HIV associated ocular disease.pptx
- 1. HIV associated ocular disease MAKENI COLLEGE OF HEALTH SCIENCES
- 2. Ocular manifestations occur in 75% of HIV/AIDS patients Maybe the only presenting feature of the infection in an otherwise healthy patient
- 3. Classification 1. Retinal microvasculopathy Occurs due to vaso-occlusive process due to direct toxic effects of the virus on vascular endothelium or immune complex deposits in the precapillary arterioles
- 4. Features Cotton wool spots Superficial & deep retinal hemorrhages Microaneurysms & telangiectasia DD CMV retinitis DM retinopathy
- 5. 2. Usual Ocular infections also seen in healthy people but occur with greater frequency and produce more severe infections in patients with HIV/AIDS. Herpes zoster ophthalmicus Herpes simplex infections Toxoplasmosis (chorioretinitis) Ocular tuberculosis, syphilis, fungal corneal ulcers.
- 6. 3. Opportunistic infections caused by microorganisms which do not affect immunocompetent people Cellular immunity suppressed by HIV or leukemia CMV retinitis Candida endophthalmitis Cryptococcus P. Jiroveci
- 7. CMV Retinitis Most common ocular OI HAART has reduced the incidence
- 8. Clinical features 1. indolent retinitis 2. Fulminating retinitis 3. Perivascular retinitis
- 9. Indolent retinitis Starts in the periphery Progresses slowly Mild granular opacification Few punctate haemorrhages No vasculitis
- 11. Fulminating retinitis- pizza-pie appearance Mild vitritis Vasculitis with perivascular sheathing Retinal opacification Dense white, geographical areas of opacification Retinal haemorrhages Brush-fire like extension along the vascular arcades Retinal detachment in uncontrolled disease
- 13. Perivascular retinitis Frosted branch angiitis along the course of the vessel
- 15. Treatment Valganciclovir 900mg BD 2-3wks, then OD Ganciclovir 5mg/kg BD,2-3wks then OD (S/E ; bone marrow suppression) Foscarnet 60mg/kg TDS 2-3 wks, then 90- 200mg OD Cidofovir 5mg/kg once weekly 2wks, then every fortnight (S/E ; nephrotoxicity)
- 16. Toxoplasma chororetinitis Lesions are larger Bilateral in 40% Vitreous inflammatory reaction overlying the area May have no pre-existing scars
- 18. Macular pigmented chorioretinal scar in Toxoplasmosis
- 19. Systemic prednisolone 1mg/kg initially then tapered according to clinical response Pyrimethamine 50mg loading, 25-50mg daily for 4weeks Sulfadiazine 1g qid for 3-4 weeks given with pyrimethamine Others Clindamycin Spiramycin, azithromycin
- 20. Syphilitic chorioretinitis Include uveitis Optic neuritis Non necrotizing retinitis Dermatological and CNS symptoms
- 21. Classic manifestation of syphilis Unilateral or bilateral pale yellow placoid retinal lesions that involve the macula Exudative RD Vitritis
- 24. Treatment 18-24 mln units IV penicillin 10-14days Then 2.4 mln units benzathine penicillin weekly for 3 weeks
- 25. Pneumocystis jiroveci choroididtis Slightly elevated, plaque-like yellow-white lesions Minimal vitritis Investigations CXR LFTs Abdominal scan
- 28. Treatment IV Trimethoprin (20mg/kg/day) 3weeks And sulfamethoxazole 100mg/kg/day Or pentamide 4mg/kg/day
- 29. Cryptococcus neoformans choroiditis Choroidal lesions Optic nerve oedema (from increased IOP)
- 32. 4. Unusual neoplasms Kaposis sarcoma - malignant vascular tumor which may appear on the eyelid or conjunctiva as multiple nodules Seen in about 3% cases of AIDS Burkitts lymphoma of the orbit is also seen in a few patients.
- 33. 5. Neuro-ophthalmic lesions - are thought to be due to CMV or other infections of the brain Include isolated or multiple cranial nerve palsies resulting in paralysis of eyelids, extraocular muscles, loss of sensory supply to the eye and optic nerve involvement causing loss of vision.
- 34. TX CMV infections can be treated by gancyclovir and foscarnet Kaposis sarcoma responds to radiotherapy Herpes zoster ophthalmicus - acyclovir.