Purpose: To determine the prevalence and type of visual symptoms among human immunodeficiency virus (HIV)–positive patients with newly diagnosed cytomegalovirus (CMV) retinitis.
Methods: The authors conducted a retrospective review of the charts of all HIV type 1–infected patients at Parkland Memorial Hospital (Dallas, TX) who had newly diagnosed CMV retinitis between July 1, 1993, and September 30, 1997. Information recorded included demographics, results of laboratory evaluations including CD4 cell count, visual symptoms at the time of diagnosis, and the zone and extent of retinal involvement at presentation. Visual symptoms in the patients with CMV retinitis were compared with those in a control group of HIV-positive patients who were screened for CMV retinitis but were not diagnosed with retinitis.
Results: Of 183 eyes (138 patients), 83% (88% of patients) had visual symptoms at the time of diagnosis. The most common presenting symptoms were blurred vision (67% of patients), floaters (49%), flashes of light (16%), eye pain (7%), and scotomata (3%). Compared with the control group of patients without CMV retinitis, patients with CMV retinitis were more likely to have any eye symptoms (88% versus 53%, respectively) as well as blurred vision, floaters, and either blurred vision or floaters (P < 0.0001). Eyes with zone 1 retinal involvement had an 88% incidence of visual symptoms at the time of diagnosis compared with 77% of eyes with peripheral retinal involvement (zones 2 and 3) (P > 0.05). Patients with zone 1 disease were more likely to note blurred or decreased vision than were patients with zone 2 or 3 disease (75% versus 47%, respectively;P < 0.0001). Eyes with <25% retinal involvement had a 76% rate of visual symptoms, which was significantly lower than the 90% rate noted among eyes with >25% retinal involvement (P < 0.05).
Conclusions: Most HIV-infected patients with newly diagnosed CMV retinitis had visual symptoms at presentation regardless of the zone of retinal involvement. The incidence of visual symptoms correlated with the degree of retinal involvement.
Departments of *Ophthalmology and †Medicine, The University of Texas Southwestern Medical Center at Dallas, Texas.
Reprint requests: Daniel J. Skiest, MD, Division of Infectious Diseases, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9113; e-mail: daniel.skiest@UTsouthwestern.edu
Dr. Park is now affiliated with the Retina Department, The Permanente Medical Group, Sacramento, CA.
No authors have a proprietary interest in any products related to this study.
Presented in part at the meeting of the American Academy of Ophthalmology; New Orleans, LA; November 1998.