Book Review

Color Atlas of Ocular Manifestations of AIDS: Diagnosis and management

N Engl J Med 1995; 333:328August 3, 1995

Article

Color Atlas of Ocular Manifestations of AIDS: Diagnosis and management
By Juan Orellana, Ronni M. Lieberman, and Steven A. Teich. 105 pp., illustrated. New York, Igaku-Shoin, 1995. $98.50. ISBN: 0-89640-273-8

Few areas of medicine remain untouched and unchanged by the AIDS pandemic. Ophthalmology is no exception. Ophthalmic manifestations were described in the first reports of patients with the disease, and nearly three quarters of all patients infected with the human immunodeficiency virus (HIV) have ocular complications at some point in the course of the disease. Because of AIDS, many ophthalmologists now routinely diagnose and treat diseases that only a decade ago were either unknown or exceedingly rare. Nevertheless, there is a surprising dearth of textbooks on the ocular problems associated with AIDS. The book by Orellana et al. goes far in filling this gap.

The book is brief (105 pages) but complete. One expects to find high-quality photographs in any book dealing with diseases of the visual system. This book does not disappoint the reader; the color plates are superb. The section on the posterior segment (the retina, optic nerve, and choroid) is especially good. It is no surprise that cytomegalovirus retinitis, the most common cause of ocular morbidity in patients with AIDS, is well covered. But there are also excellent examples of more unusual disorders, such as choroidal cryptococcosis, choroidal pneumocystis infection, herpes zoster retinitis, and candida endophthalmitis.

By strict definition, only chapters 3 through 6 should be included in this book, since it is an atlas of ocular diseases. These four chapters address the subject matter in an anatomical fashion (from the front of the eye to the back of the eye). Both the illustrative case histories and excellent color figures enrich the text.

Chapters 1 and 2, which are for the most part text, discuss the history of the AIDS pandemic and public health issues. The recommendations and photographic depictions of proper instrument handling and operating room technique, in chapter 2, are among the best I have seen in print. The final chapter, which is well illustrated, covers the most common nonocular manifestations of AIDS.

The inclusion of these three chapters in the book makes it clear that the atlas is intended for ophthalmologists. Most primary care physicians, internists, and other medical specialists would find the review of the history, epidemiology, and systemic manifestations of AIDS too basic. The depth of the discussion is perfect, however, for specialists in eye care whose background in systemic diseases is limited.

Few disorders are omitted. One of the most glaring omissions is rifabutin-induced uveitis, perhaps the most common cause of iritis in HIV-positive patients. Since descriptions of this disorder appear to postdate the most recent information in the book, the authors cannot be faulted.

Several of the authors' statements are controversial. For example, manual injection of silicone oil during the repair of cytomegalovirus-related retinal detachment may not necessarily be the safest and simplest technique.

General ophthalmologists who screen patients with AIDS for ocular complications and ophthalmologists in training will find this atlas invaluable. The high quality of the color plates and the excellence of the accompanying text facilitate the clinical identification of the entities described. The proper diagnosis of most of these ocular disorders requires a proficiency with certain instruments (e.g., slit lamp and the indirect ophthalmoscope) that nonophthalmologists may lack. Medical specialists other than ophthalmologists may therefore derive little practical knowledge from this atlas but should nevertheless find the excellent photographic depictions of the infectious, inflammatory, and neoplastic ocular complications of AIDS fascinating.

Jay S. Duker, M.D.
Tufts University School of Medicine, Boston, MA 02111