Proliferative Vitreoretinopathy in Human Immunodeficiency Virus-infected Patients in the Era of Highly Active Antiretroviral Therapy

PurposeTo assess the prevalence of proliferative vitreoretinopathy (PVR) and prognosis of cytomegalovirus (CMV) retinitis–related retinal detachment (RD) surgery in the era of highly active antiretroviral therapy (HAART).DesignRetrospective interventional cohort study.MethodsThirty-five human immunodeficiency virus (HIV)-positive patients with CMV retinitis–related RD who underwent surgical repair were assessed for PVR, CD4-positive T cell counts, and use of HAART. Main outcome measures included anatomic and functional outcomes of RD surgery as well as the presence of PVR and CD4-positive T cell counts.ResultsPVR was present in 10 of 35 patients (29%) at the time of the first surgery. The presence of PVR was associated with worse preoperative and postoperative visual acuity (P = .017 and P = .009, respectively), with the CD4-positive T cell counts above 200 cells/μL (P = .054), and with a longer interval between the diagnosis of RD and surgery (P = .025). The odds ratio for development of PVR in patients with CD4-positive T cells above 200 cells/μL was 11.3 (95% confidence interval 1.01-125). PVR was not associated with age, gender, or duration of HIV infection. Anatomic reattachment was obtained in 31 patients (89%), though the functional outcomes were limited. The central location of CMV retinitis was associated with postoperative visual acuity (VA) of less than 0.1 (P = .000). Postoperative logMAR VA was associated with preoperative logMAR VA (P < .001) and development of PVR (P = .009).ConclusionPVR was present in 29% of CMV retinitis–related RD and was associated with higher CD4-positive T cell counts and longer interval between the diagnosis of RD and surgery.