JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2010.51.2.203 jkos-51-203 Original Article Cinical Manifestations and Prognosis of Cytomegalovirus Retinitis KwunYoung Kyo MD 1 ChaeJu Byung MD 2 HamDon Il MD 1 Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea Address reprint requests to Don Il Ham, MD Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine #50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea. Tel: 82-2-3410-3567, Fax: 82-3410-0084, E-mail: oculus@naver.com 09 2010 07 09 2010 51 2 203 209 01062009 24112009 Copyright © 2010 Korean Ophthalmological Society 2010 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

Cytomegalovirus (CMV) retinitis is common in patients with immunodeficient conditions caused by acquired immunodeficiency syndrome (AIDS), cytotoxic chemotherapy and immunosuppresive treatment. The purpose of this study was to assess the clinical manifestations and prognosis of CMV retinitis cases.

 Methords

Thirty-one eyes of 21 patients who were diagnosed with CMV retinitis were retrospectively reviewed. The clinical manifestations and prognosis of all patients were analyzed.

 Results

The average age of patients was 24.4±19.8 years. Eight patients were female and 13 patients were male. The predisposing conditions of patients were leukemia (nine patients), immunosuppressed conditions due to organ transplantation (three patients), AIDS (two patients) and other (seven patients). Eleven patients exhibited bilateral disease. The mean follow-up period was 31.3 months, and there were no differences between mean initial visual acuity (0.70±0.31) and mean visual acuity (0.77±0.20) at final visit. The major causes of visual loss were retinitis and atrophic changes involving the macula. Although retinitis was successfully treated with anti-viral agents in all cases, cataract (10 eyes, 31.3%), cystoid macular edema (four eyes, 12.5%), retinal detachment (two eyes, 6.3%), epiretinal membrane (two eyes, 6.3%) and immune recovery uveitis (two eyes, 6.3%) developed after the initial treatment.

 Conclusions

Although the visual prognosis of CMV retinitis was relatively good after administration of appropriate antiviral therapy, clinicians should remain alert for the development of late complications, including retinal detachment, cystoid macular edema and immune recovery uveitis.

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Predisposing conditions of subjects.* Thrombotic thrombocytopenic purpura, Wiskott-Aldrich syndrome, congenital immune deficiency syndrome.

(A) Color fundus photograph of a transplant patient with cytomegalovirus retinitis manifested as a creamycolored area with overlying retinal hemorrhages. The lesions are located in the temporal part of the macula and do not involve the fovea. (B) Color fundus photographs after repeated intravitreal ganciclovir injections for 20 days.

Change of visual outcome through follow-up period

Complications of CMV retinitis

Subject characteristics

Variable
Number of subjects (persons) 21
Male/Female (percentage, persons) 13/8 (62/38)
Mean age (range, years) 24.4±19.8 (1–59)
Mean duration of follow up (range, months) 31.3±26.1 (4–120)
Bilateral CMV retinitis (percentage) 11 (52)
Time elapsed until CMV (range, months) 9.9±8.8 (2–32)

Symptoms of CMV retinitis

Symptoms Eyes (percentage)
Decreased visual acuity 8 (35%)
Floater 6 (26%)
Photopsia 2 (9%)
No symptom 7 (30%)
Total 23 (100%)

Infants who could not complain about their symptom were excluded.

Clinical characteristics of CMV retinitis patients

Number Age/Sex CMV Tx* Underline disease Initial VA† Final VA† Zone‡ Complication
1–1 12/M G IV§ ALL§§ 0.2 0.2 2 CME**
1–2 12/M G IV ALL 0.4 0.8 2 CME
2 50/M G IV KT∏∏ 1.0 1.0 1
3–1 16/F G IV AA 0.8 0.8 3
3–2 16/F G IV AA 0.1 0.7 1 CME
4 34/F G IV AIDS 0.5 0.8 1
5 38/M G IV CML＃＃ 1.0 0.9 2
6 10/M G IV CML 0.5 1.0 2,3
7–1 42/M G IV lymphoma 0.6 0.5 1,2,3 ERM††, IRU
7–2 42/M G IV lymphoma 1.0 0.7 1 IRU
8–1 4/M G IV ALL 0.7 0.5 1,2,3
8–2 4/M G IV ALL 0.2 0.6 2
9 40/M G IV AML 0.8 0.7 1,2
10 58/F G IV KT 0.4 0.6 2 ERM
11 59/M G IV PC＃＃＃ 0.5 0.7 2
12–1 13/M F IV∏ AML 0.9 1.0 2,3
12–2 13/M G,F IV AML 1.0 1.0 2,3
13 31/F G IV TTP∏∏∏ 0.9 0.9 2,3 RD‡‡, CME
14–1 2/F F IV AA*** − − 1,2,3,
14–2 2/F F IV AA − − 1,2,3
15 2/F F IV AML − − 2
16–1 1/M G,F IV WA sd.§§§ − − 2,3
16–2 1/M G,F IV WA sd. − − 2,3
17–1 12/M G,F IV AML 1.0 0.8 1,2
17–2 12/M G,F IV AML 1.0 0.8 1,2
18–1 45/F G IV LT††† 1.0 1.0 1,2
18–2 45/F G IV LT 1.0 0.9 1
19–1 1/M G IV IDS‡‡‡ − − −
19–2 1/M G IV IDS − − −
20 33/M G IV AIDS 1.0 0.9 2
21–1 9/F G,F IV AML 0.9 0.5 2,3
21–2 9/F G,F IV AML 0.6 0.2 2,3 RD

Cytomegalovirus treatment regimen

Visual acuity

Zone 1=the area within 1500 μm of the optic nerve or within 3000 μm of the fovea, Zone 2=from zone 1 to the equator, Zone 3=anterior to the equator

Intravenous ganciclovir

Intravenous foscarnet

Cystoids macular edema

Epiretinal membrane

Retinal detachment

Acute lymphoblastic leukemia

Kidney transplantation

Chronic myeloid leukemia

Aplastic anemia

Liver transplantation

Immune deficiency syndrome

Wiskott-Aldrich syndrome

Thrombotic thrombocytopenic purpura

Prostate cancer.