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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.
References
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Figure 1.
Predisposing conditions of subjects.* Thrombotic thrombocytopenic purpura, Wiskott-Aldrich syndrome, congenital immune deficiency syndrome.
Figure 2.
(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.
Table 1.
Subject characteristics
Table 2.
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%) |
Table 3.
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 |
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