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AIDS

 

Ocular Complications develop in 75% of AIDS patients

  1. Retinal Microangiopathy
    1. Non – infectious
    2. Cotton wool spots, hemorrhages, microaneurysms
  2. Opportunistic  infection
    1. CMV retinitis : Most common infectious cause postesior uveritis in HIV patents
      1. Treatment :
        1. I/V Ganciclovir
        2. I/V Foscarnet
        3. Intravitreal Ganciclovir Implants (Vitrasert) 
    2. Pneumocystis carinii choroiditis 
    3. Cryptococcus Choroiditis-
      1. Optic nerve involvement - disc swelling or retro bulbar neuritis.
      2. Other fungal infections that involve the posterior segment are - candidiasis and Histoplasmosis
      3. Creamy choroidal lesions
    4. Varicella – zoster Retinitis –Rapidly progressive outer retinal necrosis (PORN*).
  3. Toxoplasmosis
    Cat is a definitive host and humans, mice are intermediate host.
    1. Mode of Infection - Most commonly is in foetal life and later it reoccurs in old healed chorio – retinal scar due to rupture of cyst.
    2. Ocular Features
      1. Iridocyclitis -  Granulomatous or non -granulomatous
      2. Posterior Uveitis:
        1. Focal superficial necrotizing retinitis “Headlight in fog - appearance” *
        2. Deep retinitis (involving outer retinal layer)
        3. Granuloma
        4. Papillitis
    3. Treatment:
      1. Systemic steroids, - In immuno compromised patients sub- tenon injections are given.
      2. Co-trimoxazole
      3. Pyrimethamine.  Spiramycin in pregnancy
  4. Ocular Malignancy
  1. Large – cell – intra ocular Lymphoma
  2. Kapos’s Sarcoma-MC malignancy in HIV
  3. HIV risk factor for OSSN





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