Twelve of 13 patients with the acquired immune deficiency syndrome exhibited ophthalmoscopically detectable retinal findings, including cotton-wool spots, hemorrhages, Roth spots, and microvascular changes. When we used fluorescein angiography, we detected focal nonperfusion and microvascular changes in all 13 of our patients. Most patients had no visual complaints unless they had cytomegalovirus involvement of the optic papilla or the central retina. One patient lost central visual acuity from loss of perfusion in a portion of his perifoveal capillary net. Histopathologic studies demonstrated the loss of retinal capillary cells and focal occlusions of small vessels. Retinal vessel walls were also thickened with PAS-positive material.
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