Cystoid macular edema in a patient with acquired immunodeficiency
syndrome and past ocular history of cytomegalovirus retinitis after
initiation of protease inhibitors
Purpose: To describe a patient with acquired immunodeficiency syndrome
(AIDS) who presented with cystoid macular edema (CME) which was not
associated with active cytomegalovirus (CMV) retinitis or AIDS-related
microvasculopathy. Method: A 32-year-old man with AIDS and a past ocular
history of inactive CMV retinitis was placed on protease inhibitors when
his CD4(+) T lymphocyte counts dropped to 8 cells/mm(3). Three months
later, after his CD4(+) T lymphocyte counts had increased to 196
cells/mm(3) he complained of micropsia and metamorphopsia in his right
eye of 1 week duration. The patient had a complete ocular examination
including fluorescein angiography (FA). Results: Visual acuity (VA) was
7/10 OD. Fundus examination revealed CME and inactive CMV retinitis, and
FA demonstrated CME and a hot disc. Two transseptal injections of
corticosteroids were administered 2 weeks apart in the right eye as
treatment of the CME. The patient reported gradual visual improvement
and 6 weeks later, his VA was 10/10(-2). CME had resolved clinically and
angiographically. Conclusions: CME in our case is associated with
inactive CMV retinitis and gradually increasing number of CD4(+) T
lymphocytes after initiation of treatment with protease inhibitors. It
may be amenable to regional administration of corticosteroids without
reactivation of retinitis
