Retinal vascular occlusion in patients infected with human immunodeficiency virus.

Abstract

To describe the clinical features of retinal vascular occlusions (macrovasculopathy) and the proportion of affected patients with human immunodeficiency virus (HIV) infection. Retrospective chart review of all HIV-infected individuals with retinal vascular occlusions seen at a single tertiary care clinic between November 1983 and May 1998. Retinal vascular occlusion was found in 38 eyes of 33 (1.3%) of the 2,484 consecutive patients examined. Of the 33 patients, 16 (48.5%) had central retinal vein occlusion, 9 (27.3%) had branch retinal vein occlusion, 4 (12.1%) had hemiretinal vein occlusion, and 1 each (3.0%) had central retinal arterial occlusion, branch retinal arterial occlusion, and combined hemiretinal vein occlusion and branch retinal artery occlusion. One patient (3.0%) had Purtscher-like retinopathy in one eye. Multiple regression analysis revealed that macrovasculopathy was associated with the presence of noninfectious retinal microvasculopathy (odds ratio, 5.76; 95% confidence interval, 2.59-12.80). Vision at the time of diagnosis ranged between 20/20 and no light perception. Twenty-five (75.8%) of the 33 patients had follow-up examinations for a mean period of 9.1 months. Ocular findings during follow-up included capillary dropout in 3 patients (11.5%), posterior pole neovascularization in 4 (15.4%), vitreous hemorrhage in 4 (15.4%), and optic atrophy in 6 (23.1%). Vision at the last eye examination ranged between 20/20 and no light perception and was 20/200 or worse in 15 (39.5%) of 38 eyes. Patients with HIV infection have a small risk of retinal vascular occlusion, but complications and visual loss are common in affected patients. There is a strong association between noninfectious retinal microvasculopathy and retinal vein occlusions.