Acquired Immunodeficiency Syndrome: Nagata Y

Kashiwase M, Yamauchi Y, Sata T, Nagata Y, Usui N, Mochizuki M, Fujino Y, Iwasaki T, Sato Y, Kurata T, Usui M. · Department of Ophthalmology, Tokyo Medical University, Japan. · Nippon Ganka Gakkai Zasshi. · Pubmed #15359904 No free full text.

Abstract: PURPOSE: We examined eyeballs collected from autopsied acquired immunodeficiency syndrome patients with cytomegalovirus (CMV) retinitis, and analyzed the precise pathogenesis of CMV retinitis. MATERIAL AND METHODS: Eyeballs were fixed with 10% buffered formalin embedded in paraffin. CMV antigens were investigated by histopathological and immunohistochemical analyses. Histopathological findings were compared with funduscopic images. RESULTS: CMV antigens remained in the necrotic area of the retina and many CMV immediate early antigens existed in intact parts of the inner retina showing almost intact structure, and around retinal vessels. CONCLUSIONS: The results suggest that CMV infects the inner retina first via the retinal vessels, although funduscopic examination may appear normal. It extends through the neuronal cells and glial cells horizontally and Muller cells vertically. CMV severely damages the retinal structure.

Miyamoto C, Yashiro S, Nagata Y, Nagataki S. · Department of Ophthalmology, International Medical Center of Japan, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. · Nippon Ganka Gakkai Zasshi. · Pubmed #11510114 No free full text.

Abstract: PURPOSE: To examine the ocular complications in patients infected with human immunodeficiency virus(HIV) in Japan. METHODS: The medical records of 322 patients seen at the acquired immunodeficiency syndrome(AIDS) Clinical Center from July 1, 1997 through December 31, 1998 were reviewed, and the HIV-associated ocular complications were correlated with serum CD 4+ T-lymphocyte counts. RESULTS: Ocular complications were found in 51 patients: 35 cases with retinal microvasculopathy, 17 cases with cytomegalovirus retinitis(9 quiescent, 6 active, and 2 recurrent), and 1 case each with tuberculous uveitis, phthisis bulbi after necrotizing herpetic retinopathy, conjunctival Kaposi's sarcoma, papilledema, divergence palsy, hemianopia, and abducens palsy. Retinal microvasculopathy was present in patients with CD 4+ T-lymphocyte counts above 500/mm3, but was more common in patients with cell counts below 200/mm3. Among 6 patients with active cytomegalovirus retinitis, 5 patients had a CD 4+ T-lymphocyte count below 50/mm3 at the onset of retinitis, while one patient developed retinitis after the cell count increased to over 200/mm3 with highly active antiretroviral therapy. CONCLUSION: Cytomegalovirus retinopathy may occur in patients with a CD 4+ T-lymphocyte count of more than 200/mm3.

Kitagawa M, Nagata Y, Fujino Y, Mochizuki M. · Department of Ophthalmology, University of Tokyo, Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. · Nippon Ganka Gakkai Zasshi. · Pubmed #11210785 No free full text.

Abstract: PURPOSE: To evaluate the usefulness of routine ophthalmologic examinations for cytomegalovirus retinitis in acquired immunodeficiency syndrome (AIDS) patients. METHODS: Clinical symptoms of cytomegalovirus (CMV) retinitis in patients with AIDS who had circulating CD4+ T lymphocytes 50/microliter or less and received monthly ophthalmological examinations (examined group) were compared with those of the patients detected by non-routine ophthalmological examinations (unexamined group). RESULTS: The patients in whom early CMV retinitis was detected by monthly ophthalmological examinations had no subjective symptoms or iritis. The size of CMV retinitis was smaller than 2 disc diameters and it did not extend to the papillomacular area in a majority of the patients. On the other hand, the size of CMV retinitis in the unexamined group was larger than 10 disc diameters and it extended to the papillomacular area in most cases. The visual prognosis of the examined group was better than that of the unexamined group. CONCLUSIONS: To protect visual acuity, it is important to conduct monthly ophthalmological examinations in patients with AIDS whose serum CD4+ T lymphocyte counts are 50 cells/microliter or less.