Surgical management of HIV related retinal detachment

The appearance of a new disease entity, such as HIV related viral retinitis and retinal detachment, presents novel vitreoretinal surgical challenges. Sporadic cases of cytomegalovirus retinitis and retinal detachment had previously been reported in immunosuppressed patients1 2 but it is only since the HIV epidemic that this unique form of retinal disease has become a common clinical problem.

Various surgical approaches have been used in the treatment of HIV related retinal detachment. Prophylactic laser demarcation around areas of virus infected retina and retinal detachment has generally produced disappointing results3-5 with subretinal fluid accumulation continuing across the laser demarcation line. Likewise, the results of external scleral buckling (even when applied to eyes with isolated peripheral retinal breaks) are often unsatisfactory.4-7 The failure of these techniques is accounted for by the unique nature of retinal detachment secondary to viral retinitis. Retinal breaks are often multiple, posterior, and difficult to locate preoperatively in areas of necrotic and atrophic retina through hazy vitreous. Progressive formation of new retinal breaks following surgical repair is common; laser/cryotherapy of atrophic retina may fail to produce an adequate chorioretinal adhesion and indeed may result in retinal break formation. Furthermore, posterior vitreous separation may be incomplete and significant epiretinal membrane formation may be present.5 6 8-11This clinical picture has made vitrectomy and silicone oil tamponade the treatment of choice for the majority of patients with viral retinitis related retinal detachment. Silicone …