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Query: UMLS:C0344232 (blurred vision)
 2,072 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 49-year old female in the course of chemotherapy for adult T-cell leukemia (ATL) noticed blurred vision and visual field defect in her right eye on February 26, 1991. Ophthalmoscopic findings showed exudative necrotizing retinitis with white exudative patches and scattered retinal hemorrhages in both eyes. CMV was isolated from the urine by the shell vial cell culture assay. Anti-viral therapy was commenced using ganciclovir and gamma-globulin, which are rich in anti-CMV antibodies. The exudative lesions were absorbed gradually. The ocular signs and symptoms agreed with the patient's systemic immunosuppressed T cell function state. CMV retinitis should be considered in the differential diagnosis of retinitis in immunocompromised patients. CMV retinitis will certainly be found more frequently in accordance with the increasing number of immunocompromised hosts who have received immunosuppressive therapy or transplantation.
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PMID:[Adult T cell leukemia with cytomegalovirus retinitis]. 131 31

A 38-year-old bisexual man with acquired immunodeficiency syndrome (AIDS) who was being treated with oral acyclovir for herpetic stomatitis had a history of blurred vision OS that was diagnosed as cytomegalovirus retinitis. The patient refused ganciclovir administration. Two additional lesions developed OS in the succeeding four months. All clinical evidence of active retinitis cleared after zidovudine was administered, and the patient has remained free of any clinically active retinal lesions for 28 months while continuing to receive acyclovir and zidovudine. Although ganciclovir and foscarnet are the drugs of choice to treat cytomegalovirus retinitis, this observation may be fortuitous for patients whose other AIDS manifestations suggest using zidovudine rather than ganciclovir or for patients whose cytomegalovirus retinitis appears to be resistant to agents currently used to treat this infection.
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PMID:Zidovudine and cytomegalovirus retinitis. 132 8

Cytomegalovirus retinitis, the most frequently encountered ophthalmologic manifestation of acquired immunodeficiency syndrome (AIDS), emerges in up to 46% of such patients. In the period between april 1989-May 1990, 4 cases of AIDS-related cytomegalovirus retinitis were diagnosed in Singapore and treated at Tan Tock Hospital. Presenting complaints included blurred vision, visual field scotoma, and a field defect. Clinically, cytomegalovirus retinitis is characterized by lesions, usually in the posterior pole, that take the form of fluffy white infiltrates with irregular, translucent, granular appearing margins. There is associated retinal hemorrhage and inflammatory sheathing, leading eventually to a profound loss of vision. The treatment of choice is ganciclovir, and the lack of enlargement of existing lesions is the indicator of successful maintenance therapy. Since ganciclovir is virustatic rather than virucidal, continuous treatment is required to prevent reactivation. Even with full maintenance therapy, 30-50% of patients experience breakthrough infection. Complications of ganciclovir include conjunctival scarring, scleral induration, and neutropenia. Moreover, ganciclovir cannot be taken concurrently with zidovudine, a drug that promotes the overall well-being and survival status of AIDS patients. The development of new drugs such as foscarnet is expected to eliminate the need for AIDS patients to make a choice between preserving their eyesight and controlling virus replication.
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PMID:AIDS-CMV retinitis: Singapore's first cases. 196 62

In June 1993, in Taiwan, a woman admitted to a local hospital with cough, fever, chills, and difficult breathing who tested positive for HIV-1 infection was transferred to Taipei Veterans General Hospital. In January 1985, at a provincial hospital, then 46 years old, she underwent an anterior total hysterectomy and bilateral salpingo-oophorectomy during which she received two units of whole blood. One of the blood donors was an AIDS patient who had been treated at the same hospital in 1991 and who had died in 1993. In the interim between hospitalizations, she had two episodes of herpes zoster infection, including oral ulcers diagnosed as herpetic gingivostomatitis, and an episode of oral candidiasis. Physicians at the Taipei Veterans General Hospital diagnosed oral candidiasis, herpes simplex type 1 virus infection forming ulcers on her lips, and Pneumocystis carinii pneumonia in June 1993. Her CD4 count was 0 and her CD8 count was 20%. Treatment consisted of intravenous (IV) trimethoprim/sulfamethoxazole (TMP/SMX) and oral zidovudine, fluconazole, and acyclovir. She continued this medication after discharge in August 1993. She was readmitted to Taipei Veterans General Hospital in February 1994 for blurred vision. She was diagnosed with cytomegalovirus retinitis. Her CD4 count was up to 1% and her CD8 count was down to 8%. The candidiasis infection had extended from her oral cavity to the esophageal mucosa. She was put on IV ganciclovir, TMP/SMX, and fluconazole. She was discharged 3 weeks after admission. Her condition deteriorated thereafter, resulting in her death in August 1994. Up until this study, this HIV/AIDS case was listed with 79 other HIV/AIDS patients as unknown cause. During the 8 years between HIV exposure and her diagnosis of AIDS, she had unprotected sexual intercourse with her husband. Neither the husband nor any of her four children have AIDS. Screening for HIV-1 in Taiwan began in January 1988. The authors urgently recommend that anyone who received a blood transfusion between 1984 and 1987 in Taiwan and who currently suffers repeated episodes of opportunistic infections undergo an HIV-1 blood test.
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PMID:Transfusion-acquired AIDS in Taiwan. 864 96

We report the frequency and type of infectious ocular complications following orthotopic liver transplantation (OLT) and review diagnostic and therapeutic strategies. During the period September 1988 through November 1994, 684 patients underwent OLT at Mount Sinai Hospital (New York). Nine orthotopic liver transplant patients (1.3%) developed ocular infections: Candida albicans endophthalmitis (2), Aspergillus fumigatus endophthalmitis (1), cytomegalovirus retinitis (4), herpes simplex virus keratitis (1), and varicella-zoster virus panophthalmitis (1). The mean time from OLT to ocular symptoms was 42 days for patients with fungal infections and 128 days for patients with viral infections. Blurred vision was the commonest symptom (five of nine cases). The mean duration of follow-up was 2 years (range, 33 days to 5 years). Permanent loss of vision occurred in three patients, five had improvement in visual acuity, and one died of disseminated aspergillosis 33 days after OLT. Infectious ocular complications following OLT may occur as isolated events or with disseminated disease. Fungal infections occur earlier (mean, 42 days after OLT) than viral infections (mean, 4 months after OLT). The clinical presentation may be atypical; aggressive vitreoretinal procedures and serial examinations may be required to establish the diagnosis. Cytomegalovirus retinitis in orthotopic liver transplant patients may not require life-long maintenance therapy with antiviral agents.
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PMID:Infectious ocular complications in orthotopic liver transplant patients. 919 78

Researchers are studying the use of ganciclovir, administered by eye implants, for the treatment of CMV retinitis. Participants in a 1992/1993 study who had received the implant showed no progression of the disease while a no-implant comparison group suffered a worsening infection. The implants are designed to gradually release the drug over several months; implant replacement time is unknown, but replacement after 32 weeks is advised. Following implantation, initial blurred vision occurred, but normal vision returned within a month. Another study revealed that the non-implanted eye of a CMV retinitis patient usually became infected, but when subsequently treated with the implant, took a positive course. A study comparing different treatments for CMV retinitis is enrolling. Participants will be treated either with standard IV ganciclovir, a ganciclovir implant with oral ganciclovir, or a ganciclovir implant with placebo. Participants must have CMV retinitis in one eye. Implants are available from the manufacturer through a compassionate use program. For more information, contact The Network at (800) 734-7104.
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PMID:Good results from eye implant study. 1136 89

There are several treatment options now available for patients with CMV retinitis, a sight-threatening viral infection of the eye, and the benefits and drawbacks of each are detailed. Vitrasert implants are the top choice, selected by nearly half of all people with CMV retinitis. The implants can cause blurred vision for up to four weeks, and retinal detachment is a potential side effect. Physicians also recommend systemic CMV treatment, generally IV ganciclovir, to accompany the implant. Cidofovir (Vistide), another IV therapy, is time-consuming to administer and has severe side effects. ISIS 2922, the experimental drug fomivirsen, is a promising treatment that is currently in advanced trials; it is injected directly into the eye. Oral ganciclovir therapy, used for mild retinitis cases, requires 12 pills a day, at a cost of $1,200 per month, and is generally less effective than other treatments. Concerns about developing drug resistance are expressed.
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PMID:Saving sight. 1136 57

Symptomatic anterior uveitis is rare in HIV-positive patients. The uveitis associated with cytomegalovirus retinitis (CMVR), the commonest ocular manifestation in AIDS patients, is rarely symptomatic and patients do not typically present with a red painful eye in conjunction with blurred vision. In this article we report 12 cases of symptomatic anterior uveitis in HIV-positive patients and discuss the aetiology. The case notes of all HIV-positive patients presenting to the eye department with symptoms of uveitis over a 4-year period were studied retrospectively. The notes were analysed for age, sex, race, risk factors of HIV, features of the uveitis, concurrent disease and CD4 counts. Only 12 patients were identified to have symptomatic uveitis out of a total 172 patients. There were 9 males and 3 females with an average age of 35 years. None of these patients were taking either rifabutin, protease inhibitors or cidofovir. Seven out of the 12 patients had granulomatous uveitis. Of these 7 patients, 4 had CD4 counts over 200 and no other concurrent illness whilst 3 patients, with CD4 counts between 130-200, were subsequently found to have an underlying aetiology namely lymphoma, tuberculosis and candida. The remaining 5 patients, all with CD4 counts below 40, had a history of systemic illness with herpes zoster preceding the onset of the uveitis. HIV-positive patients with symptoms of uveitis do not have active CMVR and the ophthalmologist must search for other causes such as tuberculosis or lymphoma in those with granulomatous uveitis or herpes zoster in those with non-granulomatous uveitis. The CD4 count may be helpful.
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PMID:Symptomatic anterior uveitis in HIV-positive patients. 1203 82

Cytomegalovirus (CMV) retinitis rarely occurs in patients with connective tissue disease. We present a rare case of CMV retinitis in a patient with dermatomyositis. A 38-year-old man was admitted due to blurred vision and floaters of right eye. He had been diagnosed with dermatomyositis and taken prednisolone and immunosuppressive agents for 10 months. He was diagnosed as having CMV retinitis based upon ophthalmologic examination, decreased CD4+T cell count, and positive IgM anti-CMV antibody. Intravenous ganciclovir was administrated with cessation of immunosuppressive agents for 40 days and the lesion did not progress. This is the first report of a CMV retinitis that developed in a patient with dermatomyositis.
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PMID:Cytomegalovirus retinitis in a patient with dermatomyositis. 1655 65

An unusual case of CMV retinitis and AIDS who developed immune recovery uveitis (IRU) despite a low CD4+ T cell count achieved during HAART is reported. A 36-year-old female complained of blurred vision in both eyes six months after initiation of anti-CMV retinitis therapy and HAART. Ocular examination revealed a substantial intraocular inflammation causing a dense vitreous haze and frosted branch angiitis. Consecutive CD4+ T cell counts were 20 cells/mm(3) or less and plasma HIV mRNA was undetectable. The laboratory test for Cytomegalovirus was positive whereas those for infections known to cause uveitis were negative. The inflammatory reaction resolved with treatment, but she developed retinal detachment just before she died of pulmonary complications. A review of the literature led us to propose that our patient developed an intraocular inflammation which may probably be a form of IRU and it might be appropriate to employ additional criteria in the definition and the diagnosis of IRU.
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PMID:Immune recovery uveitis associated with highly active antiretroviral therapy in a patient with CMV retinitis and AIDS despite a low CD4+ T cell count: case report and a review of the literature. 1919 61


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