TY - JOUR
T1 - Risk of cataract in persons with cytomegalovirus retinitis and the acquired immune deficiency syndrome
AU - Kempen, John H.
AU - Sugar, Elizabeth A.
AU - Lyon, Alice T.
AU - Lewis, Richard Alan
AU - Jabs, Douglas A.
AU - Heinemann, Murk Hein
AU - Dunn, James P.
N1 - Funding Information:
Supported by cooperative agreements from the National Eye Institute, National Institutes of Health , Bethesda, Maryland, to the Mount Sinai School of Medicine (grant no.: U10 EY 08052 ), to The Johns Hopkins University Bloomberg School of Public Health (grant no.: U10 EY 08057 ), and to the University of Wisconsin, Madison School of Medicine (grant no.: U10 EY 08067 ); the National Center for Research Resources through General Clinical Research Center grants to Baylor College of Medicine (grant no.: 5M01 RR 00350 ), The Johns Hopkins University School of Medicine (grant no.: 5M01 RR 00052 ), LSU/Tulane/Charity Hospital (grant no.: 5M01 RR 05096 ), the University of California , Los Angeles (grant no.: 5M01 RR 00865 ), the University of North Carolina (grant no.: 5M01 RR00046 ), the University of Southern California (grant no.: 5M01 RR00043 ), and Weill Medical College of Cornell University (grant no.: 5M01 RR00047 ); and cooperative agreements Louisiana State University/Tulane (grant no.: U01 AI 27674 ), the University of California , Los Angeles (grant no.: U01 AI 27660 ), University of California , San Diego (grant no.: U01 AI 27670 ), the University of California , San Francisco (grant no.: U01 AI 27663 ), the University of North Carolina (grant no.: U01 AI25868 ), Washington University at St. Louis (grant no.: U01 AI25903 ), and the University of Pennsylvania (grant no.: U01 AI32783 ); the Paul and Evanina Mackall Foundation; Research to Prevent Blindness, Inc, New York, New York (D.A.J., R.A.L.); and the National Eye Institute (grant no.: EY004505 [D.A.J.]).
PY - 2012/11
Y1 - 2012/11
N2 - Objective: To evaluate cataract risk in eyes of patients with AIDS and cytomegalovirus (CMV) retinitis and to identify risk factors. Design: Prospective cohort study. Participants: Patients with AIDS and CMV retinitis. Methods: Patients 13 years of age and older were enrolled between 1998 and 2008. Demographic and clinical characteristics, slit-lamp biomicroscopy findings, and dilated ophthalmoscopy results were documented at quarterly visits. Cataract status was determined at the initial visit (prevalence) and at follow-up visits (incidence). Main Outcome Measures: For cataract, a high grade of lens opacity by biomicroscopy to which best-corrected visual acuity worse than 20/40 was attributed. Eyes that had undergone cataract surgery before enrollment or between visits also were counted as having cataract. Results: Seven hundred twenty-nine eyes of 489 patients diagnosed with CMV retinitis were evaluated. Higher prevalence was observed for patients with bilateral versus unilateral CMV retinitis (adjusted odds ratio [aOR], 2.74; 95% confidence interval [CI], 1.76-4.26) and, among unilateral CMV retinitis cases, for eyes with retinitis versus without retinitis (15% vs. 1.4%; P<0.0001). The age-adjusted prevalence of cataract among CMV retinitis cases was higher than that in a population-based sample (P<0.0001). Cataract prevalence increased with age (aOR, 11.77; 95% CI, 2.28-60.65 for age <60 years vs. younger than 40 years) and longer duration of retinitis (aOR, 1.36; 95% CI, 1.20-1.54 per year). Among eyes with CMV retinitis initially free of cataract, the cataract incidence was 8.1%/eye-year (95% CI, 6.7%-10.0%). Prior retinal detachment was associated with higher cataract risk (if repaired with silicone oil: adjusted hazard ratio [aHR], 10.37; 95% CI, 6.51-16.52; otherwise: aHR, 2.90; 95% CI, 1.73-4.87). Large CMV retinitis lesions also were associated with higher risk of cataract (for involvement of 25-49% retinal area: aHR, 2.30; 95% CI, 1.51-3.50; for <50% involvement: aHR, 3.63; 95% CI, 2.18-6.04), each with respect to ≤24% involvement, as were anterior segment inflammation (aHR, 2.27; 95% CI, 1.59-3.25) and contralateral cataract (aHR, 2.52; 95% CI, 1.74-3.66). Conclusions: Cytomegalovirus retinitis is associated with a high absolute and relative risk of cataract. Among several risk factors, large retinal lesion size and use of silicone oil in retinal detachment repair are potentially modifiable, albeit not in all cases. Cataract is likely to be an increasingly important cause of visual morbidity in this population. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
AB - Objective: To evaluate cataract risk in eyes of patients with AIDS and cytomegalovirus (CMV) retinitis and to identify risk factors. Design: Prospective cohort study. Participants: Patients with AIDS and CMV retinitis. Methods: Patients 13 years of age and older were enrolled between 1998 and 2008. Demographic and clinical characteristics, slit-lamp biomicroscopy findings, and dilated ophthalmoscopy results were documented at quarterly visits. Cataract status was determined at the initial visit (prevalence) and at follow-up visits (incidence). Main Outcome Measures: For cataract, a high grade of lens opacity by biomicroscopy to which best-corrected visual acuity worse than 20/40 was attributed. Eyes that had undergone cataract surgery before enrollment or between visits also were counted as having cataract. Results: Seven hundred twenty-nine eyes of 489 patients diagnosed with CMV retinitis were evaluated. Higher prevalence was observed for patients with bilateral versus unilateral CMV retinitis (adjusted odds ratio [aOR], 2.74; 95% confidence interval [CI], 1.76-4.26) and, among unilateral CMV retinitis cases, for eyes with retinitis versus without retinitis (15% vs. 1.4%; P<0.0001). The age-adjusted prevalence of cataract among CMV retinitis cases was higher than that in a population-based sample (P<0.0001). Cataract prevalence increased with age (aOR, 11.77; 95% CI, 2.28-60.65 for age <60 years vs. younger than 40 years) and longer duration of retinitis (aOR, 1.36; 95% CI, 1.20-1.54 per year). Among eyes with CMV retinitis initially free of cataract, the cataract incidence was 8.1%/eye-year (95% CI, 6.7%-10.0%). Prior retinal detachment was associated with higher cataract risk (if repaired with silicone oil: adjusted hazard ratio [aHR], 10.37; 95% CI, 6.51-16.52; otherwise: aHR, 2.90; 95% CI, 1.73-4.87). Large CMV retinitis lesions also were associated with higher risk of cataract (for involvement of 25-49% retinal area: aHR, 2.30; 95% CI, 1.51-3.50; for <50% involvement: aHR, 3.63; 95% CI, 2.18-6.04), each with respect to ≤24% involvement, as were anterior segment inflammation (aHR, 2.27; 95% CI, 1.59-3.25) and contralateral cataract (aHR, 2.52; 95% CI, 1.74-3.66). Conclusions: Cytomegalovirus retinitis is associated with a high absolute and relative risk of cataract. Among several risk factors, large retinal lesion size and use of silicone oil in retinal detachment repair are potentially modifiable, albeit not in all cases. Cataract is likely to be an increasingly important cause of visual morbidity in this population. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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U2 - 10.1016/j.ophtha.2012.05.044
DO - 10.1016/j.ophtha.2012.05.044
M3 - Article
C2 - 22853972
AN - SCOPUS:84868195274
SN - 0161-6420
VL - 119
SP - 2343
EP - 2350
JO - Ophthalmology
JF - Ophthalmology
IS - 11
ER -