[Pathology of the retina in patients with AIDS]

Changes in the fundus oculi are usually seen in patients with well-defined clinical features of the acquired immunodeficiency syndrome (AIDS). The commonest pathology of the retina, seen in 40-75% of the patients with advanced AIDS, is known as 'the microvascular complex of the retina associated with AIDS', and is characterized by the presence of cotton-wool exudates and retinal haemorrhages. Many of these lesions are casual findings on examination of the fundus oculi. Cytomegalic (CMV) retinitis appears in 20-30% of AIDS patients, and diagnosis is important so that treatment with foscarnet or ganciclovir may be started early to conserve vision. Occasionally necrotizing retinitis appears due to the varicella zoster virus, following the typical skin condition. There is little response to acyclovir treatment. Retinitis due to toxoplasma is much less common than cerebral toxoplasmosis. The retinal lesions are predominantly neuritic and respond well to treatment with antitoxoplasma. Other rarer causes of ocular disorders in AIDS are syphilis, tuberculosis, cryptococcus and lymphoma.