Tatalaksana Steroid Dosis Tinggi pada Pasien HIV dengan Immune Recovery Uveitis (IRU) dengan Gambaran Neuroretinitis
DOI:
https://doi.org/10.57213/medlab.v5i1.385Keywords:
CMV Retinitis, HIV, Immune Recovery Uveitis, Neuroretinitis, ONTTAbstract
Introduction: Immune reconstitution inflammatory syndrome (IRIS) is a pathological immune dysregulation that may occur in HIV patients undergoing highly active antiretroviral therapy (HAART). Immune recovery uveitis (IRU) represents the ocular manifestation of IRIS, often associated with a history of inactive cytomegalovirus (CMV) retinitis. Optic nerve involvement is a critical risk factor for severe ocular morbidity and poor visual outcomes. Case Illustration: A 34-year-old man presented with bilateral visual decline and floaters for one month. Best-corrected visual acuity (BCVA) was 0.50 in the right eye and 0.25 in the left eye. Fundoscopic examination revealed optic disc edema with minimal retinal hemorrhage and exudates. The patient had recently restarted HAART, with CD4 count improving from 24 to 152 cells/μL. Serologic testing showed reactive CMV IgG. Additional tests demonstrated decreased contrast sensitivity and central scotoma. After consultation with the internal medicine team, the patient received corticosteroid therapy following the Optic Neuritis Treatment Trial (ONTT) protocol. Post-treatment, improvements were noted in the Pelli-Robson contrast sensitivity and visual field tests, with reduction of scotoma. At the final visit, BCVA improved to 1.0 in the right eye and 0.8 in the left eye. Conclusion: The ONTT-based regimen may facilitate faster visual recovery in IRU with optic nerve involvement. However, management requires close interdisciplinary collaboration to ensure therapeutic safety. Careful consideration is essential when treating HIV-positive patients with IRU and neuroretinitis to achieve optimal visual outcomes.
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