![]() For patients with CMVR involving multiple zones, the zone nearest to the macula was reported. Zone 2 extended from zone 1 to the vortex veins and zone 3 involved the area anterior to the vortex veins. The location of CMVR lesion in each eye was categorized into three zones as described by Holland et al: Zone 1 was defined as the area within 1500 μm of the optic nerve or within 3000 μm of the centre of the macula. Lesion size was classified categorically as 50% based on accurate clinical drawings. CMVR lesions were described based on lesion size and their location. All cases of CMVR were diagnosed pre-operatively. The lesion typically consisted of an area of retinal necrosis or edema surrounded by granular infiltrates and a silvery-white border marking the edge of the active borders, with variable amounts of retinal hemorrhage and inflammatory vascular sheathing. No aqueous or vitreous samples were obtained for viral PCR to confirm or exclude the diagnosis. Elevated intraocular pressure (IOP) was defined as IOP > 25 mmHg.ĬMVR was diagnosed clinically based on indirect ophthalmoscopy findings of the typical appearance of the disease. All other post-operative complications were recorded. Functional success was defined as either preservation of VA post-operatively at better than ambulatory vision defined as BCVA of 6/120 or better, or improvement of 2 lines in LogMAR vision, after conversion from Snellen VA. Anatomical success was defined as complete retinal re-attachment at six months without the need for repeat surgery. For the purpose of data analysis, change of VA from light perception (PL) to hand movement (HM), from HM to counting fingers at two feet (CF), was defined as 2 line change in LogMAR vision. Visual acuity (VA) was measured using Snellen charts. Visual and anatomical outcomes of surgery and complications were assessed at three and six months after surgery. Proliferative vitreo-retinopathy (PVR) was classified based on the 1991 modification of the initial classification devised by the Retina Society. Concurrent phacoemulsification was performed in eyes with significant cataracts. Circumferential buckling and/or segmental scleral buckling were performed when indicated as judged by the surgeon-in-charge. Operative techniques for the majority of cases involved pars plana vitrectomy (20 or 23G), re-attachment by fluid-air exchange using a drainage retinotomy, endolaser, and internal tamponade with silicone oil or intraocular gas. The demographic characteristics, features of CMVR and RD were analyzed. Retinal re-attachment surgeries were performed by 6 experienced vitreo-retinal surgeons from the department. Ethics approval was obtained from the National Healthcare Group (NHG) Domain Specific Review Board (DSRB) (reference A/10/515), in compliance with the Helsinki Declaration. These patients were under the primary care of infectious disease physicians from the Communicable Disease Centre (CDC), Singapore. Medical records of HIV patients with CMVR-related RD who underwent retinal re-attachment surgery at our centre over 12 years from 1 January 2000 to 1 June 2011 were reviewed. ![]()
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