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A prospective study Df the Ophthalmologic findinªs

in the Acquired Immunodeficiency Syndrome in \sãoPaulo city, Brasil •

. \

Sampaio, Paulo R.5. M.D.

Kobinger, Edmund M.D.

Woller, Jaques M.D.

InstitutionReference and Training Canterof AIOS - são PauloRua Antonio Carlos 122 - 7;

são Paulo - 5P Brasil

02

Summary

g prospe~tivB study of Cphthalmologic findings in

191 patients with acquired immunodeficiency syndromB dis

closed that 99 (51%) had ocular involvement. The cytome-

galovirus retinitis, toxoplasmosis retinitis and cotton-

wool spots were frequent features in this group. These I

patients were observed in Reference and Training Center

of AIDS in são Paulo city - Brazil - by the authors.

Introduction

são Paulo presents today 15 mil1ions of people and

showed from 1980 to August 1989 a total of 3604 new AIDS

patients with an incidence to 1989 from 24,03 patientsl

100.000 people. The Reference and Training Center of AIDS

object the assistance, {hreatment and study of AIDS pati-

ents. The Ophthalmologic Department borned in April 1987.

Subjects and ~ethods

Between Apri1 and September 1989, 191 patients we-

re observed in our department until any trouble of visi-

on were noted by the patient or by the clinical depart-'

ment. 8efore, they were classified by the group of risk'

and by the criteria of the Centers Disease Control (US~).

They were examined by the sama team, using the same me-

thods. hll patients underwent complete ophthalmologic e-

xaminations, including inspection of the outer eye, mo-

tility testing, slit lamp examination, direct and indir~

ct ophthalmoscopy. Color photographs were taken of all 1

abnormal findings with a fundus camera. Patients with o-

cular abnormalities were examined every week or every t~c

Centro de Refer-::-(,~.;3 e Treinamento· DST/AIDS

BIBLIOTECA

03

weeks. others were observed once 8 month. Serum levels I

against cytomegalovirus, herpes virus, toxoplasmosis, si

philis and Elisa test were evaluated.

Results

A total of 175 (91,62%) of our patients were men I

and 16 (8,38%) were women. (see table 1)

Table 1

Summary of sex and risk factors

men Homosexual Bisexual Hetero Drug transfusional

total 109 25 13 22 6

percentual 57,08% 13,08% 6,80% 11,5% 3,14%

women Heterosexual Drug abusers Transfusiona1

total 07 08 01

percentual 3,66% 4,20% 0,52%

The cases from group I I (CDC-USA) presents 24 (80%)

men and 6 (20%) women. Only one had disturb related with

AIJ5 (3,34%) - (see table 2) - and it was a herpetic ce-

ratitis.

Table 2

Summary of ocular findings in group 11

Refractional disturb 18 75%

blefaritis 2 8 3<:'1, ia

men herpetic ceratitis 1 8,3%

congenital nistagmus 1 8,3%

pterigium 1 8,3%

ocular trauma 1 8,3%

women refractional disturb - 4 66,7%

04

women pterigium 1 16,7rrblefaritis 1 16,7%

The cases from group 111 presents 18 men (90~) and

02 (10%) women where 05 (25%) Df them had ocular disturb

re1acted with AIDS. - (see tab1e 3)

Tab1e 3

Summary Df ocular findinges in group 111

Refractiona1 disturb 11 61,1%

CMV retini tis 2 11,1%

men cotton-wool spots 2 11,1%

blefaritis 1 5,6%

herpes virus ceratitis 1 5,6%conjuntivitis 1 5,6%

women Refractiona1 disturb 2 100%

The cases from group IV presents 133 (94,3%) men '

and 8 women (5,7%) where 92 (65,2%) Df them showed ocular

disturb relacted with AI~S (see table 4)

Table 4

Summary Df ocular findings in group IV

?-etinitis 57 ó.2,9%

f<aposi's sarcoma 6 4,5%

refractiona1 disturb 33 24,8%

pterigium 5 3,8%

men corneal ulcer 1 0,8%

herpes virus ceratitis 6 4,5%

papi1aedema 12 9,0%extra ocular muscles neuritis- 5 3,8%

retinel vein oclusion 1 O, n~OjO

0'b1efaritis 7 c yr'men .;, /.

b1efaritis 1 12,51<

herpes vírus ceratítís - 2 25,01-Women

25,0%refractional dísturb 2

retinitís 2 25,0%

vitreous haemorragía 1 12,5%

Comment

In our patíents wíth AIDS, the retinitís were pre~;

sent predominantly-64 patients (33,5%). The cytomega1o-

virus presents 9,95%, toxoplasmosis 7,33%, cotton-wool

spots 8,9%, herpes vírus 1,57%, herpes zoster vírus "1,57%, syphilis 1,05%, pneumocystís carinmi and tubercu

10sis 0,5% each.

The cotton-wool spots are clustered i posterior '

pole and are similar ín appearance to those found in p~

tients ~ith diabetes mellitus and systemie hipertension.

The cJtton-wool spots are transient, resolving over a '

period of four or six weeks. It was easy for us to dif

ferentiate between the we~l-demarcated, superfieially I

loeated,and evanescent cotton-wool spots and e2~ly foei

of cyto,sgalovirus retinitis, wich tended to 2ve f1uf1y

edges, lie deeper, and increase in size o~ fo1low up.

Gancic10vir became availab1e ear1y and al1 of our pati-

ents ~ith cytomegalovirus retinitis have receívsd treat

ment. T~o thirds of them survived more than 3 ~onths

after retini tis was diagnosed.

The treatment of toxoplasmosis preco ized in o~r

s e rv ice i s w i t , sul f ad ia z ín e a ruí we h e G P o or :'s sul ts

..

6

w í t I i t , T' e y s h o UI E' d a n i n i t i a 1 9 o o d r e s ~ s but allpr

gy tr sulfa drugs or severe gastritis occurred and th~

ther2Qy was discontinued. Oral clindamycin was added

with poor results eather. Fifty per cent Df our patients

died in the in three weeks and the others in six weeks.

No patients showed any evidence of prsexisting chorio-

retinal scars. Antibody titers ranged from 1:64 to

1:4096 and the examination of cerebrospinal fluid is

not helpful in making diagnosis.

The acyclovir therapy can control the herpes sim-plex 2nd herpes zoster retini tis and appears to be the '

most effective treatment.

The therapy to pneumocystis carinii and tuberculo-

sis showed bad results and syphilis response to penicil-

lina benzatina was effective.

References

1. Wormser, G.P.,Sthal,R.E.,and Bottone,E.J.(eds.): §IDS

hcqui~~d Im~une Oeficiency Syndrome, and C~her ma~ifes-

tations of HIV infection. Park Ridge,I\!.J.,':oyes Publica

tions, 1987, pp.445-447

2.Centers for Disease Control Update: Acquirec im unode-

ficiency syndrome-United Stat8s.~.~.W.R. 35:17,1986

3.Rao,· .A.,Zimmerman,P.L.,and ~Hchols,P.\rJ.: A Clinical,

Histo~2thologic, and Electron Microscopic Study of Pneu-

rn o c y s t vs c ar i n i i Choroiditis. Ameriean Journal of Cp h t h e I

mology 107:218-228,March,1989