ritonavir and Retinal-Diseases

Topics: Diabetes Mellitus, Type 2; Diabetic Retinopathy; HIV Infections; HIV Protease Inhibitors; HIV-1; Humans; Indinavir; Nelfinavir; Retina; Retinal Diseases; Ritonavir; Saquinavir

To report a case involving a patient with presumed panretinal ritonavir-induced retinopathy.. A 52-year-old, HIV-positive patient, with no criteria for AIDS associated with the use of ritonavir for more than 10 years, underwent clinical examination, fundus photography, spectral domain optical coherence tomography, and fundus autofluorescence imaging.. Fundus examination revealed areas of atrophy and hypertrophy in the retinal pigment epithelium throughout the retina. Laboratory tests for other diseases were all negative.. HIV-positive patients undergoing ritonavir therapy should be carefully followed in the presence of low-acuity vision complaints and retinal changes.

Topics: Acquired Immunodeficiency Syndrome; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; HIV; HIV Protease Inhibitors; Humans; Male; Middle Aged; Retinal Diseases; Retinal Pigment Epithelium; Ritonavir; Time Factors; Tomography, Optical Coherence; Visual Acuity

Topics: Antirheumatic Agents; Antiviral Agents; Betacoronavirus; Coronavirus Infections; COVID-19; Cytochrome P-450 CYP3A Inhibitors; Drug Synergism; Humans; Hydroxychloroquine; Pandemics; Pneumonia, Viral; Retinal Diseases; Retinal Pigment Epithelium; Ritonavir; SARS-CoV-2

Because patients with HIV have increased life expectancies with the advent of new drug therapies, complications from iatrogenic syndromes such as drug toxicity can occur. Ritonavir-induced retinal toxicity is one such complication but has rarely been reported in the literature.. This case report describes a patient with bilateral maculopathy and bone spicule-like pigmentary changes in the midperipheral retina due to ritonavir use. In addition, novel optical coherence tomography findings are described.. A 53-year-old man presented with gradual-onset blurry vision and difficulty seeing at night. He had been diagnosed as having HIV infection 19 years prior and had previously taken ritonavir for 7 years as part of highly active antiretroviral therapy. Best-corrected acuities were 20/30 in the right eye and 20/25 in the left eye. Clinical examination revealed a subtle annular pattern of retinal pigment epithelium mottling around the fovea and bone spicule-like pigment changes in the midperiphery of both retinas. Optical coherence tomography imaging revealed abnormal subfoveal hyperreflectivity of the ellipsoid zone with relative attenuation centrally, annular parafoveal ellipsoid zone loss, and punctate hyperreflectivity within the ellipsoid zone more eccentrically. Fundus autofluorescence in both eyes showed annular hyperautofluorescence in the parafoveal region, geographic hyperautofluorescence in the areas underlying the midperipheral pigmentary changes, and discrete patches of hyperautofluorescence along the far inferotemporal arcades in areas that appeared normal with biomicroscopy. A diagnosis of retinal toxicity secondary to ritonavir use was made based on the patient's history and clinical examination.. Ritonavir retinal toxicity seems to be an uncommon adverse event that can cause decreased visual function. This case report provides further evidence of the retinal toxicity and reviews the reported clinical and optical coherence tomography manifestations of the disease.

Topics: Antiretroviral Therapy, Highly Active; Fluorescein Angiography; Fundus Oculi; HIV Infections; HIV Protease Inhibitors; Humans; Male; Middle Aged; Retina; Retinal Diseases; Ritonavir; Tomography, Optical Coherence; Vision Disorders; Visual Acuity

The purpose of this study is to report a case of ritonavir-related retinal toxicity followed over a year. Electrophysiological features and multimodal imaging, including adaptive optics, are provided and discussed.. Electrophysiological recordings and multimodal imaging were performed and repeated over 1 year.. Fundus examination revealed crystalline maculopathy in conjunction with pigment disruption. Spectral domain optical coherence tomography displayed thinning of the macula without cysts. Autofluorescence imaging revealed a mixed pattern of complete loss of the autofluorescence in the area of retinal pigment deposit and an increased transmission of the autofluorescence in the area of retinal thinning. Fluorescein angiography ruled out parafoveal telangiectasia. Indocyanine green angiography was not contributive. Increased spacing of the macular cone mosaic, crystal deposits and pigment migrations were seen with adaptive optics. Full-field electroretinogram was slightly reduced for both eyes, especially in the light-adapted responses, and mfERG confirmed bilateral maculopathy. Functional and structural abnormalities did not change with follow-up besides constant pigmentary changes monitored with adaptive optics.. Ritonavir-related retinal toxicity is a maculopathy with peculiar features including crystalline and pigment migration associated with central or temporofoveolar thinning and inconstant macular telangiectasia. Despite drug cessation, retinal remodelling continues to progress.

Topics: Electroretinography; Fluorescein Angiography; HIV Protease Inhibitors; Humans; Male; Middle Aged; Multimodal Imaging; Retinal Diseases; Retinal Pigments; Ritonavir; Tomography, Optical Coherence

Topics: Atrophy; Fluorescein Angiography; HIV Protease Inhibitors; Humans; Retina; Retinal Diseases; Retinal Pigment Epithelium; Ritonavir; Tomography, Optical Coherence

Topics: Acquired Immunodeficiency Syndrome; Adult; Cholesterol; Delavirdine; Drug Therapy, Combination; HIV Protease Inhibitors; Humans; Hyperlipidemias; Male; Retinal Diseases; Retinal Vessels; Ritonavir; Saquinavir; Triglycerides; Viral Load; Zalcitabine