Longitudinal study of the ocular complications of AIDS - 2. Ocular examination results at enrollment

Objective: To report the clinical features on eye examination of patients with AIDS in the era of highly active antiretroviral therapy (HAART). Design: Cohort study. Participants: Patients with AIDS, age >= 13 years. Methods: Ophthalmologic examination, contrast sensitivity, visual fields, and laboratory testing at enrollment. Main Outcome Measures: Eye examination findings at enrollment. Results: As of March 31, 2003, 1632 participants with AIDS were enrolled. Evidence of intraocular inflammation was substantially more common among patients with cytomegalovirus (CMV) retinitis or other major ocular complications than among those without, as were the complications of infection and inflammation, including cataracts, pseudophakia, macular edema, and epiretinal membrane. Among patients with CMV retinitis, macular edema and epiretinal membrane formation were most common among patients with long-standing retinitis and immune recovery. Patients with newly diagnosed retinitis had eye examination findings similar to those reported in the pre-HAART era. Visual impairment (< 20/40) in the better-seeing eye was present in 9.2% of patients with CMV retinitis, 41.4% of patients with other major ocular complications (primarily ocular opportunistic infections), and only 0.6% of patients with no major ocular complication (P <.0001). Although patients without major ocular complications generally had good visual acuity, approximately 9.8% of eyes and 6.6% of participants had contrast sensitivity loss sufficient to impair reading speed. Conclusions: In the HAART era, CMV retinitis and other ocular opportunistic infections are associated with intraocular inflammation, structural ocular complications, and visual impairment. Patients with newly diagnosed CMV retinitis have eye examination findings similar to those seen in the pre-HAART era.