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E. Gonzalez, MD PhD
Opthalmological Protocol
A. Patients diagnosed HIV positive
i. Newly diagnosed patients
a. Initial opthalmological exam:
i. Yearly eye exam unless symptoms
ii. If exam confirms an HIV related retinopathy then:
Workup includes:
i. PPD/sarcoid/TB (->to determin masquerade syndrome)
ii. Syphilis (RPR)
iii.Torch titers
Exam will include precise information concerning the
location/type and progression of the disease:
1. Location (zone I, II, III) within retina.
2. Type (granular indolent vs inflammatory) in the case
of CMV compared to Toxo or acute retinal necrosis (e.g.,
HSV, HZV).
3. Induction therapy - IV gancylovir by MD
4. Re-evaluation after 2 weeks induction period followed
by a monthly follup up.
Progression: Occurs when previously uninfected retina becomes
involved either by enlargement of pre-existing lesions or
development of new ones.
Activity: Defined by the severity of lesion border
opacity. Lesions with white borders are considered
active. Lesions without border opacification are
inactive.
B. Indications for Treatment:
The goal of threrapy is to preserve vision. However, the toxic side
effects of treatment complicate the decision (e.g., retinal holes/retinal
detachments/bone marrow suppression and subsequent retinal
endophalmitis).
Accepted Indications:
1. Immediate viision threatening lesions (zone I) in one or
both eyes.
2. Extension peripheral lesions (zones II and III).
With no current available vaccine or cure for HIV, there will be an
increased need for early diagnosis/treatment and management of this
potentially visually crippling disease.
With this preface in mind, the opthalmologic protocol is as follows:
i. If the lesion remains active and progressive, consider
re-induction vs different treatment modalit. Follow up
within 2 weeks until stable; then, within one month.
If the disease is progressive, then consider retinal biopsy for
diagnosis.
ii. If lesion completely inactive, follow up within 6 weeks and
then 3 months followed by yearly exams.
C. Patients diagnosisted HIV+ yiled 1% - current studies
i. Examine yearly unless there is a visual complaint.
