AUTHOR AND EDITOR INFORMATION

Section 1 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

INTRODUCTION

Section 2 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Background

In 1872, Kaposi was the first to report an idiopathic, multiple-pigmented sarcoma of the skin that predominantly affected elderly men of Mediterranean or Ashkenazi ancestry. This classic type has an indolent course and commonly presents on the lower extremities.

Since the original description, 3 additional forms have been described. Endemic Kaposi sarcoma is prevalent in central Africa, primarily affecting young men with aggressive skin and visceral lesions. Transplant-related Kaposi sarcoma has been reported in patients with renal transplants on immunosuppressive therapy. Epidemic Kaposi sarcoma, better known as AIDS-related Kaposi sarcoma, commonly affects homosexual males with AIDS. Prior to the AIDS epidemic of 1981, fewer than 25 reported cases of ophthalmic Kaposi sarcoma existed in the literature.

Pathophysiology

Whether the 4 variants of Kaposi sarcoma represent the same disease process or different processes that manifest the same end-stage lesion is unclear. Although the etiology has not been elucidated, the human herpesvirus 8 (HHV-8) has been implicated. In 1994, Chang et al identified this virus in more than 90% of patients with AIDS-related Kaposi sarcoma.

Frequency

United States

Prior to 1981, fewer than 25 reported cases of ophthalmic Kaposi sarcoma existed in the literature. Currently, the overwhelming majority of ophthalmic Kaposi sarcoma is AIDS related. In 1986, the Centers for Disease Control and Prevention (CDC) reported that Kaposi sarcoma occurs in approximately 24% of patients with AIDS and 35% of all homosexual men with AIDS. The CDC reported that during the period from 1992-1997, Kaposi sarcoma occurred in 23.8% of males with AIDS and 27.4% of all homosexual men with AIDS. During the same time period, only 2.3% of women with AIDS developed Kaposi sarcoma.

Ophthalmic involvement occurs in 20-24% of patients with AIDS-related Kaposi sarcoma. Ophthalmic presentation was the initial manifestation of AIDS-related Kaposi sarcoma in 4-12% of patients. Eye lesions are neither an early nor a late manifestation of Kaposi sarcoma. A review of the literature reports that most eye lesions involve the conjunctivae or eyelids; 10-75% of patients have conjunctival lesions, and 25-80% of patients have eyelid lesions.

In recent years, the incidence of Kaposi sarcoma among HIV patients has declined significantly, from 60.6% in 1992 to 19.7% in 1997. The exact cause for this decline is unclear, but the introduction of protease inhibitors, combination HIV therapy, and safer sexual practices may have played significant roles.

Mortality/Morbidity

• Systemic Kaposi sarcoma
• • Tumors have been linked to significant mortality and morbidity. Kaposi sarcoma can disseminate to visceral organs (ie, lungs, liver, adrenal glands, kidneys, bone marrow, gastrointestinal tract).
  • Bowel obstruction, lower extremity edema, shortness of breath, hemorrhage, and pain have been reported.
  • Visceral and lung involvement usually portends a poor prognosis.
• Ophthalmic Kaposi sarcoma
• • Generally, ophthalmic Kaposi sarcoma is indolent.
  • Ocular tumor growth can result in severe damage to the ocular adnexa and the ocular surface.
  • Involvement of the eyelids can cause significant disfigurement and lid dysfunction. Trichiasis can develop from mechanical ectropion or entropion. Lagophthalmos and trichiasis can result in profound irritation and dryness, infections, and corneal scarring. Large lid tumors can induce irregular corneal astigmatism. Conjunctival involvement may result in recurrent subconjunctival hemorrhages.
  • Ultimately, vision could be lost from lid dysfunction, corneal surface changes, or visual obstruction.

Race

• Classic Kaposi sarcoma usually involves elderly men with Mediterranean or Ashkenazi ancestry.
• Endemic Kaposi sarcoma usually involves young black males from central Africa.
• Transplant- or AIDS-related Kaposi sarcoma has no racial preference.

Sex

• Classic Kaposi sarcoma usually involves elderly men.
• Endemic Kaposi sarcoma usually involves young males.
• AIDS-related Kaposi sarcoma predominantly involves homosexual males.

Age

• Classic Kaposi sarcoma affects the older population.
• Endemic Kaposi sarcoma affects children with a male-to-female ratio of 1:1; after puberty, males predominantly are affected.
• AIDS-related Kaposi sarcoma usually affects males aged 20-49 years.

CLINICAL

Section 3 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

History

• Identify risk factors for Kaposi sarcoma. The clinician should ask about the following:
• • Demographics
  • Immune status
  • Previous skin lesions
  • Previous treatment for Kaposi sarcoma
  • History of opportunistic infections
  • Current medication use
• Symptoms of Kaposi sarcoma include the following:
• • Pain
  • Photophobia
  • Recurrent red or bloody eyes
  • Irritation and foreign body sensation
  • Epiphora
  • Dry eyes
  • Mucopurulent discharge
  • Heavy or swollen eyelids
  • Cosmetic disfigurement of the eyelids
  • Eyelashes rubbing against the eyes
  • Inability to close the eyes
  • Visual obstruction
  • Blurred vision

Physical

• Full ocular examination should include the following:
• • Inspect and evert the eyelids and lashes.
  • Perform slit lamp biomicroscopy.
  • Examine palpebral and bulbar conjunctivae and fornices in detail.
  • Palpate the lacrimal gland, and examine for masses.
  • Examine both eyes for proptosis in the rare likelihood of orbital involvement. Fortunately, intraocular Kaposi sarcoma has never been reported.
• The lesions are purplish red to bright red and highly vascular with surrounding telangiectatic vessels. They may be macular, plaquelike, or nodular.
• Dugel et al described 3 clinical stages that may help direct therapy.
• Stage I and II tumors are patchy and flat. These lesions have a thickness of less than 3 mm in vertical height and are younger than 4 months.
• Stage III tumors are nodular and elevated with a vertical height of greater than 3 mm. They tend to be older than 4 months.
• Ophthalmic Kaposi sarcoma lesions are found on the eyelids, conjunctiva, caruncle, and lacrimal sac. They rarely are found inside the orbit.
• Of ophthalmic Kaposi sarcoma cases, 6-16% are eyelid lesions, and the superior and inferior eyelids tend to be involved equally.
• Of ophthalmic Kaposi sarcoma cases, 7-18% are conjunctival lesions. Many conjunctival lesions tend to involve the inferior conjunctiva and fornix.
• Lesions tend to be indolent, but, as the tumor grows, it can alter ocular adnexal structures and the ocular surface. The mass effect of the tumor on the eyelids can cause mechanical ectropion or entropion with trichiasis and lagophthalmos and irregular astigmatism.
• • Ectropion or entropion can result in poor lid apposition, trichiasis, and lagophthalmos. Consequently, the patient may experience epiphora, poor tear clearance and drainage, recurrent corneal abrasions, pain and discomfort, foreign body sensation, dry eyes, and photophobia.
  • Long-standing trichiasis and exposure can result in corneal infection, scarring, and opacification.
• Rarely, tumor bulk may block the visual axis by ptosis or direct obstruction. Tumor bulk may even prevent the complete closure of the eyelid.
• Conjunctival involvement may present with subconjunctival hemorrhage, injection, and chemosis.

Causes

• HHV-8 has been implicated.
• Homosexual males with HIV are at an increased risk. This risk is increased markedly with the number of partners.
• Patients who have had organ transplants and use immunosuppressive agents and steroids are at an increased risk.
• Elderly males of Mediterranean or Ashkenazi ancestry are at an increased risk.

DIFFERENTIALS

Section 4 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Other Problems to be Considered

Foreign body granuloma
Lymphangioma
Conjunctival cyst
Inflamed pinguecula
Pyogenic granuloma
Allergic reaction
Infection
Eyelid edema
Sebaceous carcinoma
Amelanotic melanoma
Disseminated cryptococcal infection

WORKUP

Section 5 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Lab Studies

• HIV enzyme-linked immunosorbent assay
• HIV Western blot

Imaging Studies

• Imaging studies are generally not necessary, unless orbital or disseminated Kaposi sarcoma is suspected.

Procedures

• Cutaneous or conjunctival biopsy of the lesion may be necessary for a definitive diagnosis.

Histologic Findings

All 4 variants of Kaposi sarcoma demonstrate similar histologic findings of tissue, containing endothelium-lined vascular channels and proliferation of spindle-shaped cells surrounded by inflammatory cells. Often, an increased angiogenesis with erythrocyte extravasation is present. Dugal et al described 3 histologic types of Kaposi sarcoma, which probably represents different stages along a continuum.

Type I

• Thin, dilated vascular channels are lined by flat endothelial cells with lumen-containing erythrocytes. The cells have flat endothelial fusiform nuclei and scanty cytoplasm.
• Moderate mononuclear cell infiltrate surround these abnormal vessels.
• No spindle cells or slit spaces are observed.

Type II

• Plump, fusiform endothelial cells line thin, dilated empty vascular channels. Many of these cells have hyperchromatic nuclei.
• The inflammatory infiltrate of macrophages, plasma cells, and lymphocytes is sparse.
• Foci of a few immature spindle cells and early slit vessels are present.

Type III

• Large aggregates of densely packed spindle cells with hyperchromatic nuclei, occasional mitotic figures, and abundant slit spaces often contain erythrocytes.
• Inflammatory cells are scant.

TREATMENT

Section 6 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Medical Care

The goal of therapy is to relieve ocular irritation, mass effect, and disfigurement. Therapy is not curative. If the patient has no ophthalmic complaints, the tumor usually is observed. For AIDS-related Kaposi sarcoma, consider immune reconstitution with triple antiviral medication.

Kaposi sarcoma tends to respond to chemotherapy. Ophthalmologists may want to delegate the use of chemotherapy to a chemotherapist or an oncologist familiar with the use of the agents. If the patient has systemic involvement that requires chemotherapy, the eye lesion often resolves or is reduced markedly after starting this therapy. However, recurrence commonly follows after discontinuation of chemotherapy. If local treatment is indicated, defer for at least 4 weeks after systemic chemotherapy to allow for regression of the lesions.

• Conventional Adriamycin, bleomycin sulfate, and vinblastine sulfate (ABV) combination therapy
• • Doxorubicin hydrochloride (Adriamycin) 40 mg/m² q4wk or 20 mg/m² q2-3wk
  • Bleomycin sulfate 10 U/m² q2wk
  • Vinblastine sulfate 1.4 mg/m² with 2 mg maximum dose q2wk has been recommended with ABV combination therapy. See Medication.
• Single agent therapies
• • Liposomal daunorubicin (DaunoXome) 40 mg/m² IV q2wk until complete response; the response is comparable to ABV but with less resultant neutropenia.
  • Pegylated liposomal doxorubicin (Doxil) 20 mg/m² q3wk; the response is comparable to ABV or BV but with either lower or similar neutropenia risk.
  • Liposomal anthracyclines have a prolonged half-life when compared to their unencapsulated counterparts.
• Alternative therapies
• • Paclitaxel (Taxol) 135 mg/m² IV over 3 h q3wk or a total dose of 100 mg/m² given IV over 3 h q2wk. All patients should be premedicated with the following 3 medications to prevent hypersensitivity reactions:
  • • Dexamethasone 10 mg PO 12 h before treatment
    • Diphenhydramine 50 mg IV 30 min prior to treatment
    • Cimetidine or ranitidine IV 30 min before treatment
  • If the absolute neutrophil count is greater than 1,000 cells/mm³, then continue with treatments. Reduce the dose of subsequent treatments by 20% if the neutrophil count falls below 500 cells/mm³.
  • Other chemotherapeutic agents used in Kaposi sarcoma include etoposide (VePesid), dactinomycin (Cosmegen), cisplatin (Platinol), and interferon alfa-n3 (Alferon N).
• Intralesional chemotherapy: Interferon alfa-2a 0.5 cc of 3 million IU subconjunctival injection adjacent to the tumor was reported by Hummer et al to be efficacious in a 46-year-old man with AIDS-related conjunctival Kaposi sarcoma.
• Investigational medications
• • Human chorionic gonadotropin–associated factors
  • • Since males are at a higher risk for developing Kaposi sarcoma, some investigators believe that female hormones may play a protective role. Hermans et al experienced complete or partial regression of skin lesions in 38% of patients with AIDS-related Kaposi sarcoma after intralesional injections of human chorionic gonadotropin (hCG).
    • Sammaniego et al demonstrated that human chorionic gonadotropin–associated factors (HAF) can induce apoptosis of Kaposi sarcoma cells in vivo and in vitro.
  • Iron chelators
  • • Simonart et al currently is investigating the role of regulating iron concentration in tumor cells. They demonstrated that the addition of iron salts strongly stimulates the growth of Kaposi sarcoma and that the use of iron chelators inhibits growth. Their findings are disclosing new therapeutics in tumor management with iron-chelating agents.
    • Hermans et al speculate that the lower risk for developing Kaposi sarcoma in females may be because women have lower iron stores. He also believes that patients with renal transplants are more susceptible to Kaposi sarcoma because they tend to have higher iron loads from repeated blood transfusions.
    • Other experimental medications include fumagillin analogues (AGM 1470), bacterial cell-wall peptidoglycan (SP-PG derivatives), interleukin-4 (IL-4), and L-glutamine-tryptophan.
    • Intralesional cidofovir (an antiherpetic medication) injections have demonstrated poor results. Bailey et al have reported that all-trans-retinoic acid has not demonstrated optimistic results.
  • Irradiation
  • • Most patients respond immediately to radiation therapy, but recurrence commonly occurs. Consequently, irradiation is used primarily as a palliative measure.
    • A typical treatment includes 2,000-3,000 cGy with the total dose given in fractions of 200-300 cGy per session over 3 weeks.
    • Ocular complications of radiation include lid atrophy, skin necrosis, ectropion, telangiectasia, tearing, eyelash loss, keratitis, cataract formation, conjunctival keratinization, skin erythema, keratoconjunctivitis sicca, alopecia, optic neuropathy, and lid notching.

Surgical Care

• Cryotherapy protocol
• • Subcutaneous injection of 2% lidocaine with epinephrine applied directly under the lesion is administered.
  • Cryoprobe with circulating liquid nitrogen is set at -30°C.
  • Cryoprobe is applied to the tumor and extended out to 1-2 mm of clear margin until the lesion becomes bright white.
  • Antibiotic ointment is applied to the treated site.
  • Follow-up care is arranged for the following day.
  • Ocular complications of cryotherapy include depigmentation and erythema, lid notching, and epilation.
• Surgical excision
• • Indications for local excision include cosmetically disturbing lesions, discomfort, and obstruction of vision from tumor bulk. Consider treating a lesion to prevent entropion formation with trichiasis and exposure keratopathy and corneal ulcer.
  • Protocol for local excision
  • • A cotton swab is soaked in 0.5% tetracaine hydrochloride, then applied directly over the tumor.
    • Lidocaine 2% with epinephrine is injected subconjunctivally with a 25-gauge needle.
    • Westcott scissors are used for blunt and sharp dissection to free the tumor. Clear margins of 1-2 mm are excised.
    • The specimen is marked for orientation.
    • Antibiotic ointment is applied, and the eye is patched.
    • Patient should receive follow-up care the next day.
• • Protocol for fluorescein angiography demarcation of conjunctival lesions
  • • A 5 cc bolus of fluorescein dye is injected intravenously and photographed using a Zeiss SE-40 blue exciter filter.
    • The fluorescein angiography is used to mark tumor vessels with heat cautery.
• Conjunctival tumors
• • Dugal et al recommended an effective treatment regimen based on the clinical and histopathologic stage of the tumor.
  • If the lesion is stage I or II and confined to the bulbar conjunctiva, excisional biopsy with 1-2 mm of clear margins is suggested.
  • For stage III tumors involving the bulbar conjunctiva, surgical excision guided by fluorescein angiography delineation of tumor margins resulted in no lesion recurrence during 4-8 months of follow-up care.
• Eyelid tumors
• Stage I and II lesions may be treated with cryotherapy. Stage II lesions may require radiation therapy.
• Recurrence usually occurs within 4 weeks after surgical excision.

Consultations

• If an eye lesion is identified, a thorough workup is necessary to rule out systemic involvement and HIV/AIDS infection.
• After a thorough ophthalmologic examination, refer to an internist or oncologist/chemotherapist.
• Disseminated Kaposi sarcoma may necessitate bronchoscopy, sigmoidoscopy, or lymph node biopsy for a definitive diagnosis and systemic chemotherapy.

MEDICATION

Section 7 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Most ophthalmologists may want to delegate the administration of chemotherapeutic agents to chemotherapists or oncologists. The medical therapy for disseminated Kaposi sarcoma consists of either ABV combination or liposomal daunorubicin alone. Liposomal doxorubicin usually is reserved for those patients who fail ABV combination or who are intolerant to ABV therapy. Other second-line therapies include the use of paclitaxel and interferon alfa-n3.

Drug Category: Antineoplastics

Inhibit cell growth and proliferation.

Drug Category: Interferons

Are naturally produced proteins with antiviral, antitumor, and immunomodulatory actions. Alfa, beta, and gamma interferons may be given topically, systemically, and intralesionally.

FOLLOW-UP

Section 8 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Further Outpatient Care

• Patients should have routine ophthalmic examinations; the frequency depends on the severity of eye involvement.
• • Most eye lesions can be observed.
  • Severe eye discomfort, disfigurement, and dysfunction indicate a need for local treatment.

In/Out Patient Meds

• Most eye lesions are simply observed.

Complications

• See Mortality/Morbidity.

Prognosis

• Ophthalmic Kaposi sarcoma has an indolent course. Most lesions are observed.

Patient Education

• Instruct patients about the risk of HIV because Kaposi sarcoma may be the initial manifestation of AIDS.
• Educate patients about the importance of routine ophthalmologic examinations.

MISCELLANEOUS

Section 9 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Medical/Legal Pitfalls

• Kaposi sarcoma may be the initial manifestation of AIDS. Discovery of any Kaposi lesions without a significant clinical history of other medical problems warrants a referral to an internist for thorough evaluation for HIV or other immunocompromised conditions.
• Most ophthalmologists should delegate the use of chemotherapy to an oncologist/chemotherapist because of the lack of familiarity with the antineoplastic agents.

MULTIMEDIA

Section 10 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Media file 1:  Section of eyelid with Kaposi sarcoma lesion under high magnification. This tissue section demonstrates increased angiogenesis and spindle-shaped cells. Courtesy of Ben Glasgow, MD, University of California, Los Angeles, Department of Ophthalmology, Jules Stein Eye Institute.
	View Full Size Image
Media type:  Photo

Media file 2:  Section of eyelid with Kaposi sarcoma lesion under high magnification. This tissue section demonstrates endothelium-lined vascular channels and proliferation of spindle-shaped cells. Increased angiogenesis with erythrocyte extravasation is observed. Courtesy of Ben Glasgow, MD, University of California, Los Angeles, Department of Ophthalmology, Jules Stein Eye Institute.
	View Full Size Image
Media type:  Photo

Media file 3:  The inferior conjunctiva is involved more commonly than the superior conjunctiva in Kaposi sarcoma. Courtesy of Gary N Holland, MD, University of California, Los Angeles, Department of Ophthalmology, Jules Stein Eye Institute.
	View Full Size Image
Media type:  Photo

Media file 4:  Kaposi sarcoma involvement of the eyelid. Courtesy of Gary N Holland, MD, University of California, Los Angeles, Department of Ophthalmology, Jules Stein Eye Institute.
	View Full Size Image
Media type:  Photo

REFERENCES

Section 11 of 11

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

• Bailey J, Pluda JM, Foli A, et al. Phase I/II study of intermittent all-trans-retinoic acid, alone and in combination with interferon alfa-2a, in patients with epidemic Kaposi''s sarcoma. J Clin Oncol. Aug 1995;13(8):1966-74. [Medline].
• Brasnu E. Efficacy of interferon-alpha for the treatment of Kaposi's sarcoma herpesvirus-associated uveitis. Am J Ophthalmol. 2005;140:746-748. [Medline].
• Center for Disease Control. Surveillance for AIDS-Defining Opportunistic Illnesses. Morbidity and Mortality Weekly Report. Atlanta, Ga: Center for Disease Control;. 48:1-24.
• Center for Disease Control. The Complete Reference for Generic and Brand Drugs. 9th ed. Mosby's GenRx; 1999.
• Centers for Disease Control. Update: Acquired Immunodeficiency Syndrome - United States. Morbidity and Mortality Weekly Report. Atlanta, Ga: Center for Disease Control;. 35:17-21.
• Chang Y, Cesarman E, Pessin MS, et al. Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi''s sarcoma. Science. Dec 16 1994;266(5192):1865-9. [Medline].
• Dugel PU, Gill PS, Frangieh GT, Rao NA. Ocular adnexal Kaposi''s sarcoma in acquired immunodeficiency syndrome. Am J Ophthalmol. Nov 15 1990;110(5):500-3. [Medline].
• Dugel PU, Gill PS, Frangieh GT, Rao NA. Treatment of ocular adnexal Kaposi''s sarcoma in acquired immune deficiency syndrome. Ophthalmology. Jul 1992;99(7):1127-32. [Medline].
• Gigase PL, de Muynck A, de Feyter M. Kaposi''s sarcoma in Zaire. IARC Sci Publ. 1984;(63):549-57. [Medline].
• Gill PS, Wernz J, Scadden DT, et al. Randomized phase III trial of liposomal daunorubicin versus doxorubicin, bleomycin, and vincristine in AIDS-related Kaposi''s sarcoma. J Clin Oncol. Aug 1996;14(8):2353-64. [Medline].
• Hermans P. Epidemiology, etiology and pathogenesis, clinical presentations and therapeutic approaches in Kaposi''s sarcoma: 15-year lessons from AIDS. Biomed Pharmacother. 1998;52(10):440-6. [Medline].
• Hermans P, Clumeck N, Picard O, et al. AIDS-related Kaposi''s sarcoma patients with visceral manifestations. Response to human chorionic gonadotropin preparations. J Hum Virol. Jan-Feb 1998;1(2):82-9. [Medline].
• Holland GN, Pepose JS, Pettit TH, et al. Acquired immune deficiency syndrome. Ocular manifestations. Ophthalmology. Aug 1983;90(8):859-73. [Medline].
• Holland GN, Gottlieb MS, Yee RD, et al. Ocular disorders associated with a new severe acquired cellular immunodeficiency syndrome. Am J Ophthalmol. Apr 1982;93(4):393-402. [Medline].
• Hummer J, Gass JD, Huang AJ. Conjunctival Kaposi''s sarcoma treated with interferon alpha-2a [letter]. Am J Ophthalmol. Oct 15 1993;116(4):502-3. [Medline].
• Kaposi M. Idiopathisches multiple Pigment-sarkom der Haut. Arch Dermatol. Syphilol;1872:4. [Medline].
• Mansour AM. Adnexal findings in AIDS. Ophthal Plast Reconstr Surg. Dec 1993;9(4):273-9. [Medline].
• Meyers D. Eye signs that alert the clinician to a diagnosis of AIDS. SADJ. 2005;60:386-387. [Medline].
• Northfelt DW, Dezube BJ, Thommes JA, et al. Efficacy of pegylated-liposomal doxorubicin in the treatment of AIDS- related Kaposi''s sarcoma after failure of standard chemotherapy. J Clin Oncol. Feb 1997;15(2):653-9. [Medline].
• Palestine AG, Rodrigues MM, Macher AM, et al. Ophthalmic involvement in acquired immunodeficiency syndrome. Ophthalmology. Sep 1984;91(9):1092-9. [Medline].
• Reitz MS Jr, Nerurkar LS, Gallo RC. Perspective on Kaposi''s sarcoma: facts, concepts, and conjectures. J Natl Cancer Inst. Sep 1 1999;91(17):1453-8. [Medline].
• Samaniego F, Bryant JL, Liu N, et al. Induction of programmed cell death in Kaposi''s sarcoma cells by preparations of human chorionic gonadotropin. J Natl Cancer Inst. Jan 20 1999;91(2):135-43. [Medline].
• Schuman JS, Orellana J, Friedman AH, Teich SA. Acquired immunodeficiency syndrome (AIDS). Surv Ophthalmol. May-Jun 1987;DA - 19870828(6):384-410. [Medline].
• Shuler JD, Holland GN, Miles SA, et al. Kaposi sarcoma of the conjunctiva and eyelids associated with the acquired immunodeficiency syndrome. Arch Ophthalmol. Jun 1989;107(6):858-62. [Medline].
• Simonart T, Noel JC, Andrei G, et al. Iron as a potential cofactor in the pathogenesis of Kaposi''s sarcoma?. Int J Cancer. Dec 9 1998;78(6):720-6. [Medline].
• Stein M, Spencer D, Kuten A, Bezwoda W. AIDS-related Kaposi''s sarcoma: a review. Isr J Med Sci. Apr 1994;30(4):298-305. [Medline].
• Welles L, Saville MW, Lietzau J, et al. Phase II trial with dose titration of paclitaxel for the therapy of human immunodeficiency virus-associated Kaposi''s sarcoma. J Clin Oncol. Mar 1998;16(3):1112-21. [Medline].
• Yarchoan R. Therapy for Kaposi''s sarcoma: recent advances and experimental approaches. J Acquir Immune Defic Syndr. Aug 1 1999;21 Suppl 1:S66-73. [Medline].

Article Last Updated: Feb 1, 2007