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Viruses belonging to the herpes family group, including HSV (herpes simplex virus) 1 and 2, VZV (varicella zoster virus) and CMV (cytomegalovirus) are the leading causes of necrotizing retinitis. These viral retinal necroses generally manifest in three forms, depending on the patient's immune status: acute retinal necrosis (ARN), progressive outer retinal necrosis (PORN) and CMV retinitis. Although specific, effective drug treatments are available today, early treatment initiation is essential to avoid sight-threatening complications., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate the clinical outcome and medical management in a series of patients diagnosed with acute retinal necrosis., Material and Methods: Between 1993 and 2000, 22 patients suffering from acute retinal necrosis were referred to our department. We retrospectively reviewed the clinical course, delay between diagnosis and first clinical manifestation, biological profiles, treatment and complications., Results: All patients had vitreous inflammation; retinitis was seen upon examination in 82% of the cases. Nevertheless, for six patients (27% of the cases), failure to recognize the diagnosis led to delay (mean, 5.5 days) between the first ophthalmological examination and antiviral therapy. Nineteen patients underwent laboratory evaluation, and virological diagnosis was made in 16 of them: varicella zoster virus was found in 11 cases, herpes simplex type 1 in three cases, and herpes simplex type 2 and cytomegalovirus in one case each. Nine patients were treated with a combination of aciclovir and foscarnet and 13 with aciclovir alone. Among the 16 patients who received aciclovir, one did not respond to therapy after 2 days and was cured only after foscarnet was added. Recurrence occurred at the end of treatment in only one patient. Retinal detachment complicated the course for 11 patients and was always associated with proliferative vitreoretinopathy. Among those, seven of the ten patients who accepted surgery were successfully treated. Eleven out of 22 patients had a final visual acuity up to 20/200 and two up to 20/40., Conclusion: In our series, acyclovir alone was sufficient to cure the majority of cases. Even with antiviral therapy, the prognosis of acute retinal necrosis remains poor. Retinal detachment is the main complication.

Background: Since the beginning of the use of HIV-Protease Inhibitors (PI) to treat HIV-infected patients, a decrease of the incidence of extraocular opportunistic infections has been observed. We studied the incidence of CMV-retinitis in patients treated with a highly active antitetroviral therapy (HAART) containing PI over a mean follow-up of 12 months., Methods: Ninety-three HIV-infected patients treated with HAART containing PI were included. The mean initial CD4+ cell-count was 54/microliter (median: 22/microliter), and the mean plasma HIV-load was 5.46 log 10 RNA-copies/ml. Fundus examination was performed each month in case of a previously treated and controlled CMV-retinitis or if initial CD4 cells were below 50/microliter. In other patients, fundus examination was performed every 3 months. The mean follow-up was 362 days., Results: Among the 7 patients with a previously treated and controlled CMV-retinitis, one experienced a progression during the study (after 163 days of PI). Among the 59 patients with CD4 cells below 50/microliter and without previous CMV-retinitis before the beginning of PI, 5 experienced a CMV-retinitis (mean delay after the onset of HAART: 141 days), including 2 with relapse. When retinitis occurred, CD4 cells were below 32/microliter except in one case (147/microliter)., Conclusions: Compared to previously published reports, this study showed an increase of the time to progression of previously treated and controlled CMV-retinitis in patients treated with PI. Considering deeply immunocompromised patients (less than 50 CD4-cells/microliter), the risk of suffering from CMV-retinitis was 8.5% after 12 months of PI treatment. Longer follow-up remains necessary to confirm these results.

Background: The purpose of this study was to describe retinal complications observed in patients presenting with AIDS at Lome teaching hospital., Material: All patients who met WHO AIDS clinical case diagnostic in Africa, admitted for various signs in hospital, were followed between December 1996 and May 1997 for ocular examinations., Results: We surveyed 94 patients; 41 (43.6%) had retinal lesions. Retinal complications were cotton whool spots (30 cases), retinal hemorrhages (4 cases), papilloedema (4 cases), cytomegalovirus retinitis (8 cases). Mortality in patients with retinal complications occurred 10 months after the clinical diagnosis of AIDS., Conclusion: This study has found a high retinal morbidity contrasting with other studies in Africa. This could be explained by the longer period of follow-up larger than in previous similar studies.

Purpose: The recent developments of protease inhibitors raise big hopes for the fight against AIDS. Combined in a triple therapy with 2 nucleoside analogs, those molecules strongly inhibit human immunodeficiency virus (HIV) replication. Their biological and clinical efficacy for increasing CD4 cell count and survival time has been proved. We have followed evolution of Cytomegalovirus (CMV) retinitis in 12 patients treated by triple antiretroviral combination therapy since April 1996., Patients and Methods: Twelve AIDS patients with CMV retinitis background and a treatment by triple therapy were followed in this prospective study. At the onset of combination therapy, retinitis was cicatricial in 10 patients and active in 2 patients. Mean CD4 cell count was 23 +/- 16 CD4/microL [4-50]. Follow-up included ophthalmoscopic examination every 2 weeks and fundus photographs every month. CD4 cell count was noted at each exam., Results: The mean time follow-up after onset of combination therapy was 10.3 +/- 2.4 months [5-14]. Retinitis relapsed in 6 patients (50%) within the 3 first months, and with a CD4 cells count higher than 75/microL for 3 patients. Inflammation response was noted in 3 patients. There was no recurrence after the third month, except in 1 case at the 9th month. CD4 cell count was 122 +/- 41 CD4/microL [30-350] after 6 months. As retinal lesions were completely still for some patients, maintenance therapy was reduced, then even stopped. At the end of follow-up, maintenance therapy was stopped for 8 patients. For these patients, retinitis remained stable without maintenance therapy for a mean time of 4,5 months (10 months in 1 case). Recurrence occurred for only 1 patient after 9 months of triple therapy and 2 months without maintenance therapy. For the 11 remaining patients, retinitis remained stable for a mean total time of 9.5 +/- 2.5 months [4.5-12.5]., Conclusion: Those first results show that clinical and therapeutic history of CMV retinitis may be changing. There seems to be a restoration of immune defenses that allowed suppression of maintenance therapy for 8 out of 12 patients. Our results need to be confirmed by a longer follow-up and multicentric studies.

Purpose: To describe the clinical feature and the outcome of CMV retinitis in children with vertically transmitted HIV infection., Results: Five case-reports of cytomegalovirus retinopathy are described. These children from eight month-old to seven and a half year-old (median age at diagnosis 52 months) had been perinatally contaminated by the human immuno-deficiency virus. The ophthalmic signs included only a red eye for one patient. The clinical signs were similar to the adult's retinopathy. At the opposite the differences were emphasized like the clinical onset with a delayed diagnosis. Mean follow-up since diagnosis is 8 months with 3 patients still alive., Conclusion: CMV retinitis in vertically transmitted AIDS can occur early in childhood and must be checked systematically in the patients with low CD 4 count because of the usual asymptomatic onset.