not significantly alter the time course of IRV (P=.79). These data suggest that IRV develops in a significant number of HAART-responders with CMV retinitis and is unrelated to previous cidofovir therapy.
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Immune Recovery Vitritis Associated With Inactive Cytomegalovirus Retinitis: A New Syndrome
Archives of Ophthalmology, 1998Co-Authors: Marietta P. Karavellas, Careen Y. Lowder, J. Christopher Macdonald, Cesar P. Avila, William R. FreemanAbstract:Objective To describe a syndrome of posterior segment intraocular inflammation that causes visual loss in patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis. This syndrome was associated with immune recovery mediated by combination antiretroviral treatment including protease inhibitors. Design A case-control study at 2 university medical centers. Participants One hundred thirty patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis were examined at 2 medical centers for 15 months. In addition, the medical records of 509 patients examined at 1 center for 11 years before the initiation of protease inhibitor therapy were analyzed retrospectively. Results Five patients with symptomatic Vitritis and papillitis with cystoid macular edema or epiretinal membrane formation were documented. In each patient there was inactive cytomegalovirus retinitis that had not caused visual decrease before the onset of inflammation. All patients had elevated CD4 + T lymphocyte levels (median increase, 86×10 6 /L [86 cells/mm 3 ]) after combination treatment including protease inhibitors. Two patients with cystoid macular edema were treated with corticosteroids and had resolution of the cystoid macular edema and an increase in visual acuity without reactivation of the retinitis. Retrospective analysis failed to disclose similar patients with intraocular inflammation in the era before the introduction of protease inhibitors. Conclusions This newly described syndrome of posterior segment inflammation related to cytomegalovirus retinitis is a cause of visual morbidity in patients with acquired immunodeficiency syndrome. It is associated with increased immune competence as a result of combined antiretroviral treatment with protease inhibitors and may be amenable to corticosteroid therapy without reactivation of retinitis.
Francesca J Torriani - One of the best experts on this subject based on the ideXlab platform.
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intraocular viral and immune pathogenesis of immune recovery uveitis in patients with healed cytomegalovirus retinitis
Retina-the Journal of Retinal and Vitreous Diseases, 2006Co-Authors: Rachel D Schrier, Marietta P. Karavellas, Mikyoung Song, Irene L Smith, Dirkuwe Bartsch, Francesca J Torriani, Claudio R Garcia, William R. FreemanAbstract:Purpose:To investigate immune and viral contributions to the pathogenesis of immune recovery uveitis (IRU), which presents as Vitritis, macular edema, or formation of epiretinal membranes, and develops in patients with acquired immunodeficiency syndrome (AIDS) who experienced cytomegalovirus (CMV) r
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immune recovery Vitritis and uveitis in aids clinical predictors sequelae and treatment outcomes
Retina-the Journal of Retinal and Vitreous Diseases, 2001Co-Authors: Marietta P. Karavellas, Careen Y. Lowder, Francesca J Torriani, Daniel J Plummer, Chrisandra Shufelt, Stanley P Azen, James E Macdonald, Ben J Glasgow, William R. FreemanAbstract:PurposeTo determine 1) clinical predictors of an inflammatory syndrome associated with cytomegalovirus (CMV) retinitis (immune recovery Vitritis or uveitis [IRV or IRU]); 2) clinical sequelae of IRV; and 3) the effect of corticosteroid treatment on visual acuity.MethodsA cohort study from the AIDS O
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incidence of immune recovery Vitritis in cytomegalovirus retinitis patients following institution of successful highly active antiretroviral therapy
The Journal of Infectious Diseases, 1999Co-Authors: Marietta P. Karavellas, Francesca J Torriani, Daniel J Plummer, Christopher J Macdonald, Chrisandra Shufelt, Stanley P Azen, William R. FreemanAbstract:This study was conducted to determine the likelihood of the development of a new ocular inflammatory syndrome (immune recovery Vitritis, IRV), which causes vision loss in AIDS patients with cytomegalovirus (CMV) retinitis, who respond to highly active antiretroviral therapy (HAART). We followed 30 HAART-responders with CD4 cell counts of >/=60 cells/mm3. Patients were diagnosed with IRV if they developed symptomatic Vitritis of >/=1+ severity associated with inactive CMV retinitis. Symptomatic IRV developed in 19 (63%) of 30 patients and in 26 (59%) of 44 eyes over a median follow-up from HAART response of 13.5 months. The annual incidence of IRV was 83/100 person-years. Excluding patients with previous cidofovir therapy did not significantly alter the time course of IRV (P=.79). These data suggest that IRV develops in a significant number of HAART-responders with CMV retinitis and is unrelated to previous cidofovir therapy.
Lawrence S Morse - One of the best experts on this subject based on the ideXlab platform.
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vitreomacular traction syndrome following highly active antiretroviral therapy in aids patients with cytomegalovirus retinitis
Retina-the Journal of Retinal and Vitreous Diseases, 1998Co-Authors: John C Canzano, John B Reed, Lawrence S MorseAbstract:PURPOSE: To report the development of vitreomacular traction syndrome (VMT) following highly active antiretroviral therapy (HAART) in AIDS patients with cytomegalovirus retinitis (CMV-R). METHODS: We identified two AIDS patients with evidence of CMV-R who later developed VMT following HAART-associated immune recovery Vitritis. RESULTS: The CD4+ T-lymphocyte count increased from 5 to 190 cells/microL in Patient 1 and from 26 to 713 cells/microL in Patient 2. HIV-RNA copies/mL decreased from 341,000 to less than 400 in Patient 1 and from 43,900 to less than 400 in Patient 2. Increased vitreous inflammation occurred during this period of immune recovery. After resolution of Vitritis, VMT developed in both patients and was confirmed by B-scan ultrasound and fluorescein angiography. In both patients, CMV-R was clinically inactive at the time of VMT development. Both patients underwent pars plana vitrectomy with peeling of the posterior hyaloid, which confirmed VMT intraoperatively. CONCLUSIONS: VMT appears to be a sequelae of HAART-associated immune recovery Vitritis in AIDS-related CMV-R. Changes in immune status may permit an inflammatory response that can lead to VMT. As advances in pharmacologic intervention continue, clinical manifestations and ocular sequelae in CMV-R will change, as will the approach and management of this disease.
