Decoding Non-CMV IRU: insights into a Novel Entity
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Yes
Purpose
Describe immune recovery uveitis (IRU) in patients with non- cytomegalovirus retinitis (CMVR) ocular opportunistic infections
Methods
Retrospective review 1896 patients over 30 year period
Results
15 eyes, 9 patients found to have non- CMVR IRU. Average age 36 years, with 2 female and 7 male patients. 5 eyes/ 3 patients (3.8%) had both CMVR & toxoplasma retinochoroiditis, 2 eyes of 1 patient (1.3%) had toxoplasma retinochoroiditis & herpes simplex virus (HSV) retinitis, 3 eyes of 2 patients (2.5%) had toxoplasma retinochoroiditis, 3 eyes of 2 patients (2.5%) had HSV retinitis, and 2 eyes of 1 patient (1.3%) had syphilis. 86.6% eyes presented with intermediate uveitis, 13.33% with vasculitis. Cases of non CMVR IRU were compared with CMVR IRU and was found to be comparable in terms of CD4 counts at all points of the disease timeline, durations and visual outcomes. Non CMVR-IRU CD4 counts at nadir was 51cells/μl, at diagnosis of OI 113cells/μl, at diagnosis of IRU 379cells/μl, increase from nadir was 212.5cells/μl. Time to recover was 44.52 weeks, final visual outcome was logMAR 0.6002. OCT-A done in 4 eyes of 2 patients, 2 eyes reduction of the CME lead to reduction of dark flow void areas on SCP+ DCP on follow up, suggest no ischemic drive to macular edema. Treatment was topical steroids in 5 eyes, topical steroids+ NSAID in 2 eyes, oral steroids in 2 eyes; posterior subtenon triamcinolone (PST), topical NSAIDs, topical& oral steroids, topical+ oral steroids+ PST were all used in 1 eye each. 2 eyes of 2 patients developed recurrent IRU, and 2 eyes of 1 patient developed recurrent CME which was managed by dexamethasone implant
Conclusion
CMVR- IRU & non CMVR- IRU are comparable & can be managed similarly. The visual outcomes are also equivalent
Conflict of interest
No
1
Last name
PYARE
Initials of first name(s)
R
Department
Uvea and Medical Retina
City
Delhi
Country
India
2
Last name
Sridharan
Initials of first name(s)
S
Department
Uvea & Intraocular Inflammation
City
Chennai
Country
India
3
Last name
Manglik
Initials of first name(s)
H
Department
Ophthalmology
City
Chennai
Country
India
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