Cryptococcal infection of the central nervous system is commonly seen in patients with AIDS, causing meningitis and secondary ocular involvement.

PURPOSE:

The objetive pf this study was to determine the most frequent ophthalmic findings in patients with AIDS and central nervous system cryptococcosis.

METHODS:

We studied 15 AIDS patients (CDC criteria) with cryptococcal meningitis from 1992 to 1994. All patients were submited to a complete ophthalmological examination.

Results:

Ophthalmologic diagnoses were the following: papiledema in 7 patients (bilateral in 6); VI cranial nerve palsy in 4 patients (all of them with comcomitant bilateral papilledema); multifocal choroiditis in 3 patients (unilateral in 2 and bilateral in 1); bilateral optic atrophy in 1 patient; cotton-wool spots, multifocal choroiditis and papillitis in 1 patient. The patient with bilateral multifocal choroiditis presented also with pre-retinal hemorrhage, miliary cutaneous cryptococcosis and bilateral limbic nodules (biopsy proven). All patients were treated with amphotericin B and 3 of them received concomitant systemic corticosteroid. Visual acuity improved or remained stable with the treatment in all but one case. Thirteen of the 15 patients died 2 to 9 months after the diagnosis of ocular disease. The other 2 patients survived for 2 years.

CONCLUSION:

Ocular involvement is important in patient with AIDS and central nervous system cryptococcosis. Early diagnosis and specific therapy may result in a better visual prognosis with a longer survival.