• PDF / 171,347 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 97 Downloads / 122 Views

DOWNLOAD

REPORT

---

1 S

Maculopathy: case report A 42-year-old man developed maculopathy during treatment with lopinavir/ritonavir and ritonavir for HIV infection. The man, who had a medical history of HIV and Hepatitis C virus infection (HCV), presented to hospital at the age of 47 years with complaints of progressively worsening long standing bilateral loss of vision for the past 5 years. He was diagnosed with HIV and HCV in 1992 and had received various antiretroviral drugs since 1994. Between 22 February 2000 and 20 September 2018, he received ritonavir and between 07 November 2002 and 14 January 2016, he also received lopinavir/ritonavir [routes and dosages not stated]. Concomitantly, he had received several other anti-retroviral drugs along with sodium oxybate [gamma hydroxybutyrate] and 4-methyethylcathinone. He also had a history of cocaine use. At current presentation, his best corrected visual acuity (BCVA) was 20/25 on the left eye and 20/50 on the right eye. Fundus examination showed macular atrophy of an extensive area on both eyes. Whereas, optic nerve, vitreous and retinal mid and extreme-periphery and retinal vessels were normal. Infrared reflectance imaging (IR) showed well demarcated, polylobulated hyperreflective macular atrophy meeting with peripapillary atrophy. Additionally, multiple hyperreflective dots were noted within the atrophic lesions on IR images. Fundus blue laser autofluorescence (FAF) showed symmetric hypoautofluorescent extensive areas of retinal pigment epithelium (RPE) atrophy, surrounded by a circumferential ring of speckled hyperautofluorescence pattern, which were reaching the temporal arcades. Spectral domain optical coherence tomography (SD-OCT) showed complete RPE and outer retinal atrophy accompanied by outer retinal tubulations (ORT). Further, in the left eye SD-OCT, coupled with IR showed choroidal caverns. Fluorescein angiography (FA) showed a window defect, characterised by well demarcated hyperfluorescent areas corresponding to outer retinal and RPE atrophy. Widefield swept-source optical coherence tomography angiography (SS-OCTA) showed a large macular area of choriocapillaris alterations on both the eyes. A 6×6mm SS-OCTA showed a well demarcated area of choriocapillaris alteration. He also underwent various functional tests. A Roth 28-Hue test showed reduced colour discrimination in the tritan axis. Both Goldman and Humphrey visual fields showed a bilateral central scotoma. However, on the left eye, an isle of preserved retinal sensitivitywas noted in the foveal area, corresponding to the preserved ellipsoid zone. The full field electroretinogram (ffERG) showed a moderated cone-rod dysfunction and increased flicker delay. Multifocal ERG (mfERG) responses were non-discernible from the background noise with a complete loss of foveal peak. Predominantly on his left eye, non-systematised focal responses were noted corresponding to the preserved ellipsoid zone area. Electrophysiological findings along with retinal dysfunction were consistent with the structural disturbances. Based on thes