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Unexplained vision loss in AIDS patients calls for fluorescein angiography

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WESTPORT, CT (Reuters Health) – Ischemic maculopathy may be the culprit in patients with HIV infection who experience unexplained loss of vision, researchers report in the November issue of the American Journal of Ophthalmology. But fluorescein angiography is need to confirm this, they add.

Dr. Emmett T. Cunningham, Jr. of the University of California at San Francisco and a multicenter team reviewed the cases of five AIDS patients with ischemic maculopathy in an attempt to gain a greater understanding of this "uncommon disorder." There are "few" cases of HIV-related symptomatic ischemic maculopathy in the medical literature, they write.

In all five cases, fluorescein angiography facilitated the diagnosis of ischemic maculopathy following complaints of vision loss. Onset was usually abrupt with "opacification of the superficial retina, resulting in a cherry red spot, and intraretinal hemorrhages near the fovea" clearly present in most, but not all cases. Because these changes may be absent or transient in some patients, the researchers recommend that fluorescein angiography be performed in all HIV-infected patients with unexplained vision loss.

Four of the five patients had bilateral macular disease and visual acuity at presentation varied widely, ranging from "20/20 to counting fingers," Dr. Cunningham's team reports.

The pathogenesis of ischemic maculopathy remains unknown, although the evidence in this case series points to occult herpetic infection as a contributing factor, they write. Seven affected eyes had cytomegalovirus (CMV) retinitis and all patients were taking anti-CMV agents when they developed visual problems.

"HIV infection itself is capable of reducing vision by damaging the fine capillaries of…the macula," Dr. Cunningham said. "This cause of vision loss might be easily missed if not looked for specifically with fluorescein angiography."

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