COMMENTARY

CMV Retinitis and Cataracts in AIDS

Hemang K. Pandya, MD; Sophie J. Bakri, MD

Disclosures

October 25, 2013

Risk of Cataract in Persons With Cytomegalovirus Retinitis and the Acquired Immune Deficiency Syndrome

Kempen JH, Sugar EA, Lyon AT, et al
Ophthalmology. 2012;119:2343-2350

Study Summary

Cytomegalovirus (CMV) retinitis is the leading cause of vision loss in patients with AIDS. However, since the advent of highly active antiretroviral therapy (HAART), there potentially exists an uncharacterized shift in factors affecting vision loss. In particular, the risk for cataract development in these patients has not been fully established. The Studies of Ocular Complications of AIDS Research Group prospectively evaluated the prevalence and incidence of cataract progression in this cohort of patients.

This study evaluated 729 eyes (of 489 patients) diagnosed with CMV retinitis. All patients were evaluated for HIV status (date of CMV retinitis diagnosis, CD4 count, viral load) and the presence of systemic diseases (diabetes, hypertension, hyperlipidemia). At each visit, slit-lamp biomicroscopy was performed to grade cataracts. Only cataracts contributing to best-corrected visual acuity of 20/40 or worse were included in the study.

The age-adjusted prevalence of cataracts in patients with CMV retinitis was higher than in the population-based sample (P < .0001). When evaluating eyes without cataracts before developing CMV retinitis, the annual incidence of cataracts was 8.1% per eye. A total of 109 (14.9%) retinal detachments were found. Of these, 44 were repaired without silicone oil and 65 with silicone oil. Cataracts developed in 52 eyes (80%) of those requiring silicone oil tamponade of the detached retina (P < .0001).

CMV retinitis was found to profoundly increase the risk for cataract formation in patients with AIDS. When counseling patients diagnosed with CMV retinitis and their families, retina specialists are encouraged to discuss all sources of potential vision loss, including uveitis, retinal detachment, and cataract development.

Viewpoint

This study holds significance to current clinical practices because it provides evidence that CMV retinitis is associated with a higher risk for cataracts. Furthermore, it reinforces the concept that retinal detachment repair with silicone oil can increase the rate of cataract formation. These results have implications for both visual prognosis and for achieving desired anatomic endpoints in retinal reattachment. Hence, retina specialists may elect to have patients receive cataract evaluations during the management of CMV retinitis.

Abstract

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