16  Infectious Diseases of the Pediatric Retina

377

facial hemangiomas, though no specific reports

secondary neoplasm. Ocular manifestations of HIV

addressing its use in children are available.

typically occur in group 4 disease, during the late

Systemic corticosteroids have been used in an

stages.

attempt to suppress the inflammatory component of

Ocular manifestations of AIDS include noninfectious

the vasculopathy and optic neuropathy and to prevent

microangiopathy, opportunistic ocular infections, con-

vitreous organization [184, 240, 241]. Anticlotting

junctival, eyelid and orbital involvement with neoplasms,

agents, such as warfarin sodium [241] and aspirin

and neuroophthalmic lesions [57, 249]. Opportunistic

[242], have been used in an attempt to decrease occlu-

infections with AIDS will be discussed in their corre-

sive vasculopathy. Plasma exchange has shown prom-

sponding sections throughout this chapter; neoplastic

ise in some patients, and plasmapheresis has been used

and neuroophthalmic diseases are beyond the scope of

effectively in the treatment of central retinal vein

this chapter.

occlusion in some children [243].

Retinal detachment repair is fraught with difficul-

ties [244, 245]. Retinal breaks are usually large, mul-

16.3.5.2  Noninfectious HIV Microangiopathy

tiple and posteriorly located either in the necrotic

retina or at the junction between the necrotic and the

Acquired immunodeficiency syndrome retinopathy

healthy retina. Most patients with ARN and retinal

has been reported in 66.5% of AIDS patients [250].

detachment exhibit varying degree of proliferative vit-

The clinical picture consists of cotton-wool spots and

reoretinopathy, a feature that contributes to their unfa-

flame-shaped or punctate retinal hemorrhages without

vorable outcome. Increasing familiarity with this

evidence of an associated disorder like diabetes or ane-

disorder and the use of microsurgical techniques in

mia. Fluorescein angiographic findings include microa-

conjunction with scleral buckling have increased the

neurysms, telangiectatic vessels, and focal capillary

success rate [246].

nonperfusion. Hypotheses proposed to explain the

development of AIDS microangiopathy include circu-

lating immune complexes [251–253] with deposition

16.3.5  HIV Infection

in the retinal microvasculature leading to endothelial

cell damage and ischemia and which may also be

blamed for facilitating subsequent retinal infections

Human immunodeficiency virus (HIV) is the envel-

with opportunistic organisms. Ultrastructural studies

oped retrovirus that causes acquired immune defi-

have revealed small vessels with swollen endothelial

ciency syndrome (AIDS) in humans [247]. The first

cells and degenerating pericytes [253, 254]. HIV itself

description of a case of AIDS was in 1981. Initially,

has been isolated from the retina of infected patients,

AIDS occurred primarily in homosexual men. Disease

and immunohistochemical studies have demonstrated

occurrence in intravenous drug users and heterosexual

antigens in the retina vascular endothelium and neu-

transmission are increasingly blamed for spread of the

ronal cells [255].

disease. Vertical transmission via transplacental infec-

tion is leading cause of pediatric HIV infection.