Fundus manifestations and HIV viral loads of AIDS patients before and after HAART

AIM: To investigate the fundus manifestations and human immunodeficiency virus(HIV) viral loads of acquired immune deficiency syndrome(AIDS) patients before and after highly active antiretroviral therapy(HAART).METHODS: This retrospective study included 21 AIDS patients(42 eyes) who presented to the Department of Ophthalmology, Peking Union Medical College Hospital, from 2007 to 2011. Among the patients, 16 showed a good response to HAART, 3 presented drug resistance and 2 were pre-HAART. All patients underwent comprehensive ophthalmic examinations. The HIV viral loads and the CD4+ T-cell counts were also determined.RESULTS: The best-corrected visual acuity(BCVA) of 38 eyes(19 patients) was improved, and cytomegalovirus retinitis(CMVR) in 5 eyes(3 patients) regressed after HAART. Furthermore, 16 patients treated with effective HAART had decreased plasma HIV viral loads(<78 copies/mL)and increased CD4+ T-cell counts(343±161 cells/μL, P<0.005), but the HIV viral load in tears was still detected at 2404 copies/mL. The CD4+ T-cell count was lower in the CMVR group than in the non-CMVR group(P=0.022), but the HIV viral load in the tears was not significantly different between the two groups(P=0.439).CONCLUSION: Most patients with AIDS show a good viral response with a decreased HIV viral load and an increased CD4+ T-cell count in plasma after HAART. However, the HIV viral load remain quite high in the tear samples. Based on our results, we suggest that AIDS patients undergo long-term HAART that should not be interrupted.

Microbial spectrum and risk factors of endogenous endophthalmitis in a tertiary center of Northern China

AIM: To study the clinical features, microbial spectrum, associated factors and prognosis of endogenous endophthalmitis(EE) in a group of Chinese patients.METHODS: The medical records from 32 eyes of 29 patients diagnosed with EE in Peking Union Medical College Hospital from January 2009 to October 2019 were reviewed. RESULTS: The initial visual acuity(VA) of 30 eyes in this study was worse than 20/400. Twenty-three eyes were diagnosed with fungal endophthalmitis and nine with bacterial endophthalmitis. The most common fungal and bacterial isolates were Candida and Klebsiella pneumoniae, respectively. Several rare fungi and bacteria species were also isolated from our patients, including Cryptococcus, Paecilomyces, Brucella, and Bacillus licheniformis. The leading risk factor for EE was diabetes. The most common extraocular infection locus was genitourinary tract. Vitrectomy was performed on twenty-nine eyes. Eight eyes achieved final VA of 20/400 or better. EE caused by Candida had a better prognosis.CONCLUSION: The visual outcome of EE is based on pathogens and prompt intervention. Early vitrectomy and antimicrobial treatment are beneficial for EE.

Clinical features and treatment outcomes of intraocular lymphoma:a single-center experience in China

AIM:To investigate the clinical manifestations,diagnostic approaches,treatments,and outcomes of intraocular lymphoma.METHODS:In this retrospective study,16 patients(28 eyes)with intraocular lymphoma were recruited in the Department of Ophthalmology,Peking Union Medical College Hospital,from 2004 to 2019.All patients underwent comprehensive ophthalmic examinations.Vitreous specimens of 13 patients were sent for cytopathology examination and other adjunctive diagnostic procedures.Three patients were diagnosed with intraocular lymphoma according to analysis of the histopathological results of systemic lymphoma by one clinician.Twenty-three eyes were treated with intravitreal administration of methotrexate,4 eyes could not receive ocular treatment due to life-threatening lymphoma,and 1 eye did not require ocular treatment because the fundus lesions regressed after systematic chemotherapy.RESULTS:In 28 eyes,25 eyes were diagnosed with vitreoretinal lymphoma,and 3 eyes were diagnosed with ciliary body lymphoma,all of which were non-Hodgkin diffuse large B cell lymphomas.The final visual acuity improved in 15 eyes(54%),remained unchanged in 5 eyes(18%),and decreased in 8 eyes(29%).Anterior segment inflammation disappeared or reduced in 8 and 5 eyes,respectively;and 15 eyes had no anterior segment reaction.Twenty eyes had mild vitreous opacity,1 eye had mild vitritis,and 7 eyes had pars plana vitrectomy combinedwith silicone oil tamponade.Fundus lesions disappeared in 9 eyes and were relieved in 5 eyes;4 eyes showed no changes,and the remaining 10 eyes’fundus were normal.CONCLUSION:The clinical manifestations of intraocular lymphoma are diverse,and the misdiagnosis rate is high.Cytopathological analysis of vitreous is one of the gold standards for the diagnosis.Immunohistochemistry,gene rearrangement and flow cytometric immunophenotypic analysis can improve the diagnostic rate.Ocular chemotherapy or radiotherapy regimens may preserve visual acuity,and a multidisciplinary team can provide individualized treatment for the patients.

An unusual case report of Burkholderia cepacia endophthalmitis

Dear Editor,I am Huan Chen from the Department of Ophthalmology,Peking Union Medical College Hospital in Beijing,China.I am writing this letter to present an unusual case of Burkholderia cepacia endophthalmitis.Burkholderia cepacia[Burkholderia cepacian complex(Bcc)]is a group of genetically unique Gram-negative bacilli with similar phenotypes,belonging to the genus pseudomonas,which is widely found in water,soil and plants.

Choroidal and ciliary body tubercle: a case report

Dear Editor,I am Bing Li from the Department of Ophthalmology,Peking Union Medical College Hospital in Beijing, China,and I write to present a case report of choroidal and ciliary body tubercles.Ocular tuberculosis (TB) is an extrapulmonary tuberculous condition with variable manifestations[1].

Vascular endothelial growth factor concentration in vitreous humor of patients with severe proliferative diabetic retinopathy after intravitreal injection of conbercept as an adjunctive therapy for vitrectomy

Background:Proliferative diabetic retinopathy(PDR)is a progressive stage of diabetic retinopathy featured by the formation of neovascular and proliferative membrane.Vascular endothelial growth factor(VEGF)acts as a pivot factor in the development of neovascularization.This study was to investigate the changes of intravitreal VEGF concentrations of severe PDR after intravitreal injection of conbercept(IVC)and its potential advantages to the following vitrectomy.Methods:This was a prospective,interventional,randomized controlled study.Sixty eyes(60 patients)with severe PDR and 20 eyes from 20 patients with rhegmatogenous retinal detachment complicated with proliferative vitreoretinopathy were enrolled in this study.PDR eyes were randomly assigned to three groups by sortation randomization method with 20 eyes in each based on the interval of preoperative IVC(group A:7 days,group B:14 days,group C:non-IVC).Another 20 eyes without diabetes were enrolled as the non-diabetic control group(group D),receiving PPV directly.Vitreous specimens of all 80 patients were collected and evaluated afterwards.The intravitreal VEGF concentration of the four groups,and the total surgical time and the intraoperative bleeding rate of the PDR groups were recorded.Results:The mean intravitreal VEGF concentrations of groups A-D were 66.6±43.3,93.1±52.3,161.4±106.1 and 1.8±1.2 pg/mL,respectively.It increased significantly in PDR patients(groups A,B and C)(P=0.002,<0.001,and<0.001,respectively).PDR patients with preoperative IVC(groups A and B)presented significantly lower VEGF concentrations(P<0.001 and 0.001),intraoperative bleeding rates(P=0.004)and total surgical time(P<0.001,P=0.003)compared with group C.No statistical differences were presented between groups A and B on the three parameters.Conclusion:Seven days and 14 days of preoperative IVC are equally efficient and safe for the vitrectomy of severe PDR patients through decreasing vitreous VEGF concentrations,intraoperative bleeding rate and total surgical times.

Varicella-zoster virus as a causative agent of acute retinal necrosis in younger patients

Background: Herpes virus is considered to be the pathogen of acute retinal necrosis (ARN) infection. Previous studies have that patients with ARN caused by the varicella-zoster virus (VZV) are often older, and patients with herpes simplex virus (HSV) induced ARN are considerably younger. However, in our clinical work, we find that VZV is also a pathogen in younger ARN patients. We, therefore, aimed to analyze the common etiology of younger ARN patients. Methods: A retrospective analysis was made of 20 eyes (18 patients) diagnosed as having ARN in the Department of Ophthalmology of Peking Union Medical College Hospital from 2014 to 2016. All patients were reviewed for demographic data, clinical course, clinical manifestations, time from onset to initial physician visit, duration of follow-up, visual acuity at both presentation and final visit, and treatment strategies. A paired t test was used to compare visual acuity between the presenting vision and those of final follow-up. Vitreous or aqueous specimens from 18 eyes of 18 patients were analyzed with multiplex polymerase chain reaction (mPCR)/quantitative PCR (qPCR) and xTAG-liquid chip technology (xTAG-LCT) to determine the causative virus of ARN. Results: Final best visual acuity (BCVA) improved significantly from 1.36±0.95 (median 20/400) to 0.95±0.82 (median 20/100)￠=2.714, P = 0.015) after systemic and intravitreal antiviral treatment combined with or without pars plana vitrectomy. PCR and xTAG-LCT results showed four of the five samples in the younger group (32.2±5.2 years) and 12 of the 13 samples in the senior group (53.6±4.9 years) were positive for VZV, and two of the five samples in the younger group were positive for HSV-1. Conclusions: This study demonstrates that VZV is also a common causative virus for ARN in younger patients. Considering this finding, a systemic antiviral treatment protocol should be immediately changed to intravenous ganciclovir when the patient does not respond to acyclovir before determining the causative virus, especially in younger patients.

Partial AZFc duplications not deletions are associated with male infertility in the Yi population of Yunnan Province,China

Objective:There are many reports on associations between spermatogenesis and partial azoospermia factor c(AZFc) deletions as well as duplications;however,results are conflicting,possibly due to differences in methodology and ethnic background.The purpose of this study is to investigate the association of AZFc polymorphisms and male infertility in the Yi ethnic population,residents within Yunnan Province,ChinaMethods:A total of 224 infertile patients and 153 fertile subjects were selected in the Yi ethnic population.The study was performed by sequence-tagged site plus/minus(STS+/) analysis followed by gene dosage and gene copy definition analysis.Y haplotypes of 215 cases and 115 controls were defined by 12 binary markers using single nucleotide polymorphism on Y chromosome(Y-SNP) multiplex assays based on single base primer extension technology.Results:The distribution of Y haplotypes was not significantly different between the case and control groups.The frequencies of both gr/gr(7.6% vs.8.5%) and b2/b3(6.3% vs.8.5%) deletions do not show significant differences.Similarly,single nucleotide variant(SNV) analysis shows no significant difference of gene copy definition between the cases and controls.However,the frequency of partial duplications in the infertile group(4.0%) is significantly higher than that in the control group(0.7%).Further,we found a case with sY1206 deletion which had two CDY1 copies but removed half of DAZ genes.Conclusions:Our results show that male infertility is associated with partial AZFc duplications,but neither gr/gr nor b2/b3 deletions,suggesting that partial AZFc duplications rather than deletions are risk factors for male infertility in Chinese-Yi population.

Systemic diffuse large B-cell lymphoma with bilateral ciliary body involvement

To the Editor:Primary intraocular lymphoma(PIOL)is rare with an approximate incidence of 4.8/million and about 300 new cases annually in the United States.[1]Compared with PIOL,the prevalence of secondary intraocular lymphoma(SIOL)is significantly lower.Spreading to the eye from a distant site via the circulation,SIOLs occur within the uvea,with most cases confined to the choroid.Ciliary body involvement is rare in SIOL,while secondary diffuse large B-cell lymphoma with bilateral ciliary body involvement has,to our knowledge,been reported rarely.

A Case of Primary Central Nervous System Lymphoma with Ciliary Body Involvement

INTRODUCTION Primary central nervous system lymphoma (PCNSL) is defined as lymphoma confined to the brain,eye,spinal cord,or leptomeninges.It constitutes approximately 3％ of all brain tumors,and 20％ of all cases of non-Hodgkin lymphoma.Ocular involvement can be detected during clinical staging in about 20％ of patients with PCNSL,with primary vitreous retinal lymphoma being the most common subtype.Uveal involvement of PCNSL is uncommon,and PCNSL with ciliary body involvement (CBL),to the best of our knowledge,has not been reported.