Biomedical subjects

C L Shufelt

Publications and source records attributed to C L Shufelt.

3 recordsLinked to original sources

PubMed2001

Immune recovery vitritis and uveitis in AIDS: clinical predictors, sequelae, and treatment outcomes.

PURPOSE: To determine 1) clinical predictors of an inflammatory syndrome associated with cytomegalovirus (CMV) retinitis (immune recovery vitritis or uveitis [IRV or IRU]); 2) clinical sequelae of IRV; and 3) the effect of corticosteroid treatment on visual acuity. METHODS: A cohort study from the AIDS Ocular Research Unit of the University of California, San Diego, and a case series from the Cleveland Clinic consisted of patients who had acquired immunodeficiency syndrome and inactive CMV retinitis who responded to highly active antiretroviral therapy (HAART) with CD4 T-lymphocyte levels >60 cells/mm3. The cohort was followed for a median of 13.5 months following increase in CD4 count. The authors studied the occurrence of IRV, defined as symptomatic (vision decrease and/or floaters) vitritis of 1+ or greater severity associated with inactive CMV retinitis. Macular edema or epiretinal membrane formation was determined by clinical examination and fluorescein angiography. Five eyes were treated with sub-Tenon corticosteroid injections. RESULTS: In the cohort study, 19 (63%) of 30 HAART responders developed IRV (26 eyes). The clinical spectrum of inflammation included vitritis, papillitis, macular edema, and epiretinal membranes. Eyes with CMV surface area >30% of the retina were at the highest risk (relative risk = 4.5) of developing IRV (P = 0.03). During follow-up, inflammation persisted without treatment for a median of 20 weeks and 14 patients (16 eyes) developed macular changes. Treatment resulted in vision improvement without reactivation of retinitis. Histology and immunohistochemistry of associated epiretinal membranes showed evidence of chronic inflammation with a predominant T-lymphocyte cell population. In the case series, 3 (38%) of 8 HAART responders developed IRV (4 eyes). All four eyes were treated and resulted in visual acuity improvement of one line. CONCLUSIONS: Symptomatic IRV or IRU develops in a significant number of patients with CMV retinitis following successful HAART. Eyes with CMV surface area >30% of the retina are at the greatest risk. Eyes with IRV respond favorably to antiinflammatory therapy without reactivation of retinitis. Immune recovery vitritis may be the result of an immunologic reaction to latent CMV antigens in the eye in which T-lymphocytes play a role.

AIDS-Related Opportunistic Infections↗

PubMed2000

Optic nerve evaluation among optometrists.

PURPOSE: To determine agreement among optometrists regarding assessment of optic nerve C/D ratios and perceived glaucomatous damage and to separately analyze these results on the basis of residency training, practice setting, and glaucoma patient experience. METHODS: Fifty-six optometrists from various modes of professional practice evaluated 33 stereoscopic optic nerve photographs. Observers were asked to estimate the vertical cup-to-disk (C/D) ratio and determine the glaucomatous status of the optic nerve. The mean vertical C/D ratio, percentage perceived as glaucomatous, and levels of interobserver and intraobserver agreement (kappa) are reported. RESULTS: Estimated C/D ratios differ significantly on the basis of training (p = 0.02) practice setting (p = 0.001), glaucoma patient experience (p = 0.001). Glaucomatous damage interpretation was significantly different (p = 0.006) based upon an optometrist's practice setting. Interobserver agreement regarding C/D ratios is significantly higher among optometrists who have completed a residency (kappaw = 0.59) and practice in clinical settings (optometry school/medical center/hospital) (kappaw = 0.59) compared with non-residency-trained optometrists (kappaw = 0.52) and those practicing in commercial settings (kappaw = 0.54). Interobserver agreement of glaucomatous damage is significantly higher among optometrists who have completed a residency (kappa = 0.50) compared with non-residency-trained optometrists (kappa = 0.42). CONCLUSIONS: Intraobserver agreement is higher than interobserver agreement among optometrists when C/D ratios are estimated and the glaucomatous status of the optic nerve is assessed. Optic nerve evaluation among optometrists is significantly influenced by residency training, practice setting, and glaucoma patient encounters.

Clinical Competence↗

PubMed1999

Incidence of immune recovery vitritis in cytomegalovirus retinitis patients following institution of successful highly active antiretroviral therapy.

This study was conducted to determine the likelihood of the development of a new ocular inflammatory syndrome (immune recovery vitritis, IRV), which causes vision loss in AIDS patients with cytomegalovirus (CMV) retinitis, who respond to highly active antiretroviral therapy (HAART). We followed 30 HAART-responders with CD4 cell counts of >/=60 cells/mm3. Patients were diagnosed with IRV if they developed symptomatic vitritis of >/=1+ severity associated with inactive CMV retinitis. Symptomatic IRV developed in 19 (63%) of 30 patients and in 26 (59%) of 44 eyes over a median follow-up from HAART response of 13.5 months. The annual incidence of IRV was 83/100 person-years. Excluding patients with previous cidofovir therapy did not significantly alter the time course of IRV (P=.79). These data suggest that IRV develops in a significant number of HAART-responders with CMV retinitis and is unrelated to previous cidofovir therapy.

AIDS-Related Opportunistic Infections↗