Skip to main content
SpringerLink
Log in

Branch retinal artery occlusion (BRAO) combined with branch retinal vein occlusion (BRVO) and optic disc neovascularization associated with HIV and CMV retinitis

  • Case Report
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Two vaso-occlusive events, branch retinal artery occlusion (BRAO) and branch retinal vein occlusion (BRVO), were observed in the retina of an HIV-infected patient with cytomegalovirus (CMV) retinitis who developed neovascularization of the disc (NVD). Although BRVO and reversible NVD have been reported in association with CMV retinitis, we have seen no reports of concomitant BRAO. CMV damages endothelial cells and causes an occlusive vasculitis. In HIV-infected individuals, damaged endothelial cells and rheologic problems result in increased blood viscosity. HIV infection has also been associated systemically with elevated levels of cytokines, including tumor necrosis factor alpha (TNF-α). In vitro, TNF-α exerts effects that decrease fibrinolytic potential; this activity in the circulation of a patient with AIDS may lead to vascular occlusive events. In the patient reported here, the retinal changes were not reversed by induction therapy with ganciclovir and the NVD did not regress.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Henderly DE, Freeman WR, Smith RE, Causey D, Rao NA. Cytomegalovirus retinitis as the initial manifestation of the acquired immune deficiency syndrome. Am J Ophthalmol 1987; 103: 316–20.

    Google Scholar 

  2. Pepose JS, Hillborn LH, Canilla PR, Foos RY. Concurrent herpes simplex and Cytomegalovirus retinitis and encephalitis in acquired immune deficiency syndrome (AIDS). Ophthalmology1984; 91: 1661–7.

    Google Scholar 

  3. Cole EL, Meisler DM, Calabrese LH, Holland GN, Mondino BJ, Conant MA. Herpes zoster ophthalmicus and acquired immune deficiency syndrome. Arch Ophthalmol 1984; 102: 1027–9.

    Google Scholar 

  4. Chambers RB, Derick RJ, Davidorf FH, Koletar SL, Dangel ME. Varicella-zoster retinitis in human immunodeficiency virus infection. Arch Ophthalmol 1989; 107: 960–1.

    Google Scholar 

  5. Margolis TP, Lowder CY, Holland GN, Spaide RF, Logan AG, Weissman SS. Varicella-zoster virus retinitis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol 1991; 112: 119–31.

    Google Scholar 

  6. Reux I, Fillet AM, Agut H, Katlama C, Hauw JJ, LeHuang P. In situ detection of human herpesvirus 6 in retinitis associated with acquired immunodeficiency syndrome. Am J Ophthalmol 1992; 114: 375–7.

    Google Scholar 

  7. Nikkels AF, Debrus S, Sadzot-Delvaux C, Piette J, Delvenne P, Rentier B, Pierard GE. Comparative immunohistochemical study of herpes simplex and varicella-zoster infections. Virchows Arch A Pathol Anat Histopathol 1993; 422: 121–6.

    Google Scholar 

  8. Jacob HS, Visser M, Key NS, Goodman JL, Moldow CF, Vercellotti GM. Herpes virus infection of endothelium: New insights into atherosclerosis. Trans Am Clin Climatol Assoc 1992; 103: 95–104.

    Google Scholar 

  9. Booss J, Dann PR, Winkler SR, Griffith BP, Kim JH. Mechanisms of injury to the central nervous system following experimental cytomegalovirusinfection. Am J Otolaryngol 1990; 11: 313–7.

    Google Scholar 

  10. Newman NM, Mandel MR, Guloett J, Fujikawa L. Clinical and histologic findings in opportunistic ocular infections: Part of a new syndrome of acquired immunodeficiency. Arch Ophthalmol 1983; 101: 396–401.

    Google Scholar 

  11. Pollard RB, Egbert PR, Gallagher JG, Merigan TC. Cytomegalovirus retinitis in immunosuppressed hosts. I. Natural history and effects of treatment with adenine arabinoside. Ann Intern Med 1980; 93: 655–63.

    Google Scholar 

  12. Newsome DA, Green WR, Miller ED, Kiessling LA, Morgan B, Jabs DA et al. Microvascular aspects of acquired immune deficiency syndrome retinopathy. Am J Ophthalmol 1984; 98: 590–601.

    Google Scholar 

  13. Egbert PR, Pollard RB, Gallagher JG, Merigan TC. Cytomegalovirus retinitis in immunosuppressedhosts. II. Ocular manifestations. Ann Int Med 1980; 93: 664–70.

    Google Scholar 

  14. Fiala M, Chatterjee SN, Carson S, Poolsawat S, Heiner DC, Saxon A, Guze LB et al. Cytomegalovirus retinitis secondary to chronic viremia in phagocytic leukocytes. Am J Ophthalmol 1977; 84: 567–73.

    Google Scholar 

  15. Cantrill HL, Henry K. Acquired immune deficiency syndrome. In: Singerman LK, Jampol JM (eds) Retinal and Choroidal Manifestations of Systemic Disease. Baltimore, MD: Williams and Wilkins, 1991: 147–77.

    Google Scholar 

  16. Dahrling BE. The histopathology of early central retinal artery occlusion. Arch Ophthalmol 1965; 73: 506–10.

    Google Scholar 

  17. Braunstein RA, Gass JDM. Branch artery obstruction caused by acute toxoplasmosis. Arch Ophthalmol 1980; 98: 512–3.

    Google Scholar 

  18. Brown GC, Magargal LE, Sergott R. Acute obstruction of retinal and choroidal circulations. Ophthalmology 1986; 93: 1373–82.

    Google Scholar 

  19. Santos R, Barojas E, Alarcon-Segovia D, Ibanez G. Retinal microangiopathy in systemic lupus erythematosus. Am J Ophthalmol 1975; 80: 249–52.

    Google Scholar 

  20. Gass JDM. Ocular manifestations of acute mucormycosis. Arch Ophthalmol 1961; 65: 226–37.

    Google Scholar 

  21. Hayreh SS, Rojas P, Podhajsky P, Montague P, Woolson RF. Ocular neovascularization with retinal vascular occlusion. III. Incidence of ocular neovascularization with retinal vein occlusion. Ophthalmology 1983; 90: 488–506.

    Google Scholar 

  22. Lee S, Ai E. Disc neovascularization in patients with AIDS and cytomegalovirus retinitis. Retina 1991; 11: 305–8.

    Google Scholar 

  23. Friedman AH. The retinal lesions of the acquired immune deficiency syndrome. Trans Am Ophthalmol Soc 1984; 82: 447–91.

    Google Scholar 

  24. Skolnik PR, Pomerantz RJ, de la Monte SM, Lee SF, Hsiung GD, Foos RY et al. Dual infection of retina with human immunodeficiency virus type 1 and cytomegalovirus. Am J Ophthalmol 1989; 107: 361–72.

    Google Scholar 

  25. Manogue KR, van Deventer SJH, Cerami A. Tumor necrosis factor alpha or cachectin. In: Thomas A (ed.) The Cytokine Handbook. San Diego, CA: Academic Press, 1991: 254–49.

    Google Scholar 

  26. Gates RF, Richards RD. Macroglobulinemia with unusual vascular changes. Arch Ophthalmol 1960; 64: 77–80.

    Google Scholar 

  27. Engstrom RE, Holland GN, Hardy D, Meiselman HJ. Abnormal blood rheologic factors in patients with human immunodeficiency virus-associated conjunctival and retinal microvasculopathy. ARVO Abstracts. Invest Ophthalmol Vis Sci 1988; 29 (suppl): 43.

    Google Scholar 

  28. Lahdevirta J, Maury CP, Teppo AM, Repo H. Elevated levels of circulating cachectin/tumor necrosis factor in patients with acquired immunodeficiency syndrome. Am J Med 1988; 85: 289–91.

    Google Scholar 

  29. Van Hinsbergh VWM, Kooistra T, van den Berg E, Princen HMG, Fiers W, Emeis JJ. Tumor necrosis factor increases the production of plasminogen activator inhibitor in human endothelial cells in vitro and in rats in vivo. Blood 1988; 72: 1467–73.

    Google Scholar 

  30. Schleef RR, Bevilacqua MP, Qawdey M, Gimbrone MA Jr, Loskutoff DJ. Cytokine activation of vascular endothelium. Effects on tissue-type plasminogen activator and type 1 plasminogen activator inhibitor. J Biol Chem 1988;263: 5797–803.

    Google Scholar 

  31. Pepose JS, Holland GN, Nestor MS, Cochran AJ, Foos RY. Acquired immune deficiency syndrome: pathogenic mechanisms of ocular disease. Ophthalmology 1985; 92: 472–84.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. LSU Eye Center, Louisiana State University Medical Center School of Medicine, New Orleans, LA, USA

    Mandi D. Conway

  2. Retina Consultants, Ltd., St. Louis, MO, USA

    Patrick Tong & R. Joseph Olk

Authors
  1. Mandi D. Conway
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Joseph Olk
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported in part by an individual National Research Service Award grant F32-EY06193 (MDC) from the National Eye Institute, National Institutes of Health, Bethesda, Maryland and an unrestricted grant from Research to Prevent Blindness, Inc., New York, NY. Presented in part at the Midwest Fluorescein Conference, Door County, Wisconsin, August, 1992

Rights and permissions

Reprints and permissions

About this article

Cite this article

Conway, M.D., Tong, P. & Olk, R.J. Branch retinal artery occlusion (BRAO) combined with branch retinal vein occlusion (BRVO) and optic disc neovascularization associated with HIV and CMV retinitis. Int Ophthalmol 19, 249–252 (1995). https://doi.org/10.1007/BF00132694

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00132694

Key words

Search

Navigation