Cataract Surgery Outcomes in Human Immunodeficiency Virus Positive Patients at a Tertiary Care Academic Medical Center in the United States

ABSTRACT

Purpose: To compare cataract surgery complications and visual outcomes in patients with and without human immunodeficiency virus (HIV).

Methods: A retrospective cohort study was conducted on eyes undergoing phacoemulsification cataract surgery at an academic eye center from 1/1/2014 to 8/31/18. Outcomes included best corrected distance visual acuity (CDVA), intraoperative complications, cystoid macular edema (CME), and persistent anterior uveitis (PAU). Binary outcomes were analyzed using logistic regressions with generalized estimating equations. Visual outcomes were analyzed using a linear mixed model.

Results: 9756 eyes from 5988 patients were included in the analysis. Of these, 66 eyes from 39 patients were HIV positive (HIV+). HIV+ patients were significantly younger at the time of surgery than HIV negative patients (p < .0001). Among HIV+ patients with available lab data, the mean CD4 count was 697.3 (SD = 335.7), and 48.7% of subjects had an undetectable viral load. Five eyes from three HIV+ patients had a history of cytomegalovirus retinitis (CMVR). Positive HIV status was not associated with increased risk of intraoperative complications. Post-operative CDVA was better in the HIV negative group compared to the HIV+ group but not significantly different (about 20/24 vs. 20/28, p = .0829). Eyes from HIV+ patients were at increased risk of developing PAU after surgery (adjusted OR = 6.04, 95% CI: 2.42–15.1, p = .0001), as well as CME (adjusted OR = 3.25, 95% CI: 1.02–10.4, p = .0470).

Conclusions: Eyes from HIV+ patients were at greater risk of developing PAU and clinically significant CME; however, HIV+ patients had similar CDVA after cataract surgery compared to HIV negative patients.

KEYWORDS:

• Human immunodeficiency virus
• cataract surgery
• persistent anterior uveitis

Data availability

The dataset generated and analyzed during the current study are not publicly available as they were obtained from the University of Colorado Cataract Outcomes Database but may be available from the corresponding author on reasonable request.

Disclosure of interest

None of the authors have any proprietary interests or conflicts of interest related to this submission.

Financial support

Challenge Grant to the Department of Ophthalmology, University of Colorado School of Medicine from Research to Prevent Blindness, Inc., New York, NY.

Additional information

Funding

This work was supported by the Research to Prevent Blindness [Challenge Grant].