Didanosine-Associated Retinal Toxicity in Adults Infected With Human Immunodeficiency Virus

Figure 1. Initial color fundus photographs, taken in 2000, showing atrophic patches concentrically distributed in the midperiphery of both eyes (A and B) of a 35-year-old white man infected with human immunodeficiency virus (case 1). Subsequent imaging with color fundus photographs in 2006 reveal progression and increasing confluency of atrophy with associated pigment migration (C and D). The most recent color fundus photographs in 2011 reveal continued progression of atrophic lesions (E and F).

Figure 2. Autofluorescence (A and B) and Heidelberg optical coherence tomographic images (C [left panel] and D [left panel]) in 2011 revealing hypoautofluorescence in the areas of atrophy in both eyes of a 35-year-old white man infected with human immunodeficiency virus (case 1), with intervening lacy hyperautofluorescence and hypoautofluorescence in areas less involved and severe atrophy (C [right panel] and D [right panel]).

Figure 3. Color fundus photographs of both eyes of a 52-year-old man infected with human immunodeficiency virus (case 2) revealing patches of atrophy in the midperiphery (A and B); midperipheral mottled-lacy hyperautofluorescence and hypoautofluorescence with concentric distribution on autofluorescence photographs of both eyes (C and D) of case 2.

Figure 4. Color fundus photographs of both eyes of a 54-year-old diabetic man infected with human immunodeficiency virus (case 3) revealing patches of atrophy in the midperiphery (A and B), an atrophic cryopexy scar in the superonasal periphery, and a retinal cyst inferiorly, as evidence of prior retinal detachment and its repair (A). Autofluorescence images reveal midperipheral mottled-lacy hyperautofluorescence and hypoautofluorescence with concentric distribution in both eyes (C and D). The superonasal periphery contains a hypoautofluorescent lesion with a hyperautofluorescent posterior border, as evidence of prior cryopexy therapy (C).