1
|
Arevalo JF, Beatson B. Surgery for Infectious Retinitis - When Medical Therapy Is Not Sufficient: The Moacyr E. Alvaro Pan-American Lecture 2023. Ocul Immunol Inflamm 2024; 32:541-549. [PMID: 36758250 DOI: 10.1080/09273948.2023.2174883] [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] [Received: 09/05/2022] [Revised: 01/05/2023] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Viral retinitis composes a group of infectious ocular diseases with poor prognoses. With the advent of antivirals and HAART, the treatment of these diseases has evolved and ocular outcomes have improved. However, even with prompt medical treatment, a significant number of patients will experience complications that require surgical intervention. While there has been an abundance of research examining the medical treatment of CMV retinitis and acute retinal necrosis, the research examining surgical outcomes of complications such as retinitis-associated retinal detachment is comparatively limited. METHODS Literature review. RESULTS In this review, we discuss the current literature examining treatment of CMV retinitis and acute retinal necrosis, with a focus on surgical management of complications such as retinal detachment. CONCLUSIONS Despite significant improvements in the medical treatment of CMV retinitis and ARN over the last three decades, vision-threatening complications such as retinal detachment are relatively common and require surgical management via PPV, laser photocoagulation, and intraocular gas or silicone oil tamponade.
Collapse
Affiliation(s)
- J Fernando Arevalo
- Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Bradley Beatson
- Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Caporossi T, Bacherini D, Tartaro R, VIrgili G, Peris A, Giansanti F. Retinal findings in patients affected by COVID 19 intubated in an intensive care unit. Acta Ophthalmol 2021; 99:e1244-e1245. [PMID: 33377599 DOI: 10.1111/aos.14734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/17/2020] [Accepted: 11/29/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Tomaso Caporossi
- Department of NEUROFARBA, Ophthalmology University of Florence, Careggi Florence Italy
- Dipartimento Organomuscoloscheletrico e Organi di Sensi Careggi Florence Italy
| | - Daniela Bacherini
- Department of NEUROFARBA, Ophthalmology University of Florence, Careggi Florence Italy
| | - Ruggero Tartaro
- Department of NEUROFARBA, Ophthalmology University of Florence, Careggi Florence Italy
| | - Gianni VIrgili
- Department of NEUROFARBA, Ophthalmology University of Florence, Careggi Florence Italy
- Dipartimento Organomuscoloscheletrico e Organi di Sensi Careggi Florence Italy
| | - Adriani Peris
- Dipartimento Organomuscoloscheletrico e Organi di Sensi Careggi Florence Italy
| | - Fabrizio Giansanti
- Department of NEUROFARBA, Ophthalmology University of Florence, Careggi Florence Italy
- Dipartimento Organomuscoloscheletrico e Organi di Sensi Careggi Florence Italy
| |
Collapse
|
3
|
Moharana B, Dogra M, Tigari B, Singh SR, Katoch D, Arora A, Singh R. Outcomes of 25-gauge pars plana vitrectomy for cytomegalovirus retinitis-related retinal detachment. Indian J Ophthalmol 2021; 69:2361-2366. [PMID: 34427223 PMCID: PMC8544073 DOI: 10.4103/ijo.ijo_3539_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate the anatomical and functional outcomes of 25-gauge (G) pars plana vitrectomy (PPV) in patients with cytomegalovirus retinitis (CMVR)-related rhegmatogenous retinal detachment (RRD). Methods: Single-center retrospective consecutive case series of patients who underwent 25-G PPV for CMVR-related RRD repair with a minimum follow-up of 3 months. Complete anatomic success was defined as the complete attachment of retina including the periphery. Best-corrected visual acuity (BCVA) of ≥20/400 was defined as functional success. Results: Sixteen eyes of 15 patients were included in the study. Eleven patients were human immunodeficiency virus positive, three patients had hematological malignancies, and one patient suffered from dyskeratosis congenita. The mean follow-up was 20.5 ± 17.4 months (range 3–60 months). Complete anatomical success was seen in 15 eyes (93.75%). One eye had a residual inferior detachment with attached macula. Silicone oil was used as tamponade in 15 eyes and C3F8 gas in one eye. The mean change in BCVA was statistically significant, preoperative LogMAR BCVA was 2.05 ± 0.94 while the final follow-up postoperative LogMAR BCVA was 1.03 ± 0.61 (P < 0.001). Thirteen eyes (81.25%) had final BCVA ≥20/400. Conclusion: Microincision vitrectomy surgery can achieve excellent retinal reattachment rates in post-CMVR RRDs without significant intraoperative and postoperative complications. The visual outcome varies depending on the status of the optic disc and macula. Majority of the patients maintained functional vision.
Collapse
Affiliation(s)
- Bruttendu Moharana
- Department of Ophthalmology, Drishti Eye Hospital, Panchkula, Haryana, India
| | - Mohit Dogra
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Basavaraj Tigari
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Simar Rajan Singh
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Arora
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
4
|
Doshi B, Khatib NZ, Phatak S, Modi R, Tiwari S, Subramanyam A. Do we need separate screening strategies for cytomegalovirus retinitis in different underlying immunosuppressed states? A retrospective study from Western India. Indian J Ophthalmol 2021; 69:623-628. [PMID: 33595488 PMCID: PMC7942096 DOI: 10.4103/ijo.ijo_1398_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/11/2020] [Accepted: 08/16/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose The aim of this study was to describe the clinical features, course, and clinical outcomes of eyes with cytomegalovirus (CMV) retinitis in immunosuppressed patients of different etiologies. Methods This was a retrospective observational study from a single ophthalmic tertiary care center. The patients included referrals from the nodal cancer center and the local human immunodeficiency virus (HIV) treatment clinic. Demographics, history, visual acuity, ocular features, treatment protocol, and final visual outcome of patients who were diagnosed with CMV retinitis in the period of five years from 2014 to 2019 were studied. Results CMV retinitis was diagnosed in 25 eyes of 14 patients. Age of the patients ranged from 11-54 years. Ten (71.43%) patients were male and four (29.57%) were female. Eight of them had acute lymphoblastic leukemia (ALL), four were suffering from HIV infection and one patient each had lymphoma and history of a kidney transplant. The treatment for CMV retinitis ranged from two to sixty weeks depending on disease activity and systemic condition. Three of the patients were on maintenance therapy for ALL at the time of reactivation. Conclusion Duration of treatment for CMV retinitis in patients of ALL was longer as compared to the other etiologies, and in recurrences, it needed to be continued till the completion of maintenance therapy for ALL. It is prudent to advise regular ophthalmic screening of all immunocompromised patients, as they are at a high risk of developing CMV retinitis. Patients of ALL, especially while on maintenance therapy, should be monitored for possible development or reactivation of CMV retinitis.
Collapse
Affiliation(s)
- Bindiya Doshi
- Vitreo Retinal Department, K. B. Haji Bachooali Charitable Ophthalmic and ENT Hospital, Mumbai, Maharashtra, India
| | - Niha Z Khatib
- Vitreo Retinal Department, K. B. Haji Bachooali Charitable Ophthalmic and ENT Hospital, Mumbai, Maharashtra, India
| | - Sumita Phatak
- Vitreo Retinal Department, K. B. Haji Bachooali Charitable Ophthalmic and ENT Hospital, Mumbai, Maharashtra, India
| | - Rohit Modi
- Vitreo Retinal Department, K. B. Haji Bachooali Charitable Ophthalmic and ENT Hospital, Mumbai, Maharashtra, India
| | - Sarvesh Tiwari
- Vitreo Retinal Department, K. B. Haji Bachooali Charitable Ophthalmic and ENT Hospital, Mumbai, Maharashtra, India
| | - Anand Subramanyam
- Vitreo Retinal Department, K. B. Haji Bachooali Charitable Ophthalmic and ENT Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
5
|
Sittivarakul W, Prapakornkovit V, Jirarattanasopa P, Bhurayanontachai P, Ratanasukon M. Surgical outcomes and prognostic factors following vitrectomy in acquired immune deficiency syndrome patients with cytomegalovirus retinitis-related retinal detachment. Medicine (Baltimore) 2020; 99:e22889. [PMID: 33120835 PMCID: PMC7581021 DOI: 10.1097/md.0000000000022889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
To determine the surgical outcomes and prognostic factors of cytomegalovirus (CMV) retinitis-related retinal detachment (RD) in acquired immune deficiency syndrome (AIDS) patients following vitrectomy.A retrospective charts review was carried out on AIDS patients who were diagnosed with CMV retinitis-related RD and treated with vitrectomy between 2002 and 2016. The main outcome measures were the rates of primary anatomical success and final visual acuity (VA) success defined as postoperative VA ≥20/200. Kaplan-Meier curves on the time to retinal redetachment were performed. Multivariate logistic regression models based on a directed acyclic graph were used to identify independent factors associated with achieving VA success.Forty five AIDS patients (52 eyes) were included. Over a mean follow-up period of 41.7 months, primary anatomical success was achieved in 44 eyes (84.6%) and VA success was achieved in 34 eyes (65.4%). Receiving highly active antiretroviral therapy (HAART) prior to RD (adjusted odds ratio [aOR]=4.9, P = .043), better preoperative VA (aOR = 4.3, P = .006), undergoing vitrectomy within 3 months (aOR=6.7, P = .008), absence of optic atrophy (aOR=58.1, P < .001), and absence of retinal redetachment (aOR=38.1, P = .007) increased the odds of achieving final VA success.Vitrectomy provided favorable anatomical reattachment in AIDS patients with CMV retinitis-related RD. Majority of patients was able to retain functional vision postoperatively. The use of HAART and early vitrectomy increased the probability of achieving both anatomical and VA success.
Collapse
|
6
|
Kong W, Tao Y, Xie L, Du K, Dong H, Wei W. Prognostic Factors for Outcome after Vitrectomy for Retinal Detachment Secondary to Cytomegalovirus Retinitis in Patients with AIDS: A Retrospective Single-center Analysis. Ocul Immunol Inflamm 2020; 29:1547-1552. [PMID: 32634031 DOI: 10.1080/09273948.2020.1764591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose: To analyze the clinical characteristics and relevant prognostic factors of vitrectomy for retinal detachment (RD) secondary to cytomegalovirus retinitis (CMVR) in patients with acquired immune deficiency syndrome (AIDS).Methods: This study involved 39 eyes that underwent vitrectomy. Best-corrected visual acuity (BCVA), CD4+ cell counts, retinal attachment rate, and prognostic factors were assessed 1, 3, and 6 months postoperatively.Results: The rate of retinal attachment at 1 month (87.2%) was higher than at 3 (82.1%) and 6 (71.8%) months. Factors significantly related with recurrent RD at 6 months were CD4+ cell count <50 cell/µL (p = .000) and relaxed retinotomy (p = .002). Factors significantly related with the visual (≤logMAR1.0) prognosis at 6 months include band keratopathy (p = .015) and macular involvement by the RD (p = .012).Conclusion: CD4+ cell counts <50 cell/µL and relaxed retinotomy are associated with worse prognosis, while band keratopathy and macular involvement by the RD are related to poorer vision.
Collapse
Affiliation(s)
- Wenjun Kong
- Department of Opthalmology, Beijing You'an Hosptial, Capital Medical University, Beijing, China
| | - Yong Tao
- Department of Opthalmology, Beijing Chaoyang Hosptial, Capital Medical University, Beijing, China
| | - Lianyong Xie
- Department of Opthalmology, Beijing You'an Hosptial, Capital Medical University, Beijing, China
| | - Kuifang Du
- Department of Opthalmology, Beijing You'an Hosptial, Capital Medical University, Beijing, China
| | - Hongwei Dong
- Department of Opthalmology, Beijing You'an Hosptial, Capital Medical University, Beijing, China
| | - Wenbin Wei
- Department of Opthalmology, Beijing Tongren Hosptial, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Port AD, Orlin A, Kiss S, Patel S, D'Amico DJ, Gupta MP. Cytomegalovirus Retinitis: A Review. J Ocul Pharmacol Ther 2017; 33:224-234. [DOI: 10.1089/jop.2016.0140] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Alexander D. Port
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Anton Orlin
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Szilard Kiss
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Sarju Patel
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Donald J. D'Amico
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Mrinali P. Gupta
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Cunningham ET, Downes KM, Chee SP, Zierhut M. Cytomegalovirus Retinitis and Uveitis. Ocul Immunol Inflamm 2015; 23:359-61. [PMID: 26471353 DOI: 10.3109/09273948.2015.1090820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Emmett T Cunningham
- a The Department of Ophthalmology , California Pacific Medical Center , San Francisco , California , USA .,b The Department of Ophthalmology , Stanford University School of Medicine , Stanford , California , USA .,c The Francis I. Proctor Foundation, UCSF School of Medicine , San Francisco , California , USA
| | - Kenneth M Downes
- a The Department of Ophthalmology , California Pacific Medical Center , San Francisco , California , USA
| | - Soon-Phaik Chee
- d Singapore National Eye Centre , Singapore .,e Duke-National University of Singapore Graduate Medical School Singapore , Singapore .,f Department of Ophthalmology , Yong Loo Lin School of Medicine, National University of Singapore , Singapore .,g Singapore Eye Research Institute , Singapore , and
| | - Manfred Zierhut
- h Centre for Ophthalmology, University Tuebingen , Schleichstrasse 12 , Tuebingen , Germany
| |
Collapse
|