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Kim HJ, Brill D, Giuliari GP. OCCLUSIVE CYTOMEGALOVIRUS PANUVEITIS AFTER INTRAVITREAL DEXAMETHASONE IMPLANT. Retin Cases Brief Rep 2024; 18:442-445. [PMID: 36735929 DOI: 10.1097/icb.0000000000001407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To report a case of unilateral cytomegalovirus (CMV) panuveitis with occlusive vasculitis after injection of intravitreal dexamethasone implant in a patient with type 2 diabetes mellitus. METHODS Observational case report. RESULTS A 60-year-old immunocompetent man with well-controlled type 2 diabetes mellitus was treated with intravitreal dexamethasone implant for recurrent uveitis that was responsive to steroids. Three months after implantation, the patient develops panuveitis with occlusive vasculitis. Anterior chamber tap confirms diagnosis of cytomegalovirus retinitis. Intravitreal foscarnet and oral valganciclovir led to quiescent disease. CONCLUSIONS Patients treated with local immunosuppressants should be monitored carefully to assess treatment response and complications, even in the absence of frank immunodeficiency. Quantitative viral PCR can be an effective way to monitor treatment response to antiviral therapy.
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Affiliation(s)
- Hyun Jun Kim
- University of Cincinnati College of Medicine, Cincinnati, OH; and
- Cincinnati Eye Institute, Cincinnati, OH
| | - Daniel Brill
- University of Cincinnati College of Medicine, Cincinnati, OH; and
- Cincinnati Eye Institute, Cincinnati, OH
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Jayadev C, Sanjay S, Handa A, Agrawal S. Human immunodeficiency virus retinopathy with presumed cytomegalovirus retinitis with macular oedema in a diabetic. BMJ Case Rep 2023; 16:e252710. [PMID: 37024150 PMCID: PMC10083806 DOI: 10.1136/bcr-2022-252710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
A man in his early 50s on regular follow-up for a stable non-proliferative diabetic retinopathy (NPDR) presented with decreased vision, worsening of retinal pathology and macular oedema in both eyes. His corrected distance visual acuity (CDVA) was 6/9 in the right eye and 6/15 in the left eye and fundus examination showed multiple intraretinal haemorrhages in all quadrants. His systemic workup revealed a severe thrombocytopaenia, which prompted a further detailed systemic evaluation revealing him to be positive for HIV with retinopathy complicating the pre-existing NPDR. Given the significant inflammation and macular oedema, a cocktail of intravitreal bevacizumab, ganciclovir and dexamethasone was administered. The retinopathy and macular oedema resolved and the CDVA improved to 6/6 in both eyes over a 6-month follow-up period. Any sudden worsening of fundus findings in a patient with diabetes necessitates immediate and detailed ocular and systemic evaluation, especially when the immune status is unknown.
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Affiliation(s)
- Chaitra Jayadev
- Vitreoretina Department, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Srinivasan Sanjay
- Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Ashit Handa
- Vitreoretina Department, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sameeksha Agrawal
- Vitreoretina Department, Narayana Nethralaya, Bengaluru, Karnataka, India
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Ferreira Tátá C, Ramires T, Piteira M, Matono R, Guz C. Cytomegalovirus Retinitis as a Sole Manifestation of HIV Infection. Cureus 2021; 13:e18642. [PMID: 34786237 PMCID: PMC8580125 DOI: 10.7759/cureus.18642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/05/2022] Open
Abstract
Retinitis is the most frequent manifestation of Cytomegalovirus (CMV) disease in patients with HIV infection. The virus reaches the retina by hematogenous spread, therefore patients with serum CMV load are at increased risk of developing CMV retinitis. The evolution of retinitis without specific treatment causes irreversible visual loss. Proper treatment is essential for controlling the disease progression, prevention of relapses, and contralateral eye involvement. This report describes a 56-year-old white male who started a progressive decrease in visual acuity (VA) of the right eye, without pain or inflammatory signs. Initial fundoscopy identified a dispersed preretinal hemorrhage and yellowish exudates. For the hypothesis of CMV retinitis, serology for HIV was requested and the subsequent result was positive. Other opportunistic infections, as well as manifestations of CMV infection in other organs, were ruled out. The patient was discharged on valganciclovir and highly active antiretroviral therapy (HAART) with progressive improvement in retinal changes, but without full recovery from VA due to chronic vitritis and tractional retinal detachment. Slow recovery of lymphocyte populations and sustained decrease in viral load were observed. CMV retinitis as an initial and sole manifestation of HIV infection is rare and requires screening. The importance of this case lies in its rarity, since CMV retinitis was the only manifestation of CMV infection and the only opportunistic infection in this patient. Early diagnosis and initiation of targeted therapy decrease the morbidity associated with this infection.
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Affiliation(s)
| | - Tiago Ramires
- Internal Medicine Department, Hospital do Espirito Santo de Évora, Évora, PRT
| | - Maria Piteira
- Internal Medicine Department, Hospital do Espirito Santo de Évora, Évora, PRT
| | - Rui Matono
- Internal Medicine Department, Hospital do Espirito Santo de Évora, Évora, PRT
| | - Claudiu Guz
- Internal Medicine Department, Hospital do Espirito Santo de Évora, Évora, PRT
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RAPIDLY PROGRESSIVE NEOVASCULAR GLAUCOMA FROM CYTOMEGALOVIRUS RETINITIS IN A NON-HUMAN IMMUNODEFICIENCY VIRUS PATIENT. Retin Cases Brief Rep 2021. [PMID: 29533389 DOI: 10.1097/icb.0000000000000734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe a case of neovascular glaucoma from cytomegalovirus (CMV) retinitis in a human immunodeficiency virus-negative patient with immunosuppression after stem-cell transplant for multiple myeloma. METHODS Retrospective case report. RESULTS A 71-year-old man on monthly infusion of daratumumab for multiple myeloma after stem-cell transplant presenting with a 2-week history of floaters, photophobia, and blurry vision was found to have polymerase chain reaction-confirmed CMV retinitis associated with diffuse occlusive vasculitis. The patient was human immunodeficiency virus negative with a CD4 count of 450/mm3. Despite immediate aggressive treatment, the patient developed neovascular glaucoma with poor visual outcome. CONCLUSION Cytomegalovirus retinitis in human immunodeficiency virus-negative patients is becoming more prevalent with increasing use of systemic immunosuppression therapy for various reasons. Patients with non-human immunodeficiency virus related CMV retinitis can have severe ischemia atypical of the classic CMV retinitis and should be followed closely for neovascularization.
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5
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Treating HIV-associated cytomegalovirus retinitis with oral valganciclovir and intra-ocular ganciclovir by primary HIV clinicians in southern Myanmar: a retrospective analysis of routinely collected data. BMC Infect Dis 2020; 20:842. [PMID: 33187478 PMCID: PMC7666479 DOI: 10.1186/s12879-020-05579-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background Cytomegalovirus retinitis (CMVR) is an opportunistic infection in HIV-infected people. Intraocular or intravenous ganciclovir was gold standard for treatment; however, oral valganciclovir replaced this in high-income countries. Low- and middle-income countries (LMIC) frequently use intraocular injection of ganciclovir (IOG) alone because of cost. Methods Retrospective review of all HIV-positive patients with CMVR from February 2013 to April 2017 at a Médecins Sans Frontièrs HIV clinic in Myanmar. Treatment was classified as local (IOG) or systemic (valganciclovir, or valganciclovir and IOG). The primary outcome was change in visual acuity (VA) post-treatment. Mortality was a secondary outcome. Results Fifty-three patients were included. Baseline VA was available for 103 (97%) patient eyes. Active CMVR was present in 72 (68%) eyes. Post-treatment, seven (13%) patients had improvement in VA, 30 (57%) had no change, and three (6%) deteriorated. Among patients receiving systemic therapy, four (12.5%) died, compared with five (24%) receiving local therapy (p = 0.19). Conclusions Our results from the first introduction of valganciclovir for CMVR in LMIC show encouraging effectiveness and safety in patients with advanced HIV. We urge HIV programmes to include valganciclovir as an essential medicine, and to include CMVR screening and treatment in the package of advanced HIV care.
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Liscombe-Sepúlveda JP, Alba-Linero C, Llorenç-Belles V, Adán-Civera A. Utility of Ultra-Widefield Retinal Imaging in the Follow-up and Management of Patients with Cytomegalovirus Retinitis. Ocul Immunol Inflamm 2020; 28:659-664. [DOI: 10.1080/09273948.2019.1606257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Carmen Alba-Linero
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
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7
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Ho M, Invernizzi A, Zagora S, Tsui J, Oldani M, Lui G, McCluskey P, Young AL. Presenting Features, Treatment and Clinical Outcomes of Cytomegalovirus Retinitis: Non-HIV Patients Vs HIV Patients. Ocul Immunol Inflamm 2019; 28:651-658. [PMID: 31166809 DOI: 10.1080/09273948.2019.1604003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare clinical features, complications, and outcomes of CMV retinitis in non-HIV immunocompromised patients with HIV infected patients. METHODS A retrospective study of patients diagnosed with CMV retinitis with or without HIV infection was performed. Results: Thirty-five eyes from 27 patients (median follow up 26 months) were included. Six patients had HIV infection, the others were immunocompromised from a range of causes. The baseline visual acuity (VA) was similar in the two groups. Prevalence of different types of retinitis (fulminant/indolent) was similar in the two groups. Presence of vitreous haze ≥1+ (p = .041), presence of arteritis, (p = .016) and widespread vascular occlusion (p = .003) were more common in the non-HIV group. CONCLUSION CMV retinitis can present with different features depending on the cause of immunocompromise. Evidence of intraocular inflammation such as vitritis, retinal arteritis, and vascular occlusions was more common in HIV-negative subjects.
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Affiliation(s)
- Mary Ho
- Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, Hong Kong SAR
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan , Milan, Italy.,Faculty of Medicine and Health, University of Sydney, Save Sight Institute , Sydney, NSW, Australia
| | - Sophia Zagora
- Faculty of Medicine and Health, University of Sydney, Save Sight Institute , Sydney, NSW, Australia
| | - Jolly Tsui
- Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, Hong Kong SAR
| | - Marta Oldani
- Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan , Milan, Italy
| | - Grace Lui
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, Hong Kong SAR
| | - Peter McCluskey
- Faculty of Medicine and Health, University of Sydney, Save Sight Institute , Sydney, NSW, Australia
| | - Alvin L Young
- Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, Hong Kong SAR
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Haze M, Kobayashi T, Kakurai K, Shoda H, Takai N, Takeda S, Tada R, Maruyama K, Kida T, Ikeda T. Bilateral Cytomegalovirus Retinitis in a Patient with Systemic Lupus Erythematosus. Case Rep Ophthalmol 2016; 7:303-8. [PMID: 27462259 PMCID: PMC4943310 DOI: 10.1159/000446391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/23/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose The purpose of this study was to report the case of a patient who underwent vitrectomy for bilateral rhegmatogenous retinal detachment caused by cytomegalovirus (CMV) retinitis while undergoing steroid and immunosuppressant therapy for systemic lupus erythematosus (SLE). Case Report We report on a 29-year-old female who was undergoing steroids and immunosuppressants treatment for SLE at Osaka Medical College Hospital, Takatsuki City, Japan. Examination of the patient due to prolonged and worsening diarrhea revealed positive test results for C7-HRP, and she was diagnosed with CMV colitis. She was subsequently admitted to the hospital and started on intravenous ganciclovir for treatment. Approximately 1.5 months later, her primary complaint was deterioration of the upper visual field in her left eye, and she was then referred to the Department of Ophthalmology. Numerous granular exudative spots were found around the lower retinal area of her left eye with retinal breaks that had developed in an area of retinal necrosis that resulted in retinal detachment. After time was allowed for the patient's general condition to improve, a vitrectomy was performed on that eye. The patient subsequently developed a similar retinal detachment in her right eye, for which she underwent a vitrectomy. Although the patient required multiple surgeries on both eyes, her retinas currently remain reattached and the inflammation has subsided. Conclusion The findings of this study show that strict attention must be paid to SLE patients on immunosuppressive therapy due to the possible association of CMV retinitis.
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Affiliation(s)
- Masaya Haze
- Department of Ophthalmology, Osaka Medical College, Takasuki City, Japan
| | | | - Keigo Kakurai
- Department of Ophthalmology, Osaka Medical College, Takasuki City, Japan
| | - Hiromi Shoda
- Department of Ophthalmology, Osaka Medical College, Takasuki City, Japan
| | - Nanae Takai
- Department of Ophthalmology, Osaka Medical College, Takasuki City, Japan
| | - Sayako Takeda
- Department of Ophthalmology, Osaka Medical College, Takasuki City, Japan; Takeda Eye Clinic, Osaka City, Japan
| | - Rei Tada
- Department of Ophthalmology, Osaka Medical College, Takasuki City, Japan; Tada Eye Clinic, Ikeda City, Japan
| | - Kouichi Maruyama
- Department of Ophthalmology, Osaka Medical College, Takasuki City, Japan; Maruyama Eye Clinic, Takatsuki City, Japan
| | - Teruyo Kida
- Department of Ophthalmology, Osaka Medical College, Takasuki City, Japan
| | - Tsunehiko Ikeda
- Department of Ophthalmology, Osaka Medical College, Takasuki City, Japan
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Iu LP, Fan MC, Lau JK, Chan TS, Kwong YL, Wong IY. Long-term Follow-up of Cytomegalovirus Retinitis in Non-HIV Immunocompromised Patients: Clinical Features and Visual Prognosis. Am J Ophthalmol 2016; 165:145-53. [PMID: 27005706 DOI: 10.1016/j.ajo.2016.03.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/04/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate clinical features and long-term visual outcome of cytomegalovirus (CMV) retinitis in patients without human immunodeficiency virus (HIV) infection, and to determine factors that predict visual outcome. DESIGN Retrospective cohort study. METHODS Consecutive patients with CMV retinitis without HIV infection were reviewed. Main outcome measures included clinical features, proportion of eyes with 6-month and final visual acuity (VA) <20/70 and <20/400, and odds ratios of factors associated with poor visual outcome. RESULTS A total of 20 eyes from 13 patients were included with a median follow-up time of 17 months. All had at least 6 months of follow-up except 1 patient who died from sepsis at 1 month. At presentation, 50% of eyes had VA <20/70 and 25% had VA <20/400. Zone 1 involvement occurred in 55% and vitreous haze ≥grade 2+ occurred in 25%. Recurrence occurred in 33.3% at a mean time of 6.4 ± 3.3 weeks after discontinuation of anti-CMV therapy. The retinal detachment rate was 21.7% per eye-year and mortality rate was 11.7% per person-year. At final visit, 60% had VA <20/70 and 35% had VA <20/400. Macular involvement was significantly associated with poor final VA <20/400 (odds ratio = 25.00, P = .016). CONCLUSIONS CMV retinitis without HIV infection was often aggressive at presentation. Significant intraocular inflammation was not uncommon. The long-term visual outcome was poor, especially in those with macular involvement.
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Welling JD, Tarabishy AB, Christoforidis JB. Cytomegalovirus retinitis after central retinal vein occlusion in a patient on systemic immunosuppression: does venooclusive disease predispose to cytomegalovirus retinitis in patients already at risk? Clin Ophthalmol 2012; 6:601-3. [PMID: 22570539 PMCID: PMC3346188 DOI: 10.2147/opth.s28086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cytomegalovirus (CMV) retinitis remains the most common opportunistic ocular infection in immunocompromised patients. Patients with immunocompromising diseases, such as acquired immunodeficiency syndrome, inherited immunodeficiency states, malignancies, and those on systemic immunosuppressive therapy, are known to be at risk. Recently, it has been suggested that patients undergoing intravitreal injection of immunosuppressive agents may also be predisposed. One previous case report speculated that there may be an additional risk for CMV retinitis in acquired immunodeficiency syndrome patients with venoocclusive disease. This case study presents a case of CMV retinitis following central retinal vein occlusion in a patient on systemic immunosuppressants.
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Affiliation(s)
- John D Welling
- Department of Ophthalmology, Havener Eye Institute, Ohio State University, Columbus, OH, USA
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11
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Cho WB, Kim HC, Moon JW. Spontaneous resolution of intravitreal steroid-induced bilateral cytomegalovirus retinitis. KOREAN JOURNAL OF OPHTHALMOLOGY 2012; 26:151-5. [PMID: 22511845 PMCID: PMC3325623 DOI: 10.3341/kjo.2012.26.2.151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 07/09/2010] [Indexed: 11/23/2022] Open
Abstract
A 73-year-old woman underwent vitrectomy and intravitreal triamcinolone acetonide (IVTA) of the right eye and cataract surgery with IVTA of the left eye, for bilateral diabetic macular edema. The patient presented with visual loss in both eyes three-months postoperatively. The fundoscopic examination revealed white-yellow, necrotic peripheral lesions in the superotemporal quadrant of both eyes. Although bilateral acute retinal necrosis was suspected, azotemia resulting from diabetic nephropathy limited the use of acyclovir. Antiviral treatment was not started. A sample of the aqueous humor for polymerase chain reaction (PCR) analysis was obtained. One week later, the PCR results indicated the presence of cytomegalovirus (CMV). Since the retinal lesions did not progress and did not threaten the macula, the patient was followed without treatment for CMV. The retinal lesions progressively regressed and completely resolved in both eyes by six months of follow-up. Patients with IVTA-induced CMV retinitis may not require systemic treatment with ganciclovir.
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Affiliation(s)
- Won Bin Cho
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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12
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Chen J, Ausayakhun S, Ausayakhun S, Jirawison C, Khouri CM, Porco TC, Heiden D, Keenan JD, Margolis TP. Comparison of autophotomontage software programs in eyes with CMV retinitis. Invest Ophthalmol Vis Sci 2011; 52:9339-44. [PMID: 22064986 DOI: 10.1167/iovs.11-8322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Automated mosaic software programs are used to stitch together overlapping retinal fundus photographs. The performance of these programs in eyes with retinal diseases has not been independently evaluated. This study compares the quality of the mosaic products of three autophotomontage software programs, using digital fundus photographs of eyes with cytomegalovirus (CMV) retinitis. METHODS Photographs of 99 eyes with CMV retinitis of 94 patients with HIV were taken at Maharaj Nakorn Chiang Mai Hospital in Chiang Mai, Thailand. Automated mosaic images were created for each of the 99 eyes by three different commercially available programs: IMAGEnet (Topcon, Oakland, NJ), i2k Retina (DualAlign LLC, Clifton Park, NY), and AutoMontage (OIS, Sacramento, CA). Three masked graders ranked each set of mosaics for each eye. The graders also assessed the overall image quality and documented mosaic artifacts in each image. RESULTS i2k Retina was ranked as the best program (70%-88%) more often than AutoMontage (10%-33%, P < 0.001) or IMAGEnet (0%-4%, P < 0.001) for creating automontages from digital fundus photographs of eyes with CMV retinitis. Acceptable quality mosaic images were reported most commonly for i2k Retina (93%-94%) and AutoMontage (91%-95%), followed by IMAGEnet (27%-56%, P < 0.001). IMAGEnet had a significantly higher percentage of mosaic errors than did either i2k Retina or AutoMontage (P < 0.001). CONCLUSIONS In eyes with CMV retinitis, both the i2k Retina and AutoMontage software packages appear to create higher quality mosaics than does IMAGEnet. Automated retinal mosaic imaging may be valuable in diagnosing CMV retinitis and observing disease progression.
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Affiliation(s)
- Jenny Chen
- F. I. Proctor Foundation, San Francisco, California, USA
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Reddy AK, Balne PK, Reddy RK, Mathai A, Kaur I. Loop-mediated isothermal amplification assay for the diagnosis of retinitis caused by herpes simplex virus-1. Clin Microbiol Infect 2011; 17:210-3. [PMID: 20298270 PMCID: PMC7128213 DOI: 10.1111/j.1469-0691.2010.03216.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A loop-mediated isothermal amplification (LAMP) assay was developed for the detection of herpes simplex virus 1 (HSV-1). The specificity of the assay was tested using DNA extracted from HSV-1-infected rabbit corneal epithelium cultures, HSV-2 grown on Vero cell line, cytomegalovirus (CMV) (AD-169), varicella zoster virus (VZV) (Oka-vaccine), adenovirus, Aspergillus flavus and Staphylococcus aureus. The specificity of LAMP was confirmed by bidirectional sequencing of the amplicons. The sensitivity of the LAMP assay was tested using different concentrations of HSV-1 DNA. To evaluate the application of the LAMP assay in clinical diagnosis, we tested vitreous samples from 20 patients with suspected viral retinitis using LAMP and real-time PCR for HSV-1. The LAMP primers amplified only HSV-1 DNA; no LAMP products were detected with the DNAs of HSV-2, CMV, VZV, adenovirus A. flavus and S. aureus. The sequences of the positive HSV-1 LAMP products perfectly (99–100%) matched the HSV-1 sequences deposited in the GenBank database. LAMP is as sensitive as real-time PCR, with the lowest detection limit being 10 copies/μL of HSV-1 DNA. Of the 20 patients with suspected viral retinitis, four tested positive for HSV-1 using real- time PCR and LAMP. A 100% concordance was observed across the two methods. The LAMP assay is a rapid, highly specific and sensitive method for the diagnosis of retinitis caused by HSV-1.
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Affiliation(s)
- A K Reddy
- Jhaveri Microbiology Centre, Hyderabad Eye Research Foundation, LV Prasad Eye Institute, Hyderabad, India.
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14
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15
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Ophthalmological Emergencies in Rheumatic and Autoimmune Diseases. Autoimmune Dis 2011. [DOI: 10.1007/978-0-85729-358-9_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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16
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Viral retinitis after intravitreal triamcinolone injection in patients with predisposing medical comorbidities. Am J Ophthalmol 2010; 149:433-40.e1. [PMID: 20172069 DOI: 10.1016/j.ajo.2009.10.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 10/15/2009] [Accepted: 10/15/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To review the cases of viral retinitis after intravitreal steroid administration at a single center, to estimate the incidence, and to propose risk factors for its occurrence. DESIGN Retrospective, observational case series. METHODS Seven hundred thirty-six intravitreal triamcinolone (IVTA) injections were administered in the clinic and operating room by 3 retina specialists at a single academic medical center between September 2002 and November 2008. Inclusion criteria were simply a history of 1 or more IVTA injections during the period. The overall incidence of viral retinitis after IVTA injection was calculated. Subsequently, a chart audit was performed to estimate the number of patients with immune-altering conditions who had received IVTA during the period, and the incidence within this subgroup was calculated. RESULTS Viral retinitis developed after IVTA injection in 3 patients, yielding an overall incidence of 3 in 736 or 0.41%. An estimated 334 injections were administered to patients with an immune-altering condition, including diabetes. All 3 of the patients in whom viral retinitis developed after IVTA injection possessed abnormal immune systems, yielding an incidence rate of 3 in 334 or 0.90% within this subgroup. CONCLUSIONS Our high reported incidence for this potentially devastating complication can be attributed to multiple factors, including coexisting medical immunocompromising comorbidities, a higher dose with a longer duration of local immunosuppression in the vitreous, multiple injections, as well as previous viral retinitis. Caution with a high index of clinical suspicion and frequent follow-up is advised in patients receiving IVTA injection with potentially immune-altering conditions, even after apparent immune recovery.
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CMV retinitis after intravitreal triamcinolone acetonide injection in a patient with Behçet’s uveitis. Int Ophthalmol 2009; 30:591-3. [DOI: 10.1007/s10792-009-9332-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Accepted: 12/06/2009] [Indexed: 10/20/2022]
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Park YS, Byeon SH. Cytomegalovirus retinitis after intravitreous triamcinolone injection in a patient with central retinal vein occlusion. KOREAN JOURNAL OF OPHTHALMOLOGY 2008; 22:143-4. [PMID: 18612235 PMCID: PMC2629937 DOI: 10.3341/kjo.2008.22.2.143] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To report a case of cytomegalovirus (CMV) retinitis after intravitreal injection of triamcinolone acetonide (IVTA). A 77-year-old woman with macular edema due to central retinal vein occlusion (CRVO) developed peripheral retinitis 4 months after IVTA. A diagnostic anterior chamber paracentesis was performed to obtain DNA for a polymerase chain reaction (PCR) test for viral retinitis. The PCR test was positive for CMV DNA. Other tests for infective uveitis and immune competence were negative. Four months after presentation, gancyclovir was intravitreously injected a total of 5 times, and the retinitis resolved completely. CMV retinitis is a rare complication of local immunosuppression with IVTA. It can be managed with timely injection of intravitreal gancyclovir until recovery from local immunosuppression.
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Affiliation(s)
- Yong Sik Park
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Tammewar AM, Cheng L, Hostetler KY, Falkenstein I, Beadle JR, Barron EC, Kozak I, Freeman WR. Intraocular Properties of An Alkoxyalkyl Derivative of Cyclic 9-(S)-(3-Hydroxyl-2-Phosphonomehoxypropyl) Adenine, An Intravitreally Injectable Anti-HCMV Drug in Rabbit and Guinea Pig. J Ocul Pharmacol Ther 2007; 23:433-44. [PMID: 17900229 DOI: 10.1089/jop.2007.0018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of this study was to investigate intraocular properties and determine the highest nontoxic dose of hexadecyloxypropyl-cyclic-HPMPA (HDP-cHPMPA), a novel, potent, intravitreally injectable, slow-releasing crystalline drug for long-acting treatment of cytomegalovirus (CMV) retinitis. METHODS Various concentrations of HDP-cHPMPA were first studied in vitro in a human foreskin fibroblast (HFF) cell line infected with human cytomegalovirus (HCMV) to determine the EC50. In vivo, 9 pigmented rabbits and 3 doses (55, 100, and 550 microg/eye) were tested in triplicate in 1 eye of each animal. The eyes were monitored with slit lamp, tonopen, indirect ophthalmoscopy, electroretinography (ERG), and histology. A confirmation toxicity study with the dose equivalent to the highest nontoxic dose in rabbit was performed in 9 guinea pig eyes (a second species) to study the potential adverse effect on intraocular pressure (IOP). RESULTS In vitro testing in HFF cells showed an EC50 against HCMV of 0.02 microM, which is 75- and 60-fold greater than that of ganciclovir and cidofovir, respectively. All eyes injected with 550 microg/eye and 1 eye injected with 100 microg/eye of HDP-cHPMPA showed toxicity clinically (e.g., vitreous cells, disc edema, and retinal inflammation) as well as histologically (e.g., inflammatory cells in iris, vitreous, and retinal layers with disorganization). None of the eyes injected with 55 microg/eye of HDP-cHPMPA showed toxicity clinically (including ERG) and histologically. The equivalent dose (9.2 microg/eye) in the guinea pig eyes did not show toxicity either, including IOP evaluation (P > 0.05 at all time points after injection). CONCLUSIONS Intravitreal injection of the highest nontoxic dose of 55 microg/eye of HDP-cHPMPA in rabbit eyes yields a calculated intravitreal concentration of 65 microM, which is 3250-fold greater than the EC50 against HCMV (0.02 microM). Also, it does not cause hypotony in rabbit and guinea pig eyes and has a vitreous residence time of over 4 months.
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Affiliation(s)
- Ajay M Tammewar
- Jacobs Retina Center at Shiley Eye Center, University of California-San Diego Department of Ophthalmology, La Jolla, San Diego, CA 92037, USA
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Qi Y, Martin MP, Gao X, Jacobson L, Goedert JJ, Buchbinder S, Kirk GD, O'Brien SJ, Trowsdale J, Carrington M. KIR/HLA pleiotropism: protection against both HIV and opportunistic infections. PLoS Pathog 2006; 2:e79. [PMID: 16933987 PMCID: PMC1550271 DOI: 10.1371/journal.ppat.0020079] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Accepted: 06/29/2006] [Indexed: 11/19/2022] Open
Abstract
The compound genotype KIR3DS1/HLA-B Bw4-80I, which presumably favors natural killer cell activation, has been implicated in protection against HIV disease. We show that this genotype confers dual protection over the course of HIV disease; early direct containment of HIV viral load, and late specific defense against opportunistic infections, but not AIDS-related malignancies. The double protection of KIR3DS1/Bw4-80I in an etiologically complex disease such as AIDS, along with the disease specificity of its effects is conceptually novel and underscores the intricacy of host immunogenetics against HIV/AIDS. Natural killer (NK) cells are part of the innate immune response which provides the first line of defense against viral infections such as HIV by production of cytokines and direct killing of infected cells. NK cells possess a variety of inhibitory and activating receptors that upon binding to their HLA class I ligands on target cells, regulate activation and inhibition of NK cell responses. A protective effect of the specific combination of the activating receptor KIR3DS1 with HLA-Bw4 alleles that have isoleucine at position 80 (HLA-B Bw4-80I) against AIDS progression was reported previously. Based on this genetic association, KIR3DS1 on NK cells was proposed to bind to HLA-B Bw4-80I on HIV-1 infected target cells, thereby signaling the NK cell to kill the target. Here we present data showing that this compound genotype also confers protection against the development of AIDS defining opportunistic infections. Interestingly, no protection against the development of AIDS defining malignancies was observed. The double protection of this compound genotype in AIDS, along with the specificity of its effects is a novel finding and underscores the complex role of host immunogenetics against HIV/AIDS.
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MESH Headings
- AIDS-Related Opportunistic Infections/genetics
- AIDS-Related Opportunistic Infections/immunology
- Acquired Immunodeficiency Syndrome/genetics
- Acquired Immunodeficiency Syndrome/immunology
- Disease Progression
- HIV Seropositivity
- HIV-1
- HLA-B Antigens/genetics
- HLA-B Antigens/immunology
- Humans
- Immunocompromised Host
- Immunosuppression Therapy
- Killer Cells, Natural/immunology
- Killer Cells, Natural/virology
- Lymphoma, AIDS-Related/genetics
- Lymphoma, AIDS-Related/immunology
- Receptors, Immunologic/genetics
- Receptors, Immunologic/immunology
- Receptors, KIR
- Receptors, KIR3DS1
- Sarcoma, Kaposi/genetics
- Sarcoma, Kaposi/immunology
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Affiliation(s)
- Ying Qi
- Laboratory of Genomic Diversity, SAIC-Frederick, Inc., National Cancer Institute, Frederick, Maryland, United States of America
| | - Maureen P Martin
- Laboratory of Genomic Diversity, SAIC-Frederick, Inc., National Cancer Institute, Frederick, Maryland, United States of America
| | - Xiaojiang Gao
- Laboratory of Genomic Diversity, SAIC-Frederick, Inc., National Cancer Institute, Frederick, Maryland, United States of America
| | - Lisa Jacobson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - James J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Susan Buchbinder
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Stephen J O'Brien
- Laboratory of Genomic Diversity, National Cancer Institute, Frederick, Maryland, United States of America
| | - John Trowsdale
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Mary Carrington
- Laboratory of Genomic Diversity, SAIC-Frederick, Inc., National Cancer Institute, Frederick, Maryland, United States of America
- * To whom correspondence should be addressed. E-mail:
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