Archives of Ophthalmology

1996 Archives of Ophthalmology

doi: 10.1001/archopht.1996.01100140007001

Abstract Background: In the Foscarnet-Ganciclovir Cytomegalovirus (CMV) Retinitis Trial, time to first progression of newly diagnosed CMV retinitis was similar in the 2 treatment groups but was shorter when assessed by grading of fundus photographs at a central reading center than when assessed at the participating clinical centers. This report describes the extent and causes of this disagreement and considers the implications of the findings for clinical practice and future research. Methods: Clinical findings and photographic gradings were compared for extent and activity of retinitis at baseline and during follow-up. In selected cases of disagreement, the photographs and summaries of gradings and clinical findings were reviewed concurrently to determine the cause of disagreement. Results: Movement of the border of retinitis was observed sooner and activity of the border was considered to have increased more often at the reading center than at the clinical centers. Disagreements on time to first progression were more frequent when degree of border movement was small (odds ratios [ORs] for several comparisons ranged from 1.7 to 5.2), when border activity was judged to have decreased or remained the same since the preceding visit (OR, 2.0-193), and when retinitis at baseline did not involve zone 1 (the area within 1 disc diameter of the disc or within 2 disc diameters of the center of the macula [OR, 1.4-3.6]). There were 2 important causes of disagreement between clinical center and reading center. First, difficulty was encountered clinically in recognizing retinitis border movement in the absence of an obvious increase in border activity. Second, the reading center used a threshold for border movement small enough to be crossed by an initial expansion of retinitis borders occurring within 2 to 5 weeks of enrollment in some patients who were responding favorably to treatment (in that retinitis was becoming inactive and showed no further progression for many weeks). Conclusions: Comparisons of photographs from the current visit with those from several previous visits may increase clinicians' abilities to detect progression promptly. The use of additional outcome measures by reading centers, such as border movement of 1500 μm or more and change in area of retina involved by retinitis, may provide more accurate and useful comparisons of treatments. In making such comparisons, centralized photographic grading has the advantages of greater reproducibility and lesser risk of observer bias. References 1. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Studies of Ocular Complications of AIDS Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial, 1: rationale, design, and methods . Controlled Clin Trials . 1992;13:22-39.Crossref 2. Studies of Ocular Complications of AIDS Research Group in collaboration with AIDS Clinical Trials Group. Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis . N Engl J Med . 1992;326:213-220.Crossref 3. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial, 4: visual outcomes . Ophthalmology . 1994;101:1250-1261.Crossref 4. Holland GN, Buhles WC Jr, Mastre B, Kaplan HJ, UCLA CMV Retinopathy Study Group. A controlled retrospective study of ganciclovir treatment for cytomegalovirus retinopathy: use of a standardized system for the assessment of disease outcome . Arch Ophthalmol . 1989;107:1759-1766.Crossref 5. Palestine AG, Polis MA, DeSmet MD, et al. A randomized, controlled trial of foscarnet in the treatment of cytomegalovirus retinitis in patients with AIDS . Ann Intern Med . 1991;115:665-673.Crossref 6. Drew WL, Ives D, Lalezari JP, et al. Oral ganciclovir as maintenance treatment for cytomegalovirus retinitis in patients with AIDS . N Engl J Med . 1995;333:615-620.Crossref 7. Holland GN, Levinson RD, Jacobson MA, the AIDS Clinical Trials Group, Protocol 915 Team. Dose-related difference in progression rates of cytomegalovirus retinopathy during foscarnet maintenance therapy . Am J Ophthalmol . 1995;119:576-586. 8. The Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Combination foscarnet and ganciclovir therapy vs monotherapy for the treatment of relapsed cytomegalovirus retinitis in patients with AIDS . Arch Ophthalmol . 1996;114:23-33.Crossref

Jabs, Douglas A.;Dunn, J. P.;Enger, Cheryl;Forman, Michael;Bressler, Neil;Charache, Patricia

1996 Archives of Ophthalmology

doi: 10.1001/archopht.1996.01100140023002pmid: 8660163

Abstract Objective: To determine the prevalence of cytomegalovirus (CMV) isolates resistant to ganciclovir sodium or foscarnet sodium at the time of diagnosis of CMV retinitis, prior to the initiation of therapy. Design: Prospective epidemiologic study. Setting: An acquired immunodeficiency syndrome ophthalmology clinic. Patients: Patients with acquired immunodeficiency syndrome and newly diagnosed CMV retinitis. Intervention: Culturing blood and urine samples for CMV and testing of all positive isolates for sensitivity to ganciclovir and foscarnet. Main Outcome Measure: Prevalence of the following: blood culture isolates resistant to ganciclovir (inhibitory concentration 50% [IC50]>5.5 μmol/L) or foscarnet (IC50>400 μmol/L) and urine culture isolates resistant to ganciclovir or foscarnet. Results: Forty-nine patients were enrolled during a 13-month period. Forty-four patients had blood culture samples that could be evaluated; of these, 66% were positive (59% of patients). Thirty-four patients had urine cultures that were evaluable; of these, 82% were positive (57% of patients). Overall, 78% of patients had either a urine or blood culture sample positive for CMV. No blood culture isolates were resistant to ganciclovir, and only 1 urine culture isolate (2% of patients) was resistant to ganciclovir. Three percent of blood culture isolates and 4% of urine culture isolates (2% and 2% of patients, respectively) were resistant to foscarnet. Overall, 4% of patients had either a blood or urine culture isolate resistant to foscarnet. Conclusion: Resistance to ganciclovir or foscarnet at the time of diagnosis of CMV retinitis is uncommon. References 1. Holland GN, Pepose JS, Pettit TH, Gottlieb MS, Yee RD, Foos RY. Acquired immune deficiency syndrome: ocular manifestations . Ophthalmology . 1983;90:859-873.Crossref 2. Palestine AG, Rodrigues MM, Macher AM, et al. Ophthalmic involvement in acquired immunodeficiency syndrome . Ophthalmology . 1984;91:1092-1099.Crossref 3. Freeman WR, Lerner CW, Mines JA, et al. A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome . Am J Ophthalmol . 1984;97:133-142. 4. Pepose JS, Holland GN, Nestor MS, Cochran AJ, Foos RY. Acquired immune deficiency syndrome: pathogenic mechanisms of ocular disease . Ophthalmology . 1985;92:472-484.Crossref 5. Jacobson MA, Mills J. Serious cytomegalovirus disease in the acquired immunodeficiency syndrome (AIDS) . Ann Intern Med . 1988;108:585-594.Crossref 6. Jabs DA, Enger C, Bartlett JG. Cytomegalovirus retinitis and acquired immunodeficiency syndrome . Arch Ophthalmol . 1989;107:75-80.Crossref 7. Pertel P, Hirschtick R, Phair J, Chmiel J, Poggensee L, Murphy R. Risk of developing cytomegalovirus retinitis in persons infected with the human immunodeficiency virus . JAcquir Immune Defic Syndr Hum Retrovirol . 1992;5:1069-1074. 8. Gallant JE, Moore RD, Richman DD, Keruly J, Chaisson RE, for the Zidovudine Epidemiology Study Group. Incidence and natural history of cytomegalovirus disease in patients with advanced human immunodeficiency virus disease treated with zidovudine . J Infect Dis . 1992;166:1223-1227.Crossref 9. Hoover DR, Saah AJ, Bacellar H, et al. Clinical manifestations of AIDS in the era of Pneumocystis prophylaxis . N Engl J Med . 1993;329:1922-1926.Crossref 10. Collaborative DHPG Treatment Study Group. Treatment of serious cytomegalovirus infections with 9-(1,3-dihydroxy-2-propoxymethyl)guanine in patients with AIDS and other immunodeficiencies . N Engl J Med . 1986;314:801-805.Crossref 11. Holland GN, Buhles WC Jr, Mastre B, Kaplan HJ, and the UCLA CMV Retinopathy Study Group. A controlled retrospective study of ganciclovir treatment for cytomegalovirus retinopathy: use of a standardized system for the assessment of disease outcome . Arch Ophthalmol . 1989;107:1759-1766.Crossref 12. Gross JG, Bozzette SA, Mathews WC, et al. Longitudinal study of cytomegalovirus retinitis in acquired immune deficiency syndrome . Ophthalmology . 1990;97:681-686.Crossref 13. Spector SA, Weingeist T, Pollard RB, et al. A randomized, controlled study of intravenous ganciclovir therapy for cytomegalovirus peripheral retinitis in patients with AIDS . J Infect Dis . 1993;168:557-563.Crossref 14. Palestine AG, Polis MA, De Smet MD, et al. A randomized, controlled trial of foscarnet in the treatment of cytomegalovirus retinitis in patients with AIDS . Ann Intern Med . 1991;115:665-673.Crossref 15. Studies of Ocular Complications of AIDS Research Group in Collaboration With the AIDS Clinical Trials Group. Foscarnet-ganciclovir cytomegalovirus retinitis trial, 4: visual outcomes . Ophthalmology . 1994;101:1250-1261.Crossref 16. The Oral GCV European and Australian Cooperative Study Group. Intravenous versus oral ganciclovir: European/Australian comparative study of efficacy and safety in the prevention of cytomegalovirus retinitis recurrence in patients with AIDS . AIDS . 1995;9:471-477.Crossref 17. Drew WL, Ives D, Lalezari JP, et al. Oral ganciclovir as maintenance treatment for cytomegalvirus retinitis in patients with AIDS . N Engl J Med . 1995;333:615-620.Crossref 18. Martin DF, Parks DJ, Mellow SD, et al. Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant: a randomized controlled clinical trial . Arch Ophthalmol . 1994;112:1531-1539.Crossref 19. Drew WL, Miner RC, Busch DF, et al. Prevalence of resistance in patients receiving ganciclovir for serious cytomegalovirus infection . J Infect Dis . 1991;163:716-719.Crossref 20. Erice A, Chou S, Biron KK, Stanat SC, Balfour HH Jr, Jordan MC. Progressive disease due to ganciclovir-resistant cytomegalovirus in immunocompromised patients . N Engl J Med . 1989;320:289-293.Crossref 21. Knox KK, Drobyski WR, Carrigan DR. Cytomegalovirus isolate resistant to ganciclovir and foscarnet from a marrow transplant patient . Lancet . 1991;337:1292-1293.Crossref 22. Sullivan V, Coen DM. Isolation of foscarnet-resistant human cytomegalovirus patterns of resistance and sensitivity to other antiviral drugs . J Infect Dis . 1991;164:781-784.Crossref 23. Flores-Aguilar M, Kuppermann BD, Quiceno JI, et al. Pathophysiology and treatment of clinically resistant cytomegalovirus retinitis . Ophthalmology . 1993;100:1022-1031.Crossref 24. Dunn JP, MacCumber MW, Forman MS, Charache P, Apuzzo L, Jabs DA. Viral sensitivity testing in patients with cytomegalovirus retinitis clinically resistant to foscarnet or ganciclovir . Am J Ophthalmol . 1995;119:587-596. 25. Danker WM, Scholl D, Stanat SC, Martin M, Sonke RL, Spector SA. Rapid antiviral DNA-DNA hybridization assay for human cytomegalovirus . J Virol Methods . 1990;28:293-298.Crossref 26. Drew WL, Miner RC, Saleh E. Antiviral susceptibility of cytomegalovirus: criteria for detecting resistance to antivirals . Clin Diagn Virol . 1993;1:179-185.Crossref 27. Swierkosz E, Biron K. Antiviral susceptibility testing . In: Isenberg HD, ed. Clinical Microbiology Procedure Handbook Supplement II . Washington, DC: American Society for Microbiology; 1994;2:8.26.1-8.26.21. 28. Jabs DA. Ocular manifestations of HIV infection . Trans Am Ophthalmol Soc . 1995;93:623-683. 29. Jacobson MA, Drew WL, Feinberg J, et al. Foscarnet therapy for ganciclovirresistant cytomegalovirus retinitis in patients with AIDS . J Infect Dis . 1991;163:1348-1351.Crossref 30. Aweeka F, Ganbertoglio J, Mills J, Jacobson MA. Pharmacokinetics of intermittently administered intravenous foscarnet in the treatment of acquired immunodeficiency syndrome patients, with serious cytomegalovirus retinitis . Antimicrob Agents Chemother . 1989;33:742-745.Crossref 31. Kupperman BD, Quiceno JI, Flores-Aguilar M, et al. Intravitreal ganciclovir concentration after intravenous administration in AIDS patients with cytomegalovirus retinitis: implications for therapy . J Infect Dis . 1993;168:1506-1509.Crossref 32. Drew WL, Sweet ES, Miner RC, Mocarski ES. Multiple infections by cytomegalovirus in patients with acquired immunodeficiency syndrome: documentation by Southern blot hybridization . J Infect Dis . 1984;150:952-953.Crossref 33. Spector SA, Hirata KK, Neuman TR. Identification of multiple cytomegalovirus strains in homosexual men with acquired immunodeficiency syndrome . J Infect Dis . 1984;150:953-956.Crossref

Marx, Jeffrey L.;Kapusta, Michael A.;Patel, Sunil S.;LaBree, Laurie D.;Walonker, Francis;Rao, Narsing A.;Chong, Lawrence P.

1996 Archives of Ophthalmology

doi: 10.1001/archopht.1996.01100140029003pmid: 8660164

Abstract Objective: To evaluate the efficacy of the ganciclovir implant in the treatment of recurrent cytomegalovirus (CMV) retinitis. Methods: Patients with acquired immunodeficiency syndrome and recurrent CMV retinitis were evaluated for entry into the study. A ganciclovir implant was inserted in 91 eyes of 70 patients between October 1992 and October 1995. The efficacy of the implant and visual results were retrospectively reviewed. Results: Fifty-three (76%) of 70 eyes had inactive CMV retinitis 1 month postoperatively (positive initial response). Twenty-one eyes of 19 patients had less than 1 month of follow-up. Nineteen (36%) of 53 eyes developed recurrent CMV retinitis. The median time to recurrence for those patients with a positive initial response was 7 months. Forty-eight (84%) of57 patients with follow-up longer than 1 month after implant insertion in the first eye received systemic anti-CMV medication during the study. The cumulative risk for developing a retinal detachment was 23% at 6 months following implant insertion. Other complications included vitreous hemorrhage, hyphema, and suprachoroidal implantation of the device. Conclusion: The ganciclovir implant is effective as an adjunct to continued systemic therapy in those patients with recurrent CMV retinitis. References 1. Holland GN, Pepose JS, Pettit TH, Gottlieb MS, Yee RD, Foos RY. Acquired immune deficiency syndrome: ocular manifestations . Ophthalmology . 1983;90:859-873.Crossref 2. Palestine AG, Rodrigues MM, Macher AM, et al. Ophthalmic involvement in acquired immunodeficiency syndrome . Ophthalmology . 1984;91:1092-1099.Crossref 3. Pepose JS, Holland GN, Nestor MS, Cochran AJ, Foos RY. Acquired immune deficiency syndrome: pathogenic mechanisms of ocular disease . Ophthalmology . 1985;92:472-484.Crossref 4. Jabs DA, Green WR, Fox R, Folk BF, Bartlett JG. Ocular manifestations of acquired immune deficiency syndrome . Ophthalmology . 1989;96:1092-1099.Crossref 5. Gross JG, Bozette SA, Mathews WC, et al. Longitudinal study of cytomegalvirus retinitis in acquired immune deficiency syndrome . Ophthalmology . 1990;97:681-686.Crossref 6. Orellana J, Teich SA, Friedman AH, Lerebours F, Winterkonn J, Mildvan D. Combined short- and long-term therapy for the treatment of cytomegalovirus retinitis using ganciclovir (BW B759U) . Ophthalmology . 1987;94:831-838.Crossref 7. Jabs DA, Newman C, de Bustros S, Polk BF. Treatment of cytomegalovirus retinitis with ganciclovir . Ophthalmology . 1987;94:824-830.Crossref 8. Holland GN, Sidikaro Y, Kreiger AE, et al. Treatment of cytomegalovirus retinopathy with ganciclovir . Ophthalmology . 1987;94:815-823.Crossref 9. Henderly DE, Freeman WR, Causey DM, Rao NA. Cytomegalovirus retinitis and response to therapy with ganciclovir . Ophthalmology . 1987;94:425-434.Crossref 10. Holland GN, Buhles WC Jr, Mastre B, Kaplan HJ, UCLA CMV Retinopathy Study Group. A controlled retrospective study of ganciclovir treatment for cytomegalovirus retinopathy: use of a standardized system for the assessment of disease outcome . Arch Ophthalmol . 1989;107:1759-1766.Crossref 11. LeHoang P, Girard B, Robinet M, et al. Foscarnet in the treatment of cytomegalovirus retinitis in acquired immune deficiency syndrome . Ophthalmology . 1989;96:865-873.Crossref 12. Palestine AG, Polis MA, DeSmet MD, et al. A randomized, controlled trial of foscarnet in the treatment of cytomegalovirus retinitis in patients with AIDS . Ann Intern Med . 1991;115:665-673.Crossref 13. Holland GN, Shuler JD. Progression rates of cytomegalovirus retinopathy in ganciclovir-treated and untreated patients . Arch Ophthalmol . 1992;110:1435-1442.Crossref 14. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Foscarnet-Gancicloivir Cytomegalovirus Retinitis Trial, 4: visual outcomes . Ophthalmology . 1994;101:1250-1261.Crossref 15. Kuppermann BD, Flores-Aguilar M, Quiceno JI, Rickman LS, Freeman WR. Combination ganciclovir and foscarnet in the treatment of clinically resistant cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome . Arch Ophthalmol . 1993;111:1359-1366.Crossref 16. Henry K, Cantrill H, Fletcher C. Use of intravitreal ganciclovir (dihydroxy propoxymethyl guanine) for cytomegalovirus retinitis in a patient with AIDS . Am J Ophthalmol . 1987;103:17-23. 17. Ussery FM III, Gibson SR, Conklin RH, Piot DF, Stool EW, Conklin AJ. Intravitreal ganciclovir in the treatment of AIDS-associated cytomegalovirus retinitis . Ophthalmology . 1988;95:640-648.Crossref 18. Cantrill HL, Henry K, Melroe NH, Knobloch WH, Ramsay RC, Balfour HH. Treatment of cytomegalovirus retinitis with intravitreal ganciclovir: long-term results . Ophthalmology . 1989;96:367-374.Crossref 19. Diaz-Llopis M, Chipont E, Sanchez S, Espana E, Navea A, Menezo JL. Intravitreal foscarnet for cytomegalovirus retinitis in a patient with acquired immunodeficiency syndrome . Am J Ophthalmol . 1992;114:742-747. 20. Heinemann M-H. Long-term intravitreal ganciclovir therapy for cytomegalovirus retinopathy . Arch Ophthalmol . 1989;107:1767-1772.Crossref 21. Sanborn GE, Anand R, Torti RE, et al. Sustained-release ganciclovir therapy for treatment of cytomegalovirus retinopathy: use of an intravitreal device . Arch Ophthalmol . 1992;110:188-195.Crossref 22. Anand R, Nightingale SD, Fish RH, Smith TJ, Ashton P. Control of cytomegalovirus retinitis using sustained release of intraocular ganciclovir . Arch Ophthalmol . 1993;111:223-227.Crossref 23. Smith TJ, Pearson PA, Blandford DL, et al. Intravitreal sustained-release ganciclovir . Arch Ophthalmol . 1992;110:255-258.Crossref 24. Martin DF, Parks DJ, Mellow SD, et al. Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant . Arch Ophthalmol . 1994;112:1531-1539.Crossref 25. Freeman WR, Henderly DE, Wan WL, et al. Prevalence, pathophysiology, and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis . Am J Ophthalmol . 1986;103:527-536. 26. Jabs DA, Enger C, Haller J, de Bustros S. Retinal detachments in patients with cytomegalovirus retinitis . Arch Ophthalmol . 1991;109:794-799.Crossref 27. Sidikaro Y, Silver L, Holland GN, Kreiger AE. Rhegmatogenous retinal detachments in patients with AIDS and necrotizing retinal infections . Ophthalmology . 1991;98:129-135.Crossref 28. Freeman WR, Friedberg DN, Berry C. Risk factors for development of rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis . Am J Ophthalmol . 1993;116:713-720.

Hoover, Donald R.;Peng, Yun;Saah, Alfred;Semba, Richard;Detels, Roger R.;Rinaldo, Charles R.;Phair, John P.

1996 Archives of Ophthalmology

doi: 10.1001/archopht.1996.01100140035004pmid: 8660165

Abstract Objective: To estimate the incidence and prevalence of cytomegalovirus retinitis (CMV-R) in late-stage human immunodeficiency virus type 1 disease. Design: Cohort study. Setting: The Multicenter AIDS Cohort Study, an ongoing 10-year study of human immunodeficiency virus type 1-infected homosexual men with semiannual visits and CD4+ cell testing. Study Participants: Three hundred sixty-seven human immunodeficiency virus type 1-infected men from the Multicenter AIDS Cohort Study who were receiving zidovudine and Pneumocystis carinii prophylaxis and who had CD4+ cell counts fall below 0.10×109/L(100/μL). Main Outcome Measures: Kaplan-Meier—type estimates for various longitudinal quantifications of incidence and prevalence of CMV-R were obtained. Results: Among these 367 individuals, cytomegalovirus disease developed in 103, of whom 73 (71%) had ocular complications. At 4 years after the first CD4 cell count (<0.1 10×109/L), the probability for these subjects to have (1) remained living without CMV-R was 11%, (2) died without experiencing CMV-R was 66%, (3) experienced CMV-R and be living was 6%, and (4) experienced CMV-R and died was 18%. During these 4 years, there was a 25% chance for the development of CMV-R and, on average, 0.211 person-years of CMV-R morbidity. Among those subjects in whom CMV-R developed, about 19% did have CMV-R before a CD4+ cell count of less than 0.05 ×109/L (<50/μL) was observed, and 81% had CMV-R after the CD4+ cell count reached this threshold. Conclusion: These estimates may be relevant to current clinical practice and help in allocating resources and planning for treatment and prophylaxis against cytomegalovirus disease. References 1. Jacobson MA, Mills D. Serious cytomegalovirus disease in the acquired immunodeficiency syndrome (AIDS) . Ann Intern Med . 1988;108:585-594.Crossref 2. Gallant JE, Moore RD, Richman DD, Keruly J, Chaisson RE, and the Zidovudine Epidemiology Study Group. Incidence and natural history of cytomegalovirus disease in patients with advanced human immunodeficiency virus disease treated with zidovudine . J Infect Dis . 1992;166:1223-1227.Crossref 3. Jabs DA, Green WR, Fox R, Polk BF, Bartlett JG. Ocular manifestations of acquired immunodeficiency syndrome . Ophthalmology . 1989;96:1092-1099.Crossref 4. Palestine AG, Polis MA, De Smet MD, et al. A randomized controlled trial of foscarnet in the treatment of cytomegalovirus retinitis in patients with AIDS . Ann Intern Med . 1991;115:665-673.Crossref 5. Holland GN, Buhles NC Jr, Mastre B. A controlled trial of ganciclovir treatment for cytomegalovirus retinopathy use of a standardized system for assessment of disease outcome . Arch Ophthalmol . 1989;107:1759-1766.Crossref 6. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis . N Engl J Med . 1992;326:213-220.Crossref 7. Gallant JE, Moore RO, Chaisson RE. Prophylaxis for opportunistic infections in patients with HIV infection . Ann Intern Med . 1994;120:931-944.Crossref 8. Quinn TC, Piot P, McCormick JB, et al. Serologic and immunologic studies in patients with AIDS in North America and Africa: the potential role of infectious agents as cofactors in human immunodeficiency virus infection . JAMA . 1987;257:2617-2621.Crossref 9. Sullivan JL, Brewster FE, Brettler DB, et al. Hemophiliac immunodeficiency: influence of exposure to factor VIII concentrate LAV/HTLV-III and herpes virus . J Pediatr . 1986;108:504-510.Crossref 10. Quinnan GV, Masur H, Rook AH, et al. Herpes virus infections in the acquired immune deficiency syndrome . JAMA . 1984;252:72-77.Crossref 11. Collier AC, Meyers JD, Corey L, Murphy VL, Roberts PL, Handsfield HH. Cytomegalovirus infection in homosexual men: relationship to sexual practices, antibody to human Immunodeficiency virus and cell-mediated immunity . Am J Med . 1987;82:593-601.Crossref 12. Drew WL, Mintz L, Miner RC, Sands M, Ketterer B. Prevalence of cytomegalovirus infection in homosexual men . J Infect Dis . 1981;143:188-192.Crossref 13. Rinaldo CR Jr, Kingsley LA, Ho M, Armstrong JA, Zhou S. Enhanced shedding of cytomegalovirus in semen of human immunodeficiency virus-seropositive homosexual men . J Clin Microbiol . 1992;30:1148-1155. 14. Rinaldo CR Jr. Cytomegalovirus as a cofactor in HIV infection and AIDS . In: Watson RR, ed. Cofactors in HIV-1 Infection and AIDS . Boca Raton, Fla: CRC Press Inc; 1989:151-185. 15. Hoover DR, Saah AJ, Bacellar H, et al. Clinical manifestations of AIDS in the era of Pneumocystis carinii prophylaxis . N Engl J Med . 1993;329:1922-1926.Crossref 16. Crowe SM, Carlin JB, Stewart KI, Lucas CR, Hoy JF. Predictive value of CD4 lymphocyte numbers for the development of opportunistic infections and malignancies in HIV-infected persons . J Acquir Immune Defic Syndr Hum Retrovirol . 1991;4:771-776. 17. Schwartlander B, Horsburgh CR, Hamouda O, Skrabis H, Koch MA. Changes in the spectrum of AIDS-defining conditions and decrease in CD4+ lymphocyte counts at AIDS manifestations in Germany from 1986 to 1991 . AIDS . 1992;6:413-420.Crossref 18. Pertel P, Hirschtick R, Phair J, Chmiel J, Poggensee L, Murphy R. Risk of developing cytomegalovirus retinitis in persons infected with human immunodeficiency virus . J Acquir Immune Defic Syndr Hum Retrovirol . 1992;5:1069-1074. 19. Luckie A, Ai E. Diagnosis and management of cytomegalovirus retinitis in AIDS . Curr Opin Ophthalmol . 1993;4:81-89.Crossref 20. Kaslow RA, Ostrow DG, Detels R, Phair JP, Polk BF, Rinaldo CR Jr. The Multicenter AIDS Cohort Study: rationale, organization and selected characteristics of the participants . Am J Epidemiol . 1987;126:310-318.Crossref 21. Centers for Disease Control. Update acquired immunodeficiency syndrome—United States . MMWR Morbid Mortal Wkly Rep . 1987;32:245-248. 22. Kuppermann BD, Petty JG, Richman DG, et al. Correlation between CD4+ counts and prevalence of cytomegalovirus and human immunodeficiency virusrelated noninfectious renal vasculopathy in patients with acquired immunodeficiency syndrome . Am J Ophthalmol . 1993;115:575-582. 23. Baldassano V, Dunn JP, Feinberg J, Jabs DA. Cytomegalovirus retinitis and low CD4+ t-lymphocyte counts . N Engl J Med . 1995;333:670.Crossref 24. Centers for Disease Control. Guidelines for prophylaxis against Pneumocystis carinii pneumonia for persons infected with human immunodeficiency virus . MMWR Morbid Mortal Wkly Rep . 1989;38( (suppl 5) ):1-9. 25. Aalen O. Nonparametric estimation of partial transition probabilities in multiple decrement models . Ann Stat . 1978;6:534-545.Crossref 26. Anderson PK, Borgain O, Gill RD, Keiding N. Statistical Methods Based on Counting Processes . New York, NY: Springer-Verlag NY Inc; 1994. 27. Hoover DR, Peng Y, Saah AJ, Detels RR, Rinaldo CR, Phair JP. Projecting disease when death is likely . Am J Epidemiol . 1996;143:943-952.Crossref

Plummer, Daniel J.;Arevalo, J. Fernando;Fram, Nicole;Quiceno, Jose I.;Sample, Pamela A.;Freeman, William R.

1996 Archives of Ophthalmology

doi: 10.1001/archopht.1996.01100140042005pmid: 8660166

Abstract Objective: To determine the the effectiveness of random particle motion, presented on a computer monitor, as a noninvasive test for detecting cytomegalovirus retinitis. Design: A prospective masked study in which patients were asked to trace out any disturbances on a transparency placed over a computer monitor that displayed continuous random particle motion, while the patient fixated on a central spot (entoptic perimetry). Setting: The Acquired Immunodeficiency Syndrome Ocular Research Unit at the University of California, San Diego, in La Jolla. Patients: Twenty-two men with cytomegalovirus retinitis who were positive for human immunodeficiency virus, 11 men without cytomegalovirus retinitis who were positive for human immunodeficiency virus, and eight men who were negative for human immunodeficiency virus. Intervention: None. Measurements: Sensitivities and specificities were used to compare the results of entoptic perimetry with fundus photographs. Results: Entoptic perimetry demonstrated a 95% sensitivity and a 95% specificity in detection of cytomegalovirus retinitis. Conclusion: Entoptic perimetry may be an effective and inexpensive screening test for cytomegalovirus retinitis in hospitals and community clinics. References 1. Hoover DR, Saah AJ, Bacellar H, et al. Clinical manifestations of AIDS in the era of Pneumocystis prophylaxis: Multicenter AIDS Cohort Study . N Engl J Med . 1993;329:1992-1926.Crossref 2. Holland GN. Ophthalmic disorders associated with the acquired immune deficiency syndrome . In: Insler MS, ed. AIDS and Other Sexually Transmitted Diseases and the Eye . Orlando, Fla: Grune & Stratton Inc; 1987:145-172. 3. Kuppermann BD, Petty JG, Richman DD, et al. Correlation between CD4+ counts and prevalence of cytomegalovirus retinitis and human immunodeficiency virusrelated noninfectious retinal vasculopathy in patients with acquired immunodeficiency syndrome . Am J Ophthalmol . 1993;115:575-582. 4. Gross JG, Bozzette SA, Mathews WC, et al. Longitudinal study of cytomegalovirus retinitis in acquired immune deficiency syndrome . Ophthalmology . 1990;97:681-686.Crossref 5. Studies of Ocular Complications of AIDS (SOCA) Research Group in collaboration with the AIDS Clinical Trials Group (ACTG). Studies of ocular complications of AIDS: foscarnet-ganciclovir cytomegalovirus retinitis trial, 2: mortality . N Engl J Med . 1992;326:213-220.Crossref 6. Bachman DM, Bruni LM, DiGioia RA, et al. Visual field testing in the management of cytomegalovirus retinitis . Ophthalmology . 1992;99:1393-1399.Crossref 7. Quiceno JI, Capparelli E, Sadun AA, et al. Visual dysfunction without retinitis in patients with the acquired immunodeficiency syndrome . Am J Ophthalmol . 1992;113:8-13. 8. Aulhorn E, Kost G. White noise-field campimetry: a new form of perimetric examination . Klin Monatsbl Augenheilkd . 1988;194:284-288.Crossref 9. Ramachandran VS. Blind spots . Sci Am . 1992;266:86-91.Crossref 10. Ramachandran VS, Gregory RL. Perceptual filling in of artificially induced scotomas in human vision . Nature . 1991;350:699-702.Crossref 11. Troxler D. Über Das Verschwinden grgebener Gegenstände innerhalb unseres Gesichtskreises . In: Himly, Schmidt, eds. Ophthalm. Bibliothek. II . Jenna; 1804:51-53. 12. Moses R, Hart W, eds. Adler's Physiology of the Eye: Clinical Application . St Louis, Mo: CV Mosby Co; 1987:395. 13. Ryan S, ed. Retina . St Louis, Mo: CV Mosby Co; 1994;1:153-154.

Cunningham, Emmett T.;Short, Graham A.;Irvine, Alexander R.;Duker, Jay S.;Margolis, Todd P.

1996 Archives of Ophthalmology

doi: 10.1001/archopht.1996.01100140048006pmid: 8660167

Abstract Objectives: To describe 2 patients with acquired immunodeficiency syndrome who experienced a rapidly progressive, bilateral retinitis due to herpes simplex virus (HSV) (1 case due to HSV type 1 [HSV-1] and 1 case due to HSV type 2 [HSV-2]) and to present a novel diagnostic polymerase chain reaction (PCR)—based assay. Methods: The presentation, clinical course, and diagnostic PCR-based assay used to make the diagnosis of HSV retinitis in 2 patients with acquired immunodeficiency syndrome are described. Results: Both patients experienced a rapidly progressive, bilateral retinal necrosis associated with intraretinal hemorrhages and a diffuse vasculitis. The PCR-based assays demonstrated HSV DNA in the vitreous specimens from the 2 patients. Restriction analysis on the amplified DNA showed HSV-1 in 1 patient and HSV-2 in the second patient. The diagnosis was supported in both patients by the occurrence of a herpes simplexlike encephalitis, and in 1 patient by a positive vitreous culture. The HSV-1—associated vasculitis affected primarily the retinal arterioles, with marked capillary dropout and occlusion of larger arcade vessels. In contrast, the HSV-2—associated vasculitis affected the retinal veins more than the arterioles, and was associated with an exudative retinal detachment. Conclusions: To our knowledge, these are the first 2 patients with acquired immunodeficiency syndrome in whom HSV has been implicated as the sole cause of a rapidly progressing, necrotizing retinitis. Combined PCR and restriction analysis of vitreous samples from such patients is a useful and highly specific means of diagnosing HSV-1 and HSV-2 retinitis. References 1. Schuman JS, Friedman AH. Retinal manifestations of the acquired immune deficiency syndrome . Eye . 1983;103:177-189. 2. Palestine AG, Rodrigues MM, Macher AM, et al. Ophthalmic involvement in the acquired immune deficiency syndrome . Ophthalmology . 1984;91:1092-1099.Crossref 3. Freeman WR, Lerner CW, Mines JA, et al. A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome . Am J Ophthalmol . 1984;97:133-142. 4. Pepose JS, Holland GN, Nestor MS, Cochran AJ, Foos RY. Acquired immune deficiency syndrome: pathogenic mechanisms of ocular disease . Ophthalmology . 1985;92:474-484. 5. Jabs DA, Green WR, Fox R, Polk BF, Bartlett JG. Ocular manifestations of acquired immune deficiency syndrome . Ophthalmology . 1989;96:1092-1099.Crossref 6. Pertel P, Hirschtick R, Phair J, Chmiel J, Poggensee L, Murphy R. Risk of developing cytomegalovirus retinitis in persons infected with the human immunodeficiency virus . J Acquir Immune Defic Syndr . 1992;5:1069-1074. 7. Friberg TR, Jost BF. Acute retinal necrosis in an immunosuppressed patient . Am J Ophthalmol . 1984;98:515-517.Crossref 8. Jabs DA, Schachat AP, Liss R, Knox DL, Michel RG. Presumed varicella-zoster retinitis in immunocompromised patients . Retina . 1987;7:9-13. 9. Foster DJ, Dugel PU, Frangieh GT, Liggett PE, Rao NA. Rapidly progressive outer retinal necrosis in the acquired immunodeficiency syndrome . Am J Ophthalmol . 1990;110:341-348. 10. Margolis TP, Lowder CY, Holland GN, et al. Varicella-zoster virus retinitis in patients with acquired immunodeficiency syndrome . Am J Ophthalmol . 1991;112:119-131. 11. Engstrom RE Jr, Holand GN, Margolis TP, et al. The progressive outer retinal necrosis syndrome: a variant of necrotizing herpetic retinopathy in patients with AIDS . Ophthalmology . 1994;101:1488-1502.Crossref 12. Short GA, Margolis TP, Kuppermann DB, et al. A PCR-based assay for the diagnosis of AIDS-associated VZV retinitis. Am J Ophthalmol. In press. 13. Siegel D, Golden E, Washington AE, et al. Prevalence and corelates of herpes simplex infections: the population-based AIDS in multiethnic neighborhoods study . JAMA . 1992;268:1702-1708.Crossref 14. Sidikaro Y, Silver L, Holland GN, Kreiger AE. Rhegmatogenous retinal detachments in patients with AIDS and necrotizing retinal infections . Ophthalmology . 1991;98:129-135.Crossref 15. Freeman WR, Thomas EL, Rao NA, et al. Demonstration of herpes group virus in acute retinal necrosis syndrome . Am J Ophthalmol . 1986;102:701-709. 16. Pepose JS, Hilborne LH, Cancilla PA, Foos RY. Concurrent herpes simplex and cytomegalovirus retinitis and encephalitis in the acquired immune deficiency syndrome (AIDS) . Ophthalmology . 1984;91:1669-1677.Crossref 17. Rummelt V, Rummelt C, Gahn G, et al. Triple retinal infection with human immunodeficiency virus type 1, cytomegalovirus, and herpes simplex type 1: light and electron microscopy, immunohistochemistry, and in situ hybridization . Ophthalmology . 1994;101:270-279.Crossref 18. Cao M, Xiao X, Egbert B, Darragh TM, Yen TS. Rapid detection of cutaneous herpes simplex virus infection with the polymerase chain reaction . J Invest Dermatol . 1989;92:391-392.Crossref 19. Lakeman FD, Whitley RJ, and the National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease . J Infect Dis . 1995;171:857-863.Crossref 20. Matsuo T, Date S, Tsuji T, et al. Immune complex containing herpes-virus antigen in a patient with acute retinal necrosis syndrome . Ophthalmology . 1989;96:875-878.Crossref 21. Lewis ML, Culbertson WW, Post JD, Miller D, Kokame GT, Dix RD. Herpes simplex virus type 1: a cause of the acute retinal necrosis syndrome . Ophthalmology . 1989;101:368-371. 22. Shibata D, Martin WJ, Appleman MD, Causey DM, Leedom JM, Arnheim M. Detection of cytomegalovirus DNA in peripheral blood of patients infected with human immunodeficiency virus . J Infect Dis . 1988;158:1185-1192.Crossref 23. McCann JD, Margolis TP, Wong MG, et al. A sensitive and specific polymerase chain reaction—based assay for the diagnosis of cytomegalovirus retinitis . Am J Ophthalmol . 1994;118:219-226. 24. Pavan-Langston D, Brockhurst RJ. Herpes simplex panuveitis: a clinical report . Arch Ophthalmol . 1969;81:783-787.Crossref 25. Minckler DS, McLean EB, Shaw CM, Hendrickson A. Herpesvirus hominis encephalitis and retinitis . Arch Ophthalmol . 1976;94:89-95.Crossref 26. Bloom JN, Katz JI, Kaufman HE. Herpes simplex retinitis and encephalitis in an adult . Arch Ophthalmol . 1977;95:1798-1799.Crossref 27. Savir H, Grosswasser Z, Mendelson L. Herpes virus hominis encephalomyelitis and retinal vasculitis in adults . Ann Ophthalmol . 1980;12:1369-1371. 28. Grutzmacher RD, Henderson D, McDonald PJ, Coster DJ. Herpes simplex chorioretinitis in a healthy adult . Am J Ophthalmol . 1983;96:788-796. 29. Peyman GA, Goldberg MF, Uninsky E, Tessler H, Pulido J, Hendricks R. Vitrectomy and intravitreal antiviral drug therapy in acute retinal necrosis syndrome: report of two cases . Arch Ophthalmol . 1984;102:1618-1621.Crossref 30. Ludwig IH, Zegarra H, Zakov ZN. The acute retinal necrosis syndrome: possible herpes simplex retinitis . Ophthalmology . 1984;91:1659-1664.Crossref 31. Sarkies N, Gregor Z, Forsey T, Darougar S. Antibodies to herpes simplex virus type 1 in intraocular fluids of patients with acute retinal necrosis . Br J Ophthalmol . 1986;70:81-84.Crossref 32. Duker JS, Nielsen JC, Eagle RC Jr, Bosley TM, Granadier R, Benson WE. Rapidly progressive acute retinal necrosis secondary to herpes simplex virus, type 1 . Ophthalmology . 1990;97:1638-1643.Crossref 33. Margolis TP, Atherton SS. Herpes simplex virus diseases: posterior segment of the eye . In: Pepose JS, Holland GN, Wilhelmus KR, eds. Ocular Infection and Immunity . St Louis, Mo: Mosby—Year Book; 1996:1155-1167. 34. Partamian LG, Morse PH, Klein HZ. Herpes simplex type 1 retinitis in an adult with systemic herpes zoster . Am J Ophthalmol . 1981;92:215-220. 35. Uninsky E, Jampol LM, Kaufman S, Naraqi S. Disseminated herpes simplex infection with retinitis in a renal allograft recipient . Ophthalmology . 1983;90:175-178.Crossref 36. Balfour HH Jr, Benson C, Braun J, et al. Management of acyclovir-resistant herpes simplex and varicella-zoster virus infections . J Acquir Immune Defic Syndr . 1994;7:254-260. 37. Erlich KS, Jacobson MA, Koehler JE, et al. Foscarnet therapy for severe acyclovirresistant herpes simplex virus type-2 infections in patients with the acquired immunodeficiency syndrome (AIDS): an uncontrolled trial . Ann Intern Med . 1989;110:710-713.Crossref 38. Safrin S, Crumpacker C, Chatis P, et al. A controlled trial comparing foscarnet with vidarabine for acyclovir-resistant mucocutaneous herpes simplex in the acquired immunodeficiency syndrome . N Engl J Med . 1991;325:551-555.Crossref 39. Coen DM. Molecular aspects of anti-herpesvirus drugs . Semin Virol . 1992;3:3-12.

1996 Archives of Ophthalmology

doi: 10.1001/archopht.1996.01100140054007

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract In the article titled "Imaging Congenital Optic Disc Pits and Associated Maculopathy Using Optical Coherence Tomography," published in the February Archives (1996;114:165-170), the authors inadvertently left the name of a coauthor out of the byline. On page 165, "Richard Rosen, MD" should have appeared after the mention of the fourth author.

Wu, Albert W.;Coleson, Laura C.;Holbrook, Janet;Jabs, Douglas A.

1996 Archives of Ophthalmology

doi: 10.1001/archopht.1996.01100140055008pmid: 8660168

Abstract Objective: To develop and test a brief questionnaire designed to assess visual symptoms, visual function in daily activities, and impact of treatment administration in patients with cytomegalovirus retinitis related to acquired immunodeficiency syndrome. Design: Observational cross-sectional study. Patients were recruited in June and July 1992. Setting: Seven university-based sites participating in the Studies of Ocular Complications of AIDS. Patients: Twenty-six subjects enrolled in a randomized trial that compared foscarnet and ganciclovir for the treatment of cytomegalovirus retinitis. Main Outcome Measures and Analysis: Distributions of scores, reliability, and validity of newly developed scales to assess visual function, visual symptoms, and global vision. Spearman rank correlations with 95% confidence intervals were used to test hypothesized relationships between scale scores, visual acuity, visual field, and findings from visual examination. Results: The final 18-item self-administered questionnaire required 5 minutes to complete. The new scales had high internal consistency (Cronbach α=.81 to.94). As hypothesized, patient-reported vision scores decreased with greater abnormalities found on ophthalmologic examination. Visual symptoms were most strongly related to findings in the worse eye. Visual function and global vision scores were moderately correlated with findings from visual testing and examination, and less strongly related to general health perceptions. Patients reported considerable impairment: 42% reported blurred vision; 40%, difficulty reading; 44%, difficulty driving; and 40%, that treatment interfered with social activities; 50% reported substantial trouble with their vision. Conclusions: The brief questionnaire developed to assess patient-reported visual function in cytomegalovirus retinitis appears reliable and valid as a measure of performance of vision-related activities, visual symptoms, and the impact of treatment administration. Further research is needed to test its utility as an outcome measure in longitudinal studies of cytomegalovirus retinitis. References 1. Hoover DR, Saah AJ, Bacellar H, et al. Clinical manifestations of AIDS in the era of the Pneumocystis prophylaxis . N Engl J Med . 1993;329:1922-1926.Crossref 2. Jabs DA, Enger C, Bartlett JG. Cytomegalovirus retinitis and acquired immunodeficiency syndrome . Arch Ophthalmol . 1989;107:75-80.Crossref 3. Genensky SM. Acuity measurements—do they indicate how well a partially sighted person functions or could function? Am J Optom Physiol Opt . 1976;53:809-812.Crossref 4. Elliot DB, Hurst MA, Weatherill J. Comparing clinical tests of visual function in cataract with the patient's perceived visual disability . Eye . 1990;4:712-717.Crossref 5. Bernth-Petersen P. Visual functioning in cataract patients: methods of measuring and results . Acta Ophthalmol . 1981;59:198-205.Crossref 6. Javitt JC, Brenner MH, Curbow B, Legro MW, Street DA. Outcomes of cataract surgery . Arch Ophthalmol . 1993;111:686-691.Crossref 7. Mangione CM, Phillips RS, Seddon JM, et al. Development of the Activities of Daily Vision Scale . Med Care . 1992;30:1111-1126.Crossref 8. Brenner MH, Curbow B, Javitt J, Legro MW, Sommer A. Vision change and quality of life in the elderly . Arch Ophthalmol . 1992;111:680-685.Crossref 9. Steinberg EP, Tielsch JM, Schein OD, et al. The VF-14: an index of functional impairment in patients with cataract . Arch Ophthalmol . 1994;112:630-638.Crossref 10. User's Manual: Cataract Type Specification . Bloomington, Minn: Health Outcomes Institute; 1993. 11. Applegate WB, Miller ST, Elam JT, Freeman JM, Wood TO, Gettlefinger TC. Impact of cataract surgery with lens implantation on vision and physical function in elderly patients . JAMA . 1987;257:1064-1066.Crossref 12. Kleiner RC, Enger C, Alexander MF, Fine SL. Contrast sensitivity in age related macular degeneration . Arch Ophthalmol . 1988;106:55-57.Crossref 13. Ball K, Owsley C. The useful field of view test: a new technique for evaluating age-related declines in visual function . J Am Optom Assoc . 1993;64:71-79. 14. Ferguson BA, Buxton MJ, Drummond MF. Measuring and valuing health states related to visual impairment: a review of the literature, concepts, and methods . In: Drummond MF, ed. Measuring the Quality of Life of People With Visual Impairment: Proceedings of a Workshop . Washington, DC: US Dept of Health and Human Services; 1990:69-92. National Institutes of Health publication 903078. 15. Scott IU, Schein OD, West S, Bandeen-Roche K, Enger C, Folstein MF. Functional status and quality of life measurement among ophthalmic patients . Arch Ophthalmol . 1993;112:329-335.Crossref 16. Babbie ER. The Practice of Social Research . 4th ed. Belmont, Calif: Wadsworth Publishing Co; 1986:265. 17. National Center for Health Statistics. Current Estimates From the Health Interview Survey: United States, 1968 . Washington, DC: National Center for Health Statistics; 1970. Public Health Service publication 1000, series 10, No. 63. 18. Stewart AL, Hays RD, Ware JE. The MOS Short-Form General Health Survey: reliability and validity in a patient population . Med Care . 1988;26:724-735.Crossref 19. Ware JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36), I: conceptual framework and item selection . Med Care . 1992;30:473-483.Crossref 20. Rubin HR, Wu AW, Gutierrez M, Liriano 0, Safrin S. Reliability and validity of English and Spanish versions of a quality of life instrument for acute Pneumocystis carinii pneumonia. Read before the VIII International Conference on AIDS, July 20-23, 1992, Amsterdam, the Netherlands. 21. The Diabetic Retinopathy Study Research Group. Designs, methods, and baseline and results: DRS report #6 . Invest Ophthalmol Vis Sci . 1981;21( (1, 2) ):149-209. 22. Ferris FL III, Kassoff A, Bresnick GH, Bailey I. New visual acuity charts for clinical research . Am J Ophthalmol . 1982;94:91-96. 23. Ferris FL III, Sperduto RD. Standardized illumination for visual acuity testing in clinical research . Am J Ophthalmol . 1982;94:97-98. 24. Bailey IL, Lobie JE. New design principles for visual acuity letter charts . Am J Optom Physiol Opt . 1976;53:740-745.Crossref 25. Studies of the Ocular Complications of AIDS (SOCA) Research Group in collaboration with the AIDS Clinical Trials Group (ACTG). Studies of the Ocular Complications of AIDS Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial: rationale, design, and methods . Controlled Clin Trials . 1992;13:22-39.Crossref 26. Cronbach LJ. Coefficient alpha and the internal structure of tests . Psychometrika . 1951;16:297.Crossref 27. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis . N Engl J Med . 1992;326:213-220.Crossref 28. Sullivan P, Caldwell G, Alexander N, Kohner E. Long term outcome after photocoagulation for proliferative diabetic retinopathy . Diabet Med . 1990;7:788-794.Crossref 29. Spellman DC, Alexander KR, Fishman GA, Derlack DJ. Letter contrast sensitivity in retinitis pigmentosa patients assessed by Regan charts . Retina . 1989;9:287-291.Crossref 30. Bernth-Petersen P. Outcome of cataract surgery, II: visual functioning in aphakic patients . Acta Ophthalmol . 1982;60:243-251.Crossref 31. Bernth-Petersen P. Cataract surgery . Acta Ophthalmol Suppl . 1985;174:9-47. 32. Gardner MJ, Altman DG. Statistics With Confidence: Confidence Intervals and Statistical Guidelines . London, England: British Medical Journal; 1989:46. 33. Karnofsky DA, Abelman WH, Craver LF, Burcheneal JH. The use of nitrogen mustards in the palliative treatment of carcinoma . Cancer . 1948;1:634-656.Crossref 34. Nunnally JC. Psychometric Theory . New York, NY: McGraw-Hill International Book Co; 1978:245. 35. Helmstater GC. Principles of Psychological Measurement . New York, NY: Appleton-Century-Crofts; 1964. 36. Guyatt GH, Bombardier C, Tugwell PX. Measuring disease specific quality of life in clinical trials . Can Med Assoc J . 1986;134:889-895. 37. Patrick DL, Deyo RA. Generic and disease-specific measures in assessing health status and quality of life . Med Care . 1989;27:S217-S233.Crossref 38. Wu AW, Rubin HR, Mathews WC, et al. A health status questionnaire using 30 items from the Medical Outcomes Study . Med Care . 1991;29:786-798.Crossref 39. Wu AW, Rubin HR, Mathews WC, et al. Functional status and well-being in a placebo-controlled trial of zidovudine in early AIDS-related complex . J Acquir Immune Defic Syndr . 1993;6:452-458.Crossref 40. Wu AW, Lichter SL, Richardson W, et al. Quality of life in patients receiving clarithromycin for Mycobacterium avium complex (MAC) infection and AIDS. Read before the VIII International Conference on AIDS, July 20-23,1992, Amsterdam, the Netherlands. 41. Burgess A, Catalan J, Deyer M, et al. The reliability and validity of two HIVspecific health-related quality of life measures . AIDS . 1993;7:1001-1008.Crossref 42. Ganz PA, Schag CAC, Kahn B, Petersen L. Assessing the quality of life of HIV infected persons . Psychol Health . 1994;9:93-110.Crossref 43. Wachtel T, Piette J, Mor V, Stein M, Fleishman J, Carpenter C. Quality of life in persons with human immunodeficiency virus infection: measurement by the Medical Outcomes Study instrument . Ann Intern Med . 1992;116:129-137.Crossref 44. Bozzette SA, Hays RD, Berry SH, Knaouse DE, Wu AW. Derivation and properties of a brief health-related quality-of-life assessment instrument for use in HIV disease . J Acquir Immune Defic Syndr . 1995;8:253-265.Crossref 45. Lubeck DP, Fries JE. Health status among persons infected with human immunodeficiency virus: a community based study . Med Care . 1993;31:3.Crossref 46. Ware JE. Scales for measuring general health perceptions . Health Serv Res . 1976;11:396-415. 47. Croog SH, Levine S. Quality of life and health care interventions . In: Freeman HE, Levine S, eds. Handbook of Medical Sociology . 4th ed. Englewood Cliffs, NJ: Prentice-Hall International Inc; 1989:508-528. 48. Brislin RW. Back-translation for cross-cultural research . J Cross Cult Psychol . 1970;1:185-216.Crossref

1996 Archives of Ophthalmology

doi: 10.1001/archopht.1996.01100140062009

Abstract Objective: To illustrate 2 common problems encountered in evaluating the response of cytomegalovirus retinitis to antiviral treatment and to consider their clinical importance. Methods: Four illustrative cases were selected from 76 cases reviewed during a study that compared clinical evaluation and centralized grading of fundus photographs in the assessment of cytomegalovirus retinitis. Results: These cases illustrate 2 problems noted during the review: (1) that progression of retinitis may be difficult to recognize clinically in the absence of an obvious increase in retinitis border activity and (2) that movement of retinitis borders by 750 μm or more (the principal criterion used to define retinitis progression) during the initial 4 weeks of treatment does not necessarily represent an unfavorable response to treatment. Conclusions: Ophthalmologists who participate in the management of cytomegalovirus retinitis should be aware of the subtlety of retinitis activity that sometimes accompanies progression in patients undergoing treatment with currently approved agents. Side-by-side comparison of good-quality photographs from the current visit (as soon as they are available) with photographs from previous visits, using adequate illumination and magnification, may be helpful in detecting progression promptly. When applying the results of clinical trials to clinical practice, clinicians should not equate retinitis border movement of 750 μm or more during the first 4 weeks of treatment with treatment failure. References 1. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Assessment of cytomegalovirus retinitis: clinical evaluation vs centralized grading of fundus photographs . Arch Ophthalmol . 1996;114:791-805.Crossref 2. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Studies of ocular complications of AIDS Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial, 1: rationale, design and methods . Controlled Clin Trials . 1992;13:22-39.Crossref 3. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis . N Engl J Med . 1992;326:213-220.Crossref 4. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial, 4: visual outcomes . Ophthalmology . 1994;101:1250-1261.Crossref

1996 Archives of Ophthalmology

doi: 10.1001/archopht.1996.01100140069010

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract In the report titled "Aggressive Conjunctival Squamous Cell Carcinoma in Three Young Africans," published in the February Archives (1996;114:215-218), an error was made in the abstract section. On page 215, the last sentence should have read as follows: "Test results for human papillomavirus were negative in all three cases." We regret the error.