The objective of this prospective study was to evaluate the efficacy and complications of the use of an intraocular sustained-release ganciclovir implant for the treatment of active cytomegalovirus (CMV) retinitis in AIDS patients. Thirty-nine eyes of 26 patients were submitted to ocular surgery. All patients underwent complete ocular examination before and after surgery. The surgical procedure was always done under local anesthesia using the same technique. The mean time for the surgical procedure was 20 min (range, 15 to 30 min). The average follow-up period was 3.7 months. Of all patient, only 4 presented recurrence of retinitis after 8, 8, 9 and 2 months, respectively. Three of them received a successful second implant. All 39 eyes of the 26 patients presented healing of retinitis as shown by clinical improvement evaluated by indirect binocular ophthalmoscopy and retinography. Retinitis healed within a period of 4 to 6 weeks in all patients, with clinical regression signs from the third week on. Six (15.4%) eyes developed retinal detachment. None of the patients developed CMV retinitis in the contralateral eye. The intraocular implant proved to be effective in controlling the progression of retinitis for a period of up to 8 months even in patients for whom systemic therapy with either ganciclovir or foscarnet or both had failed. The intraocular sustained-release ganciclovir implant proved to be a safe new procedure for the treatment of CMV retinitis, avoiding the systemic side effects caused by the intravenous medications and improving the quality of life of the patients.

OBJETIVO: Avaliar as manifestações oculares do paciente HIV positivo. MATERIAL E MÉTODOS: É um estudo retrospectivo em 1100 pacientes ambulatoriais HIV positivo em três anos com ficha padrão e exame oftalmológico completo, atendidos no Departamento de Oftalmologia da Escola Paulista de Medicina. RESULTADOS: Dos 1100 pacientes, 869 (79%) eram do sexo masculino e 231 (21%) do feminino. Os fatores de risco mais importantes foram: homossexualidade masculina em 303 (27,55%), heterossexualidade em 272 (24,73%), usuários de drogas endovenosas em 168 (15,27%) e causa indeterminada ou não revelada em 246 (22,36%). As queixas oculares mais freqüentes foram: 432 (39,27%) pacientes com baixa da acuidade visual; 138 (12,55%) com embaçamento visual; 64 (5,82%) com dor ocular, 186 (16,9%) com queixas inespecíficas e 235 (21,36%) pacientes não apresentavam qualquer queixa. As manifestações oculares mais freqüentes foram: retinite por CMV em 246 (22,36%) dos pacientes; exsudatos algodonosos em 110 (10%), blefarite em 51(4,64%) e toxoplasmose ocular em 48 (4,36%). CONCLUSÃO: Houve progressão da doença entre os heterossexuais e aumento da incidência no sexo feminino nesta população estudada. Os que apresentavam queixas oculares foram a maioria. A manifestação ocular mais freqüente foi a retinite por CMV em 246 (22,36%). Encontramos 10% de exsudatos algodonosos.

PURPOSE: To evaluate ocular manifestations of HIV-infected patients MATERIAL AND METHODS: A restropective study of 1,100 HIV positive out patients in 3 years with a standard complete ophthalmological exam. RESULTS: Eigth hundred and sixty nine (79%) of the 1,100 patients studied were male and 231 (21%) female. The most important risk factors were: male homossexuality in 303 cases (27.55%), heterossexuality in 272 (24.73%), endovenous drugs use in 168 (15.27%), and unknown cause in 246 (26.36%). Related to ocular complains, we found 432 (39.27%) patients with decreased visual acuity, 138 (12.55%) with visual hazy, 64 (5.82%) with ocular pain, 186 (16.9%) with inespecific complaints, and 235 (21.36%) with no complains. The most frequent ocular manifestations were: CMV retinitis in 246 (22.36%), cotton wool spots in 110 (10%), blepharitis in 51 (4.64%), and toxoplasmosis in 48 (4.36%). CONCLUSION: The increase of disease ratio was observed among heterossexual and females in this specific population. Patients with ocular complains were 79.42% . The most frequent ocular manifestations was CMV retinitis, in 246 (22.36%). We found also 10% of cotton wool spots.

RESUMO Realizamos um estudo amostral populacional para melhor conhecer a prevalência de Toxoplasmose ocular em Venda Nova do Imigrante, ES e compará-la com a prevalência de lesões em outras regiões do Brasil. De 1.074 pessoas examinadas, 11,27% foram diagnosticadas como portadoras de toxoplasmose ocular, baseado em achados fundoscópicos. Esta prevalência foi superior à existente nos Estados Unidos; (0,6%) e em São Paulo (9%), mas inferior à de Erechin, RS (17,7%). Foram encontrados quatro casos familiares (2 famílias com 2 irmãos não-gêmeos e 2 famílias com casos de mães e filhos afetados), sugerindo toxoplasmose adquirida. A acuidade visual foi igual ou inferior a 20/200 em 7% dos olhos com lesões oculares, devido a presença de lesões maculares.

SUMMARY We perfomed a population-based household survey to better understand the prevalence of ocular toxoplasmosis in Venda Nova do Imigrante, Espírito Santo state and to compare the results with other regions of Brazil. Of 1074 patients from Venda Nova do Imigrante - ES examinated, 11.27% were deemed to have ocular toxoplasmosis on basis of conservative assessment of ophthalmic findings. This prevalence was higher than in North America (0.6%) and in São Paulo (9%) but lower than in Erechin (RS) (17.7%). Four familial cases were found (2 families with affected siblings and 2 families with affected mother and son), suggesting also acquired toxoplasmosis as mode of transmission. The visual acuity with pinhole was lower or equal to 20/200 in 7% of the eyes with toxoplasmic scars, due to macular lesions.