Zidovudine-induced macular edema

A 42-year-old man with human immunodeficiency virus (HIV) infection and stable chronic anterior uveitis had two episodes of blurred vision due to cystoid macular edema; in both instances, blurred vision occurred within a few days of starting zidovudine therapy and improved with drug withdrawal. Hence, zidovudine was clearly implicated as the cause of macular edema and impaired visual acuity. Human immunodeficiency virus itself causes retinal lesions and is associated with various recognizable opportunistic retinal infections. On the other hand, macular edema frequently causes very subtle funduscopic findings. Macular edema and HIV-associated retinopathies may well coexist. Zidovudine should be withdrawn in patients who develop macular edema; however, patients with HIV-associated retinopathies may benefit from the drug. Thus, because it will completely alter the approach to treatment, macular edema must be excluded in all patients who are receiving zidovudine therapy and have declining visual acuity, even in the presence of other retinal abnormalities.