1
|
Cachero Rodríguez JM, Artaraz J, Imaz N, Fonollosa A. Fluocinolone intravitreal implant (Iluvien) for macular edema secondary to immune recovery uveitis in patient with acute myeloid leukemia. J Ophthalmic Inflamm Infect 2024; 14:19. [PMID: 38700565 PMCID: PMC11068715 DOI: 10.1186/s12348-024-00397-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/07/2024] [Indexed: 05/06/2024] Open
Abstract
PURPOSE To report the use of Fluocinolone intravitreal implant (Iluvien) for the treatment of persistent cystoid macular edema (CME) due to immune recovery uveitis syndrome in a patient with previous cytomegalovirus retinitis and acute myeloid leukemia. DESIGN Case report. METHODS The clinical history of a patient who received an Iluvien implant in one eye for the treatment of cystoid macular edema due to immune recovery uveitis syndrome, previously treated with peribulbar Triamcinolone and intravitreal Dexamethasone injections, was reviewed. RESULTS A 48-year-old woman presented with cystoid macular edema due to immune recovery uveitis syndrome. The patient had a history of cytomegalovirus retinitis 3.5 years prior, secondary to immunosuppressive treatment for an acute myeloid leukemia. Three periocular triamcinolone injections and two dexamethasone intravitreal implants were performed, but the edema recurred, so fluocinolone intravitreal implant was used, achieving a sustained control of the condition at one year of follow-up. CONCLUSION The Fluocinolone intravitreal implant may be an effective treatment for persistent CME in patients with immune recovery uveitis syndrome.
Collapse
Affiliation(s)
- J M Cachero Rodríguez
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain.
- Instituto Oftalmológico Etxeandia, Galdakao, Spain.
| | - J Artaraz
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Nora Imaz
- Department of Ophthalmology, Donostia University Hospital, Donostia, Spain
| | - A Fonollosa
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
- Department of Retina, Instituto Oftalmológico Bilbao, Bilbao, Spain
| |
Collapse
|
2
|
Rodrigues Alves N, Barão C, Mota C, Costa L, Proença RP. Immune recovery uveitis: a focus review. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06415-y. [PMID: 38381160 DOI: 10.1007/s00417-024-06415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 12/23/2023] [Accepted: 02/11/2024] [Indexed: 02/22/2024] Open
Abstract
Immune recovery uveitis (IRU) is an intraocular inflammation that typically occurs as part of immune reconstitution inflammatory syndrome (IRIS) in the eye. Typically, it affects human immunodeficiency virus (HIV)-infected patients with recognized or unrecognized cytomegalovirus (CMV) retinitis who are receiving highly active antiretroviral therapy (HAART). IRU is a common cause of new vision loss in these patients, and it manifests with a wide range of symptoms and an increased risk of inflammatory complications, such as macular edema. Recently, similar IRU-like responses have been observed in non-HIV individuals with immune reconstitution following immunosuppression of diverse etiologies, posing challenges in diagnosis and treatment. This review provides an updated overview of the current literature on the epidemiology, pathophysiology, biomarkers, clinical manifestations, diagnosis, differential diagnosis, and treatment strategies for IRU.
Collapse
Affiliation(s)
- Nuno Rodrigues Alves
- Department of Ophthalmology, Unidade Local de Saúde de São José, Centro Hospitalar Universitário Lisboa Central, Rua José António Serrano, 1150-199, Lisbon, Portugal.
| | - Catarina Barão
- Department of Ophthalmology, Unidade Local de Saúde de São José, Centro Hospitalar Universitário Lisboa Central, Rua José António Serrano, 1150-199, Lisbon, Portugal
| | - Catarina Mota
- Department of Ophthalmology, Unidade Local de Saúde de São José, Centro Hospitalar Universitário Lisboa Central, Rua José António Serrano, 1150-199, Lisbon, Portugal
| | - Lívio Costa
- Department of Ophthalmology, Unidade Local de Saúde de São José, Centro Hospitalar Universitário Lisboa Central, Rua José António Serrano, 1150-199, Lisbon, Portugal
- NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rita Pinto Proença
- Department of Ophthalmology, Unidade Local de Saúde de São José, Centro Hospitalar Universitário Lisboa Central, Rua José António Serrano, 1150-199, Lisbon, Portugal
| |
Collapse
|
3
|
Yuen YS, Holder GE, Lingam G, Shen TYT. Diffuse retinal dysfunction following immune reconstitution uveitis in patients with prior cytomegalovirus retinitis: a novel observation. Doc Ophthalmol 2023; 147:139-145. [PMID: 37639171 DOI: 10.1007/s10633-023-09947-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/01/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To report continuing diffuse retinal dysfunction following resolution of immune reconstitution uveitis (IRU) in patients with cytomegalovirus retinitis (CMVR). METHODS Retrospective case series describing two patients with IRU following CMVR who underwent serial fundus photography and macular optical coherence tomography. One patient had serial electrophysiology. RESULTS Both patients had CMVR successfully treated with antiviral medication. The affected eyes later developed IRU that resolved with steroids. However, following resolution, chronic retinal damage was evidenced by ellipsoid line loss in one case and gradual optic disc cupping in the other. Electrophysiology in both cases revealed generalized retinal dysfunction worse in the eye with more severe IRU and demonstrated objectively the efficacy of treatment intervention in the patient with serial recordings. CONCLUSIONS Patients with IRU following CMV retinitis may have continuing diffuse retinal dysfunction despite apparent recovery and normal visual acuity. An aggressive approach to inflammation control may be warranted in such patients.
Collapse
Affiliation(s)
- Yew Sen Yuen
- Department of Ophthalmology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore.
| | - Graham E Holder
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- UCL Institute of Ophthalmology, London, UK
| | - Gopal Lingam
- Department of Ophthalmology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | - Tina Yu Ting Shen
- Department of Ophthalmology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| |
Collapse
|
4
|
Zhao Q, Li NN, Chen YX, Zhao XY. Clinical features of Cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome and efficacy of the current therapy. Front Cell Infect Microbiol 2023; 13:1107237. [PMID: 37305416 PMCID: PMC10254806 DOI: 10.3389/fcimb.2023.1107237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/12/2023] [Indexed: 06/13/2023] Open
Abstract
Background Cytomegalovirus retinitis (CMVR) is the most common and sight-threatening opportunistic retinal infection in patients with acquired immunodeficiency syndrome (AIDS) and several controversies remain to be settled. We aimed to summarize the current evidence and clarify the clinical features and prognosis of CMVR in AIDS patients. Methods The databases PubMed, EMBASE, and Ovid from inception to April 2022 were searched to identify the relevant studies. R software version 3.6.3 was used to perform the statistical analyses. Results in proportion with 95% confidence interval (CI) were calculated using the Freeman-Tukey variant of arcsine square transformation. Results We finally included 236 studies comprising 20,214 patients. CMVR in AIDS was male-dominated (88%, 95%CI 86%-89%), with 57% (95%CI 55%-60%) aged <41 years and 44% (95%CI 41%-47%) being bilaterally involved. CMVR was preponderant in AIDS patients with the following characteristics: white and non-Hispanic, homosexual, HIV RNA load ≥ 400 copies/mL, and CD4+ T-cells <50 cells/μL. The positivity of CMV-DNA in blood, aqueous humor, and vitreous humor was 66% (95%CI 52%-79%), 87% (95%CI 76%-96%), and 95% (95%CI 85%-100%), respectively. The most common symptoms were blurred vision (55%, 95%CI 46%-65%), followed by asymptomatic, visual field defect, and floaters. CMVR was first diagnosed and regarded as the clue to AIDS diagnosis in 9% (95%CI 6%-13%) of CMVR patients. Approximately 85% (95%CI 76%-93%) of the CMVR patients have received cART. CMVR remission was observed in 72%-92% of patients depending on the specific category of anti-CMV therapy. The general incidence of CMVR-related RD in the entire course was 24% (95%CI 18%-29%), of which most patients received PPV with SO or gas tamponade and the rate of anatomic success was 89% (95%CI 85%-93%). Conclusion CMVR is a common opportunistic infection with diverse clinical features in AIDS patients, preponderant in those who are male, homosexual, or with CD4+ T-cells <50 cells/μL. Current therapies for CMVR and CMVR-related RD were shown to be effective. Early detection and routine ophthalmic screening should be promoted in AIDS patients. Systematic review registration PROSPERO, identifier CRD42022363105.
Collapse
Affiliation(s)
- Qing Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning-ning Li
- Department of Operating Room, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - You-xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin-yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
5
|
Montiel-Esparza R, Michalak SM, Le AHD, Or C, Nguyen QD, Khoury R, Grimley MS, Bertaina A, Klinger E, Shah AJ, Wood EH. Viral-specific T cells for Cytomegalovirus retinitis following hematopoietic stem cell transplantation: A success story. Pediatr Blood Cancer 2023:e30429. [PMID: 37243390 DOI: 10.1002/pbc.30429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/05/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
Cytomegalovirus retinitis (CMVR) following hematopoietic stem cell transplantation (HCT) for a primary immunodeficiency is a rare but highly morbid condition with potential irreversible consequences despite optimal antiviral pharmacotherapy. Viral-specific T cells (VSTs) pose a promising and safe approach eradicating intractable viral disease. We describe the case of a 21-month-old male with Wiskott-Aldrich syndrome (WAS) and CMVR post HCT with sustained long-term virologic and clinical response after CMV-specific T-cell therapy. This case highlights the need to consider VST as an adjunct upfront strategy in refractory CMVR and for routine ophthalmologic screening and surveillance in high-risk patients post HCT.
Collapse
Affiliation(s)
- Raul Montiel-Esparza
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Suzanne M Michalak
- Spencer Center for Vision Research, Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, California, USA
| | - Anthony Huy Dinh Le
- University of Missouri - Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Christopher Or
- Spencer Center for Vision Research, Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, California, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, California, USA
| | - Ruby Khoury
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michael S Grimley
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alice Bertaina
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Edna Klinger
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Ami J Shah
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Edward H Wood
- Spencer Center for Vision Research, Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, California, USA
| |
Collapse
|
6
|
Tungsattayathitthan U, Singcanvanit R, Choopong P, Jaru-Ampornpan P, Tesavibul N, Sopitviriyaporn W, Boonsopon S. Predictors for Recurrence of Cytomegalovirus Retinitis in HIV-Negative Patients. Ocul Immunol Inflamm 2023:1-8. [PMID: 36749945 DOI: 10.1080/09273948.2023.2170250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE To investigate the incidence of and predictive factors for recurrent cytomegalovirus retinitis (CMVR) in human immunodeficiency virus (HIV)-negative patients. METHODS A retrospective review of HIV-negative patients who were newly diagnosed with CMVR between January 2005 and February 2019. RESULTS Of 28 patients (44 eyes), 35.9% of eyes had a recurrence of CMVR after discontinuation of anti-CMV therapy. The incidence of CMVR recurrence was 17 per 100 eye-years. The factors significantly associated with CMVR recurrence were eyes with retinitis area of more than 25% (P = .013), absence of vitreous haze (P = .003), neutropenia at presentation (P = .001), and absence of systemic immunosuppression therapy prior to presentation (P = .002). CONCLUSION Eyes with a large area of retinitis, absence of vitreous haze, and neutropenia at presentation are predictive of CMVR recurrence while receiving systemic immunosuppression prior to CMVR presentation has a lower risk of CMVR recurrence.
Collapse
Affiliation(s)
- Usanee Tungsattayathitthan
- Department of Ophthalmology, Faculty of Medicine, Siriaj Hospital, Mahidol University, Bangkok, Thailand
| | - Rithorn Singcanvanit
- Department of Ophthalmology, Faculty of Medicine, Siriaj Hospital, Mahidol University, Bangkok, Thailand
| | - Pitipol Choopong
- Department of Ophthalmology, Faculty of Medicine, Siriaj Hospital, Mahidol University, Bangkok, Thailand
| | - Pimkwan Jaru-Ampornpan
- Department of Ophthalmology, Faculty of Medicine, Siriaj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattaporn Tesavibul
- Department of Ophthalmology, Faculty of Medicine, Siriaj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanchana Sopitviriyaporn
- Department of Ophthalmology, Faculty of Medicine, Siriaj Hospital, Mahidol University, Bangkok, Thailand
| | - Sutasinee Boonsopon
- Department of Ophthalmology, Faculty of Medicine, Siriaj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
7
|
Arora A, Singh R, Dogra M. Bilateral cytomegalovirus retinitis as the presenting feature of Dyskeratosis Congenita. Eur J Ophthalmol 2022; 33:NP122-NP125. [PMID: 35243907 DOI: 10.1177/11206721221086154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a young male with bilateral sequential Cytomegalovirus retinitis (CMVR) as the presenting feature of Dyskeratosis Congenita. CASE REPORT A 25-year-old human immunodeficiency virus (HIV) negative male developed CMVR in his left eye, while on a three week course of oral valganciclovir therapy for CMV retinitis in his right eye. Systemic examination revealed reticular hypopigmentation of the forearms, dystrophic nails, oral leukoplakia and complete blood counts showed pancytopenia. A diagnosis of Dyskeratosis Congenita was confirmed with genetic testing. CONCLUSION CMVR in non-HIV individuals should be considered as a harbinger of systemic immunosuppressive conditions. Ophthalmologists may be the first ones to suspect and diagnose congenital immunosuppressive disorders like Dyskeratosis Congenita in these patients.
Collapse
Affiliation(s)
- Atul Arora
- Advanced Eye Centre, 29751Post Graduate Institute of Medical Education and Research, Chandigarh-160012, India
| | - Ramandeep Singh
- Advanced Eye Centre, 29751Post Graduate Institute of Medical Education and Research, Chandigarh-160012, India
| | - Mohit Dogra
- Advanced Eye Centre, 29751Post Graduate Institute of Medical Education and Research, Chandigarh-160012, India
| |
Collapse
|
8
|
Reddy S, Tyagi M, Behera S, Pappuru RR, Dave VP, Basu S, Agrawal H. Cytomegalovirus retinitis in patients of non-Hodgkin's lymphoma: clinical presentations and outcomes. J Ophthalmic Inflamm Infect 2021; 11:26. [PMID: 34611773 PMCID: PMC8492880 DOI: 10.1186/s12348-021-00257-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/09/2021] [Indexed: 01/10/2023] Open
Abstract
Background Cytomegalovirus (CMV) retinitis in patients with Non-Hodgkin’s Lymphoma (NHL) can occur even in the presence of high CD 4 counts and can behave differently when compared to CMV retinitis in human immunodeficiency (HIV) patients. It, therefore, becomes important to understand its varied presentations and the challenges in management of these cases. The aim of this study was to analyse the various patterns of presentations and outcomes of CMV Retinitis in patients with NHL. Study design A retrospective chart review of seven eyes of four patients of NHL presenting with CMV retinitis between June 2017 and May 2020 was done. Methods Clinical patterns of CMV Retinitis, CD4 counts at the time of presentation and the duration of treatment along with recurrences and time for recurrence of retinitis were assessed. Results Granular or indolent retinitis (6 out of 7 eyes) was the commonest form of CMV retinitis in patients of NHL. Three patients had a presenting CD4 count above 150 cells/mm3 and none of them were below 50 cells/mm3. Floaters were the commonest presenting complaint. All patients had vitritis and majority of the patients (3 out of 4) had anterior chamber (AC) inflammation. Two out of the 4 patients had a recurrence (mean time 33.8 days) after stopping the maintenance phase of ganciclovir and one patient had significant myelosuppression related to oral valganciclovir which required discontinuation of the drug. Conclusion CMV retinitis in NHL patients is usually of an indolent or granular type and can occur even in the presence of high CD4 counts as compared to patients with HIV. These patients may require a long term maintenance in view of frequent recurrences after discontinuation of treatment.
Collapse
Affiliation(s)
- Subhakar Reddy
- Uveitis and Ocular Immunology Services, LV Prasad Eye Institute, Hyderabad, -500034, India.,Smt Kanuri Santhamma Center for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, -500034, India
| | - Mudit Tyagi
- Uveitis and Ocular Immunology Services, LV Prasad Eye Institute, Hyderabad, -500034, India. .,Smt Kanuri Santhamma Center for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, -500034, India.
| | - Shashwat Behera
- Smt Kanuri Santhamma Center for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, -500034, India
| | - Rajeev R Pappuru
- Uveitis and Ocular Immunology Services, LV Prasad Eye Institute, Hyderabad, -500034, India.,Smt Kanuri Santhamma Center for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, -500034, India
| | - Vivek P Dave
- Smt Kanuri Santhamma Center for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, -500034, India
| | - Soumyava Basu
- Uveitis and Ocular Immunology Services, LV Prasad Eye Institute, Hyderabad, -500034, India
| | - Hitesh Agrawal
- Uveitis and Ocular Immunology Services, LV Prasad Eye Institute, Hyderabad, -500034, India.,Smt Kanuri Santhamma Center for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, -500034, India
| |
Collapse
|
9
|
Kao CC, Hsu SL, Sheu SJ. Presumed cytomegalovirus retinitis in a non-immune compromised patient with breast carcinoma during treatment: A case report. Am J Ophthalmol Case Rep 2021; 23:101161. [PMID: 34307962 PMCID: PMC8283142 DOI: 10.1016/j.ajoc.2021.101161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/24/2021] [Accepted: 07/05/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose Cytomegalovirus (CMV) retinitis is one of the most common opportunistic infections in immunocompromised patients, including patients with acquired immunodeficiency syndrome (AIDS). CMV retinitis in non-human immunodeficiency virus (HIV)-infected patients has been reported with variable presentations. Significant intraocular inflammation is common, and visual prognosis is poor if not properly managed. Observations We present a case of presumed CMV retinitis in a non-immunocompromised breast cancer patient that occurred during cancer treatment. The ocular symptoms developed one day after partial mastectomy with intra-operative radiotherapy following five months of chemotherapy treatment. Ocular manifestations included panuveitis with mild peripheral retinitis. Conclusions and Importance Early diagnosis and prompt treatment with oral valganciclovir based on the clinical manifestation and serologic test findings helped to preserve vision.
Collapse
Affiliation(s)
- Chia-Chen Kao
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Taiwan.,Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shiuh-Liang Hsu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Taiwan.,Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Taiwan.,Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
10
|
Zemba M, Rogoz RE, Zaharia AC, Dimirache AE, Dumitrescu OM, Dărăbuş DM. Challenges in HIV-Negative Cytomegalovirus Retinitis - case report. Rom J Ophthalmol 2021; 65:247-254. [PMID: 35036645 PMCID: PMC8697781 DOI: 10.22336/rjo.2021.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 20-year-old girl with severe combined seronegative immunodeficiency who developed a bilateral decrease in visual acuity due to retinal necrosis. After further investigations, increased serological viral levels of Cytomegalovirus (CMV) were detected and confirmed the diagnosis of CMV retinitis in both eyes. After three weeks of systemic therapy with oral valganciclovir, her condition improved, with the best corrected visual acuity of the most affected eye changing from finger counting at presentation to 6/ 12. Although financial matters determined her to discontinue the antiviral treatment after three months, her ophthalmological status remained stable, and she resumed therapy after four weeks of pause. At the four months follow-up, despite an unchanged visual function, her general condition deteriorated. In the absence of appropriate treatment for her immunodeficiency both the patient's ophthalmological and systemic prognosis were poor.
Collapse
Affiliation(s)
- Mihail Zemba
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
- “Carol Davila” University of Medicine and Farmacy Bucharest, Romania
| | - Roxana-Elena Rogoz
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
| | - Alexandra Cătălina Zaharia
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
| | - Andreea Elena Dimirache
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
| | - Otilia-Maria Dumitrescu
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
| | - Diana-Maria Dărăbuş
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
| |
Collapse
|
11
|
Sudharshan S, Babu RB, Nair N, Biswas J. Combined infection of ocular tuberculoma and cytomegalovirus retinitis in the same eye of a patient with human immunodeficiency virus. Indian J Ophthalmol 2021; 68:1965-1967. [PMID: 32823438 PMCID: PMC7690518 DOI: 10.4103/ijo.ijo_1321_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | - Nivedita Nair
- Medical Research Foundation, Sankara Nethralaya, Bengaluru, Karnataka, India
| | - Jyotirmay Biswas
- Medical Research Foundation, Sankara Nethralaya, Bengaluru, Karnataka, India
| |
Collapse
|
12
|
Xie LY, Chen C, Kong WJ, Jiang TY, Du KF, Dong HW, Guo CG, Li XN, Wei WB. Effect of Anti-CMV Therapy at Different Stages on Retinal Detachment in Patients with AIDS and CMVR. Adv Ther 2021; 38:2294-2301. [PMID: 33730351 DOI: 10.1007/s12325-021-01674-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/14/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The present study aimed to investigate the effect of anti-cytomegalovirus (anti-CMV) therapy at different stages on retinal detachment in patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus retinitis (CMVR). METHODS Ninety-seven patients with AIDS and CMVR diagnosed and treated at the Ophthalmology and Infection Center of Beijing You'an Hospital, affiliated with Capital Medical University, from November 2017 to January 2020 were retrospectively analyzed. Of the 138 eyes included, 30 eyes with concomitant retinal detachment were enrolled as the study subjects. The eyes with retinal detachment were divided into a pre-induction group, an intra-induction group, and a post-induction group of anti-CMV therapy. The occurrence and characteristics of retinal detachment at different stages of anti-CMV therapy were observed. RESULTS Retinal detachment occurred in 30 of the 138 eyes of 97 patients, with an incidence of retinal detachment of 21.74%. Retinal detachment occurred in eight eyes in the pre-induction group, with an incidence of 26.67%, and in four eyes in the intra-induction group, with an incidence of 13.33%. The difference in incidence between the two groups was statistically significant (P = 0.000). Retinal detachment occurred in 18 eyes in the post-induction group, with an incidence of 60%. The difference in incidence between the intra-induction group and the post-induction group was statistically significant (P = 0.001). CONCLUSION The incidence of retinal detachment at the intra-induction stages of anti-CMV therapy was lower than that at the pre-induction stage, and retinal detachment during the anti-CMV therapy predominantly occurred after the end of the induction stage.
Collapse
Affiliation(s)
- Lian-Yong Xie
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Chao Chen
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Wen-Jun Kong
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Tai-Yi Jiang
- Department of Infectious Diseases, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Kui-Fang Du
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Hong-Wei Dong
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Chun-Gang Guo
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Xiao-Na Li
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
| |
Collapse
|
13
|
Sadik MT, Aksu Ceylan N, Cebeci Z, Kir N, Oray M, Tugal-Tutkun I. Patterns of cytomegalovirus retinitis at a tertiary referral center in Turkey. Int Ophthalmol 2021; 41:2981-2992. [PMID: 33885967 DOI: 10.1007/s10792-021-01857-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze predisposing conditions in Turkish patients with CMV retinitis and to compare HIV-positive and HIV-negative patients. METHODS We reviewed medical charts and ocular images of 41 patients with CMV retinitis diagnosed between 1996 and 2019. RESULTS Eleven patients (27%) had HIV infection and 30 were immunocompromised from diverse causes. Initial visual acuity, type, zone, and extent of CMV retinitis, and response to anti-CMV treatment were not significantly different between the two groups. Vitreous haze and panretinal occlusive vasculopathy were the presenting features only in non-HIV patients, seen in 34% and 16% of eyes, respectively. Although not statistically significant, recurrent CMV retinitis was more common in non-HIV patients (17.4% vs. 4.3%/eye-year) and immune recovery uveitis was more common in HIV patients (43% vs. 26%/eye-year). Visual outcomes were similar. Final visual acuity of 1 logMAR or worse was significantly associated with the recurrence of CMV retinitis (odds ratio 9.67; p = 0.01) and also with the occurrence of immune recovery uveitis (odds ratio 4.31; p = 0.058). CONCLUSIONS Diverse immunocompromising conditions are more commonly associated with CMV retinitis than HIV infection in Turkish patients. Intraocular inflammation was more commonly associated with active retinitis in non-HIV patients and immune recovery uveitis was more common in HIV patients.
Collapse
Affiliation(s)
- Muhammed Talha Sadik
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Nihan Aksu Ceylan
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Zafer Cebeci
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Nur Kir
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Merih Oray
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi Goz Hastaliklari A.D. Capa, 34093, Istanbul, Turkey.
| |
Collapse
|
14
|
He XQ, Huang YQ, Zeng YM, Qin YY, Tang SQ, Xu XL, Harypursat V, Lu YQ, Liu M, Yuan J, Chen YK. Timing of antiretroviral therapy for HIV-infected patients with cytomegalovirus retinitis: study protocol of a multi-center prospective randomized controlled trial. Trials 2021; 22:218. [PMID: 33736696 PMCID: PMC7977244 DOI: 10.1186/s13063-021-05159-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background Cytomegalovirus retinitis (CMVR) is an important opportunistic infection (OI) occurring mainly in patients with acquired immunodeficiency syndrome (AIDS) and has the potential to cause severe visual impairment and blindness among AIDS patients. Subsequent to the adoption and implementation of widespread antiretroviral therapy (ART), the prognosis of AIDS-associated CMVR has been substantially improved. Nevertheless, the equivocal clinical evidence as regards the optimal timing for ART initiation in patients with an established CMVR diagnosis is required. We therefore designed the present study in order to investigate the optimal timing for ART initiation in AIDS/CMVR patients. Methods This will be a prospective, randomized controlled trial to be performed at 17 hospitals in mainland China. A total of 300 participants with CMVR will be randomly assigned to an early ART initiation group (ART initiation within 2 weeks after anti-CMV therapy), or a deferred ART initiation group (initiation of ART more than 2 weeks after anti-CMV therapy) at a 1:1 ratio. All participants will receive 48 weeks of follow-up after anti-CMV therapy initiation. Our primary outcome will be the incidence of visual loss (to a visual acuity worse than 20/40 or 20/200) in the two groups during the 48-week follow-up period. Secondary outcomes will include changes in HIV virological suppression and serum CD4+ T-cell counts, the incidence of mortality, retinitis progression (movement of the peripheral border of a CMV lesion ≥ ½ disc diameter, or occurrence of a new CMV lesion), retinal detachment, immune recovery uveitis (IRU), and other OIs and adverse events between the two study groups during the 48 weeks of follow-up. Discussion The study aims to investigate the optimal timing for ART initiation in AIDS/CMVR patients. We hope to be able to extract robust clinical evidence for use in optimal AIDS/CMVR management should our trial be successful. Trial registration This research was registered as one of the twelve clinical trials under the name of a general project “A study for precision diagnosing and treatment strategies in difficult-to-treat AIDS cases and HIV-infected patients with highly fatal or highly disabling opportunistic infections”, ChiCTR1900021195. Registered on 1 February 2019, http://www.chictr.org.cn/showproj.aspx?proj=35362.
Collapse
Affiliation(s)
- Xiao-Qing He
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, China
| | - Yin-Qiu Huang
- National Key Laboratory for Infectious Diseases Prevention and Treatment with Traditional Chinese Medicine, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Yan-Ming Zeng
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, China
| | - Yuan-Yuan Qin
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, China
| | - Sheng-Quan Tang
- National Key Laboratory for Infectious Diseases Prevention and Treatment with Traditional Chinese Medicine, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Xiao-Lei Xu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, China
| | - Vijay Harypursat
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, China
| | - Yan-Qiu Lu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, China
| | - Min Liu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, China
| | - Jing Yuan
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, China
| | - Yao-Kai Chen
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, China.
| |
Collapse
|
15
|
Suzuki K, Namba K, Mizuuchi K, Iwata D, Ito T, Hase K, Kitaichi N, Ishida S. Development of cytomegalovirus retinitis after negative conversion of cytomegalovirus antigenemia due to systemic antiviral therapy. Graefes Arch Clin Exp Ophthalmol 2021; 259:971-8. [PMID: 33185730 DOI: 10.1007/s00417-020-05011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/18/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Cytomegalovirus (CMV) antigenemia assays have been widely used as adjunct tests to diagnose tissue invasive CMV diseases, including cytomegalovirus retinitis (CMVR). In this study, we examined CMVR cases to assess the presence of CMV in sera and aqueous humor and antiviral therapy received prior to the onset of CMVR. METHODS A total of 37 eyes from 26 different cases of CMVR in patients who visited Hokkaido University Hospital between 2007 and 2015 were enrolled. The diagnosis of CMVR was established based on characteristic ophthalmoscopic findings and the presence of local and/or systemic CMV infection. Among the 26 cases, 3 cases (12%) were HIV-positive, while the other 23 cases (88%) were HIV-negative. The records of clinical and laboratory results were reviewed from clinical charts retrospectively. RESULTS CMV antigenemia was positive at the onset of CMVR in 14 cases (53.8%) and negative in the other 12 cases. In 9 cases among the antigenemia-negative cases (75.0%), the antigenemia had been previously positive and had turned negative before the onset of CMVR. In 12 of the 14 antigenemia-positive cases (85.7%) and in 8 of the 9 antigenemia-negative cases (88.9%) that were previously positive, systemic antiviral therapies had never been used or had been used before but had been discontinued prior to the onset of CMVR. CONCLUSION Even if viremia turns negative, the risk of developing CMVR exists for more than several weeks after the completion of systemic therapy.
Collapse
|
16
|
Du KF, Chen C, Huang XJ, Xie LY, Kong WJ, Dong HW, Wei WB. Utility of Ultra-Wide-Field Imaging for Screening of AIDS-Related Cytomegalovirus Retinitis. Ophthalmologica 2020; 244:334-338. [PMID: 33120392 DOI: 10.1159/000512634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To explore the potential use of ultra-wide-field (UWF) imaging for screening of cytomegalovirus retinitis (CMVR) in AIDS patients. METHODS Ninety-four patients whose CD4 count was below 200 cells/μL were enrolled in a prospective study. Each patient underwent UWF imaging and indirect ophthalmoscopy. The main outcome measures were the concordance and detection rates of these 2 approaches and the sensitivity and specificity of UWF imaging. RESULTS Twenty-seven eyes in 18 patients were diagnosed with CMVR by the indirect ophthalmoscopy. UWF imaging missed the diagnosis in 1 eye because of a zone 3 CMVR lesion. The UWF image showed several CMVR patterns and locations: hemorrhagic necrotizing lesion, granular lesion, frosted branch angiitis, and optic neuropathy lesion. The concordance of the 2 approaches was excellent for the diagnosis of CMVR, classification of CMVR pattern, and location of CMVR. The detection rates of UWF imaging and indirect ophthalmoscopy were 14.0% (26/186; 95% CI 0.089-0.190) and 14.5% (27/186; 95% CI 0.094-0.196), respectively (p = 1.000). The sensitivity and specificity of UWF imaging were 96.3 and 100%, respectively. CONCLUSIONS UWF imaging is capable of documentation of different CMVR lesions and AIDS-related CMVR screening when examination by an ophthalmologist is not available.
Collapse
Affiliation(s)
- Kui-Fang Du
- Department of Ophthalmology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Chao Chen
- Department of Ophthalmology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Jie Huang
- Department of Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Lian-Yong Xie
- Department of Ophthalmology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wen-Jun Kong
- Department of Ophthalmology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hong-Wei Dong
- Department of Ophthalmology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
17
|
López-Herrero F, Sánchez-Vicente JL, Espiñeira-Periñán MA, de Las Morenas-Iglesias J, Franco-Ruedas C, Rueda-Rueda T. Chronic cytomegalovirus necrotizing retinitis in a patient with scleroderma and mixed connective tissue disease. Arch Soc Esp Oftalmol (Engl Ed) 2020; 96:392-396. [PMID: 34217479 DOI: 10.1016/j.oftale.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/10/2020] [Indexed: 10/23/2022]
Abstract
The case is presented of a 52-year-old woman with scleroderma, mixed connective tissue disease, and interstitial lung disease, who developed chronic cytomegalovirus necrotizing retinitis while on treatment with prednisone, mycophenolate, and hydroxychloroquine. Initially diagnosed as macular hole, the patient underwent a pars plana vitrectomy. Two months after surgery, due to progressive worsening, the diagnosis was made and treatment started (intravenous and intravitreal ganciclovir). The patient developed severe macular atrophy with final visual acuity of counting fingers. A chronic retinal necrosis can be caused by cytomegalovirus infection in non-HIV patients with partial immune dysfunction from other causes, characterized by a slowly progressive granular retinitis with occlusive vasculitis.
Collapse
Affiliation(s)
- F López-Herrero
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L Sánchez-Vicente
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M A Espiñeira-Periñán
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | | | - C Franco-Ruedas
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - T Rueda-Rueda
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| |
Collapse
|
18
|
Son G, Lee JY, Kim JG, Kim YJ. Clinical features of cytomegalovirus retinitis after solid organ transplantation versus hematopoietic stem cell transplantation. Graefes Arch Clin Exp Ophthalmol 2021; 259:585-91. [PMID: 32761472 DOI: 10.1007/s00417-020-04871-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/08/2020] [Accepted: 07/27/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To investigate and compare the clinical features of cytomegalovirus (CMV) retinitis after solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) and to determine the poor prognostic factors. METHODS Patients consulted to the ophthalmology department for CMV viremia after transplantation between March 2008 and February 2018 and followed for more than 6 months were analyzed. Medical records regarding demographic, serologic, and ocular characteristics were compared between the SOT and HSCT groups. Factors associated with poor visual outcomes were determined with logistic regression. RESULTS CMV retinitis developed in 11.3% of patients with CMV viremia following transplantation. In the SOT group (25 eyes/18 patients) and the HSCT group (33 eyes/21 patients), CMV retinitis occurred at 5.8 months and 3.7 months post-transplantation, respectively. Mortality was significantly higher in the HSCT group (52.4% vs. 5.6%, P < 0.001). During the mean 11.7 months of follow-up, visual acuity tended to be aggravated (P = 0.087) despite antiviral treatment, which was especially notable in the SOT group (P = 0.028). Six eyes (10.3%) underwent vitrectomy due to retinal detachment, most of which (5 eyes) were in the SOT group. Multivariate logistic regression analysis showed that the presence of concurrent CMV disease (OR = 14.11, P = 0.009) and foveal involvement (OR = 114.85, P = 0.001) were poor prognostic factors. CONCLUSION Clinical manifestations of CMV retinitis differed between the HSCT and SOT group. Concurrent CMV diseases and foveal involvement were associated with poor visual outcomes in CMV retinitis following transplantation.
Collapse
|
19
|
Chen C, Xie LY, Kong WJ, Dong HW, Li XN, Du KF, Guo CG, Wei WB. [A comparative study of retinal nerve fiber layer thickness in AIDS patients with different fundus diseases]. Zhonghua Yan Ke Za Zhi 2020; 56:258-265. [PMID: 32306617 DOI: 10.3760/cma.j.cn112142-20200730-00398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the characteristics of retinal nerve fiber layer (RNFL) thickness in AIDS patients with normal fundus, HIV-related microvascular retinopathy (MVR), and cytomegalovirus retinitis (CMVR). Methods: In this cross-sectional study, 111 patients were diagnosed with AIDS from 2012 to 2017 by infectious disease physicians in Beijing You'an Hospital. There were 105 males and 6 females, aged 20-65 years. According to the results of ophthalmic examination, the patients were divided into three groups: 31 patients in the active-stage CMVR group, 47 patients in the MVR group, and 33 patients with normal fundus in the control group. RNFL thickness was measured by optical coherence tomography in all patients. At the same time, visual acuity, intraocular pressure, and fundus were examined, and AIDS-related systemic examination (CD4(+) T lymphocyte count, HAART treatment status, and blood cytomegalovirus DNA level) was performed. The measurement data were compared by t-test, variance analysis or rank sum test. The counting data were compared by chi square test or Fisher exact probability method. Results: In the control group, the thickness of RNFL in the superior quadrant in the left and right eyes was 145 (79, 231) μm and 142 (46, 179) μm, respectively; the difference was statistically significant (Z=-2.481, P=0.013). The RNFL thickness of the diseased and healthy eyes in the MVR group was 116 (91, 138) μm and 122 (82, 192) μm, respectively, with no significant difference (Z=-0.861, P=0.389); the best corrected visual acuity was 0.0 (0.0, 0.2) and 0.0 (0.0, 0.2), respectively, with no significant difference (Z=-0.378, P=0.705). In the CMVR group, the best corrected visual acuity of the diseased and healthy eyes was (0.23±0.48) and (0.02±0.82), respectively, and the difference was statistically significant (t=-2.944, P=0.003); the RNFL thickness was 133 (61, 219) μm and 121 (69, 146), respectively, in the whole optic disc, with statistically significant difference (Z=-2.385, P=0.017), 104 (41, 374) μm and 82 (55, 121) μm, respectively, in the nasal quadrant, and 99 (14, 173) μm and 72 (36, 111) μm, respectively, in the temporal quadrant, with statistically significant difference (Z=-2.045, -2.543; P=0.041, 0.011). The RNFL thickness in the CMVR group, the MVR group, and the control group was 149 (61, 350) μm, 126 (71, 304) μm, and 113 (87, 149) μm, respectively, with statistically significant difference (H=20.908, P=0.000). Conclusions: The fundus of AIDS patients had different characteristics on optical coherence tomography. In active CMVR patients, the thickness of RNFL was generally thickened. In MVR patients, the average thickness of RNFL was thicker than that in the normal control group.(Chin J Ophthalmol, 2020, 56:258-265).
Collapse
Affiliation(s)
- C Chen
- Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - L Y Xie
- Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - W J Kong
- Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - H W Dong
- Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - X N Li
- Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - K F Du
- Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - C G Guo
- Beijing You An Hospital, Capital Medical University, Beijing 100069, China
| | - W B Wei
- Beijing Tongren Eye Center, Beijing key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Beijing Tong Ren Hospital, Capital Medical University, Beijing 100730, China
| |
Collapse
|
20
|
Tabatabaei SA, Cheraqpour K, Pour EK, Bohrani Sefidan B. Long-term prophylaxis in an immunocompetent patient with Cytomegalovirus retinitis: a case report and review of literature. J Ophthalmic Inflamm Infect 2020; 10:16. [PMID: 32588149 PMCID: PMC7316935 DOI: 10.1186/s12348-020-00207-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Cytomegalovirus retinitis is an infectious sight-threatening condition that usually occurs in immunosuppressed individuals, but rare cases of Cytomegalovirus retinitis have been reported in immunocompetent patients. Findings A 68-year-old woman without any history of systemic diseases referred to the emergency ward of Farabi eye hospital with a two-week history of decreased vision in her left eye. Fundoscopy of the left eye revealed mild venous tortuosity, hemorrhagic retinitis within the macula, and papillitis. The right eye had a history of Cytomegalovirus retinitis 2 years ago that complicated with rhegmatogenous retinal detachment. Immunologic evaluations were normal without any sign of immunosuppressive conditions. She was treated with intravenous ganciclovir for 2 weeks, intravitreal ganciclovir (twice weekly) for 1 week, and also daily oral valganciclovir as maintenance therapy for 6 months resulted in resolving of retinitis patches and improving her best-visual acuity from hand motions to 20/100. Forty-five days after stopping maintenance therapy recurrence occurred. So we started the treatment again to stabilize the patient. She is currently maintained on valganciclovir 900 mg daily without recurrence for 9 months. Conclusions Cytomegalovirus retinitis can recur in the same or contralateral eye of immunocompetent patients, especially without prophylactic medication.
Collapse
Affiliation(s)
- Seyed Ali Tabatabaei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias Khalili Pour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Bohrani Sefidan
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
21
|
Keat GY, Ahmad SS, Subramaniam S, Ghani SA, Samsudin A. Cytomegalovirus retinitis associated with high CD4 counts and DHEA abuse. Indian J Sex Transm Dis AIDS 2020; 41:119-122. [PMID: 33062999 PMCID: PMC7529169 DOI: 10.4103/ijstd.ijstd_90_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 08/30/2016] [Accepted: 12/03/2019] [Indexed: 11/04/2022] Open
Abstract
The most frequent ocular manifestation of acquired immunodeficiency syndrome (AIDS) is cytomegalovirus retinitis (CMVR). This infection is reportedly inversely proportional to the CD4 counts. Usually CMVR develops once the CD4 counts fall below 50/mm3. Our case report documents an AIDS patient who developed CMVR despite CD4 counts being persistently >200/mm3. The patient was self-administering dehydroepiandrosterone, high dose Vitamin C, testosterone and hydrocortisone. This case report describes a unique case of pharmacologically induced elevated CD4 counts, which however, did not prevent the development of CMVR in the patient.
Collapse
Affiliation(s)
- Gan Yuen Keat
- Department of Ophthalmology, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
| | - Syed Shoeb Ahmad
- Department of Ophthalmology, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
| | - Suresh Subramaniam
- Department of Ophthalmology, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
| | | | - Amir Samsudin
- Department of Ophthalmology, University Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
22
|
Kaplan RI, Do BK, Gentile RC, Kedhar SR. Cytomegalovirus retinitis after treatment with topical difluprednate in an aphakic eye of an immunocompetent patient. Am J Ophthalmol Case Rep 2019; 16:100552. [PMID: 31650081 PMCID: PMC6804500 DOI: 10.1016/j.ajoc.2019.100552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 06/10/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To report a case of an immunocompetent 64-year-old man who developed cytomegalovirus (CMV) retinitis after using topical difluprednate. Observations A 64-year-old man with type 2 diabetes developed hemorrhagic retinitis while using topical difluprednate after penetrating keratoplasty. Polymerase chain reaction of the vitreous was positive for CMV DNA. Complete blood count was within normal limits and 4th generation human immunodeficiency virus assay was negative. The retinitis resolved with oral valgancyclovir and intravitreal foscarnet injections. Conclusion and importance CMV retinitis may occur after topical difluprednate in an immunocompetent patient.
Collapse
Affiliation(s)
- Richard I. Kaplan
- Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Brian K. Do
- Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, NY, USA
- USC Roski Eye Institute, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Ronald C. Gentile
- Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, NY, USA
- Department of Ophthalmology, NYU Winthrop Hospital, Mineola, NY, USA
| | - Sanjay R. Kedhar
- Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, NY, USA
- Gavin Herbert Eye Institute, University of California Irvine Health, Irvine, CA, USA
- Corresponding author. Gavin Herbert Eye Institute, University of California Irvine Health, 850 Health Sciences Road, Irvine, CA, 92697, USA.
| |
Collapse
|
23
|
Tadepalli S, Bajgai P, Dogra M, Singh SR, Sharma A, Gupta V, Dogra MR, Singh R. Ultra-Widefield Fundus Autofluorescence in Cytomegalovirus Retinitis. Ocul Immunol Inflamm 2019; 28:446-452. [PMID: 31136217 DOI: 10.1080/09273948.2019.1595671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To study the role of ultra-wide field (UWF) fundus autofluorescence (FAF) in the management of CMV (cytomegalovirus) retinitis.Material and methods: In this prospective, observational, non-randomized study, we followed up patients with active CMV retinitis on UWF fundus photograph (FP) and UWF-FAF.Results: A total of 16 patients (24 eyes) were studied. There were 13 males and mean age of patients was 37 (range 9-56) years. On UWF FP, out of 24 eyes, 13 (54.2%) had granular lesions, 3 (12.5%) had necrotizing pattern, 1 (4.1%) had a frosted branch angiitis (FBA), and 7 (29.2%) had a mixed pattern. UWF-FAF showed better delineation of borders of lesions in 7 eyes (29.1%), larger area of involvement in 8 eyes (33.3%), picked up 7 of 9 (77.77%) eyes of recurrence and helped differentiate cotton wool spots from retinitis lesion in one eye.Conclusion: UWF-FAF is useful in the management of CMV retinitis.
Collapse
Affiliation(s)
- Sameeksha Tadepalli
- Advanced eye center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Priya Bajgai
- Advanced eye center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced eye center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Simar Rajan Singh
- Advanced eye center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced eye center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mangat R Dogra
- Advanced eye center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced eye center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
24
|
Qian Z, Li H, Tao Y, Li W. Initial intravitreal injection of high-dose ganciclovir for cytomegalovirus retinitis in HIV-negative patients. BMC Ophthalmol 2018; 18:314. [PMID: 30526535 PMCID: PMC6288921 DOI: 10.1186/s12886-018-0983-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study is to examine the clinical outcomes achieved by using initial high-dose intravitreal ganciclovir injections to treat cytomegalovirus retinitis in patients without human immunodeficiency virus (HIV) infection. METHODS Twenty-four eyes (24 patients) with cytomegalovirus retinitis received multiple intravitreal injections of ganciclovir in weekly intervals. A higher dose (6 mg) of ganciclovir was applied at the first intravitreal injection, and a lower dose was used for maintenance. Anterior aqueous humour was obtained before each injection. The best-corrected visual acuity and cytomegalovirus loads in the anterior aqueous humour were measured. RESULTS The mean cytomegalovirus DNA load in aqueous humour decreased significantly from (2.59 ± 2.28) × 105 copies/mL at baseline to (1 ± 1.76) × 104 copies/mL one month later. The aqueous cytomegalovirus DNA load was negative in 17 eyes (70.8%) one month later. No obvious improvement of best-corrected visual acuity was found during the treatment. A positive correlation was proven between initial cytomegalovirus DNA titers in aqueous humour and the total number of intravitreal injections of ganciclovir, as well as between the baseline and final best-corrected visual acuities. No severe complications developed. CONCLUSIONS An initial high dose of ganciclovir (6 mg) and continuous intravitreal injections of ganciclovir could significantly decrease the cytomegalovirus load in HIV-negative patients with cytomegalovirus retinitis. TRIAL REGISTRATION http://clinicaltrials.gov, NCT03598452, retrospectively registered on 24 July 2018.
Collapse
Affiliation(s)
- Zhuyun Qian
- Shanghai Aier Eye Hospital, Shanghai, China, No. 1286, Hongqiao Road, Changning District, Shanghai, 200050, China
| | - Haili Li
- Department of Ophthalmology, the First Hospital of Peking University, Beijing, China
| | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Road of Worker's Stadium, Chaoyang District, Beijing, 100020, China.
| | - Wensheng Li
- Shanghai Aier Eye Hospital, Shanghai, China, No. 1286, Hongqiao Road, Changning District, Shanghai, 200050, China. .,Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China.
| |
Collapse
|
25
|
Dogra M, Rohilla V, Dogra M, Singh R. Macular cytomegalovirus retinitis following dexamethasone intravitreal implant combined with phacoemulsification. Indian J Ophthalmol 2018; 66:1361-1363. [PMID: 30127173 PMCID: PMC6113845 DOI: 10.4103/ijo.ijo_171_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 60-year-old diabetic patient, who had undergone a renal transplant 2 years earlier, presented with sudden decrease in vision in his left eye (LE). He had undergone phacoemulsification combined with intravitreal dexamethasone implant injection in his LE 2 months earlier, for coexistent cataract and diabetic macular edema. Examination revealed necrotizing retinitis with hemorrhages in the macula. A diagnosis of cytomegalovirus retinitis was made, which was confirmed on vitreous polymerase chain reaction. Intravitreal and systemic ganciclovir led to the resolution of retinitis and improvement of visual acuity over a follow-up of 9 months.
Collapse
Affiliation(s)
- Mohit Dogra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikash Rohilla
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mangat Dogra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
26
|
Shoeibi N, Abrishami M, Mohammad Esmaeil E, Hosseini SM. Visual prognosis, clinical features, and predisposing factors in non-HIV patients with cytomegalovirus retinitis. Int Ophthalmol 2018; 39:1709-1715. [PMID: 30030661 DOI: 10.1007/s10792-018-0991-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/14/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE To study the characteristics and visual outcome of cytomegalovirus retinitis in patients of a tertiary referral ophthalmology center. METHODS This retrospective cross-sectional study included 16 patients who presented with CMV retinitis between February 2014 and January 2017. Demographics, clinical signs, course of treatment, and visual and anatomical results were analyzed. RESULTS Twenty five eyes of 16 patients were included. Eleven (68.8%) were females. The mean age was 29.37 ± 17.12 (range 11-73) years. Involvement was bilateral in 9 (56.2%) cases. HIV serology was negative in all patients. Best-corrected visual acuity was 0.57 ± 0.55 logarithm of the minimal angle of resolution (LogMAR) at the time of presentation and decreased to 0.69 ± 0.55 LogMAR on final visit (P = 0.332). None of the patients participating in this study was HIV-positive. CONCLUSION CMV retinitis is a devastating complication in immunosuppressed. The visual acuity usually decreases despite aggressive appropriate treatment. This observation supports the increasing incidence of CMV infection in non-HIV patients.
Collapse
Affiliation(s)
- Nasser Shoeibi
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Abrishami
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | |
Collapse
|
27
|
Zafeiropoulos P, Tamboura P, Dimou M, Christodoulou E, Stefaniotou M. Cytomegalovirus retinitis, in a diabetic immunocompetent patient, after intravitreal ranibizumab injection. Eur J Ophthalmol 2018; 29:NP10-NP12. [PMID: 29747535 DOI: 10.1177/1120672118772525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We here report a case of cytomegalovirus retinitis in a diabetic patient that occurred after intravitreal ranibizumab injection. A 75-year-old woman was treated with intravitreal ranibizumab injections for diabetic macular edema. During this period, a retinitis occurred in her left eye along with increased IgG and later IgM cytomegalovirus antibody titers. Ocular and intravenous ganciclovir was administered. Cytomegalovirus retinitis subsided post treatment with residual areas of retinal atrophy. Ophthalmologists should be aware of the incidence of cytomegalovirus retinitis, in diabetic patients, after ranibizumab injection.
Collapse
Affiliation(s)
| | | | - Maria Dimou
- 2 General Hospital of Ptolemaida, Ptolemaida, Greece
| | | | | |
Collapse
|
28
|
Abstract
Cytomegalovirus (CMV) retinitis is an opportunistic infection commonly seen in disorders that affect the immune system of the body such as acquired immunodeficiency syndrome and hematological malignancies such as leukemia/lymphoma or organ transplantation. The occurrence of CMV retinitis in the absence of such condition should be thoroughly investigated, as it is a strong indicator of poor immune competence. We here report an interesting case of CMV retinitis as a presenting feature of rare multisystem disorder “Dyskeratosis congenita.”
Collapse
Affiliation(s)
- Swapnil Parchand
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Adarsh Barwad
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| |
Collapse
|
29
|
Yashiro S, Nishijima T, Yamamoto Y, Sekine Y, Yoshida-Hata N, Iida T, Oka S. Spectral domain optical coherence tomography and fundus autofluorescence findings in cytomegalovirus retinitis in HIV-infected patients. Jpn J Ophthalmol 2018; 62:373-89. [PMID: 29445945 DOI: 10.1007/s10384-018-0574-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the usefulness of spectral domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) findings in cytomegalovirus (CMV) retinitis. STUDY DESIGN Observational case series. METHODS Thirteen eyes of 11 human immunodeficiency virus (HIV)-positive patients with CMV retinitis underwent full ophthalmologic examinations, SD-OCT, and 4 eyes of 4 patients underwent FAF. FAF images included short-wavelength autofluorescence (SW-AF) and near-infrared autofluorescence (IR-AF). CMV retinitis was classified into proposed categories of acute, subacute, remission, and recurrent; the acute stage was further subdivided into initial, early, and late stages. RESULTS In the initial stage, vertical structural disruption of all retinal layers was observed by SD-OCT, and FAF showed hyperautofluorescence on SW-AF and hypoautofluorescence on IR-AF. In the early stage, SD-OCT showed significant retinal thickening; cells and debris from the retinal surface to the vitreous; enlarged vessels with/without thickened vessel walls; and highly complicated serous retinal detachment. In the late to subacute stage, features observed included rhegmatogenous retinal detachment with shrinking posterior hyaloid membrane and waving from the ellipsoid zone to the retinal pigment epithelium. In remission, FAF findings were hypoautofluorescence on SW-AF and hyperautofluorescence on IR-AF. CONCLUSION Although the number of examined eyes was limited, SD-OCT and FAF provide new information in various stages of CMV retinitis in patients with HIV infection that is not obtainable by conventional examination and which may be of great benefit when screening for the initial stage of CMV retinitis.
Collapse
|
30
|
Iu LPL, Fan MCY, Lam WC, Wong IYH. Repeated intraocular crystallization of ganciclovir in one eye after bilateral intravitreal injections: a case report. BMC Ophthalmol 2018; 18:36. [PMID: 29426296 PMCID: PMC5807747 DOI: 10.1186/s12886-018-0703-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 02/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) retinitis is an opportunistic infection that primarily affects immunocompromised individuals. Intravitreal ganciclovir injection monotherapy or in combination with systemic anti-CMV therapy are effective treatments for CMV retinitis. Crystallization of ganciclovir after intravitreal injection is extremely rare. Only two cases had been reported in literature. Crystallization in only one eye after bilateral injections had not been reported before. We hereby report a case of intraocular ganciclovir crystallization in one eye after bilateral intravitreal injections, and repeated crystallization in the same eye after repeated injections. CASE PRESENTATION A 79-year-old patient had bilateral cytomegalovirus retinitis and received bilateral intravitreal ganciclovir injections of 2.5 mg in 0.05 ml sterile water. Fundus examination after injection showed formation of needle-shaped, golden-yellow crystals in the vitreous of right eye but not in left eye. The crystals dissolved spontaneously. Repeated bilateral intravitreal ganciclovir injections 4 days later resulted in repeated crystallization of ganciclovir in right eye but not in left eye. The crystals dissolved spontaneously and completely after 5 minutes. Visual acuity remained unchanged and intraocular pressure was normal. CONCLUSIONS Intraocular ganciclovir crystallization could occur after intravitreal injections. It is important to perform fundus examination after injection. The crystals may dissolve rapidly and vitrectomy may not be necessary. Our case suggested intraocular ganciclovir crystallization is an idiosyncratic phenomenon, subjects to distinctive intraocular environment which could be different between two eyes of the same patient. The susceptible intraocular environment could be persistent leading to repeated crystallization.
Collapse
Affiliation(s)
- Lawrence P L Iu
- Department of Ophthalmology, The University of Hong Kong, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong, Hong Kong.
| | - Michelle C Y Fan
- Department of Ophthalmology, The University of Hong Kong, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong, Hong Kong
| | - Wai-Ching Lam
- Department of Ophthalmology, The University of Hong Kong, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong, Hong Kong
| | - Ian Y H Wong
- Department of Ophthalmology, The University of Hong Kong, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong, Hong Kong
| |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW Ophthalmologic conditions were among the earliest described findings in patients with the acquired immunodeficiency syndrome (AIDS). The purpose of this review is to highlight recent changes in the pathophysiology and management of ophthalmologic conditions in patients infected with the human immunodeficiency virus (HIV). RECENT FINDINGS The introduction of highly active antiretroviral therapy (HAART) in 1996 changed ophthalmologic findings from predominantly acute infectious diseases to chronic, slowly progressive, debilitating conditions. HIV-associated neuroretinal disorder infrequently leads to blindness, but it causes visual disability in a large percentage of patients. Cytomegalovirus retinitis is now seen less commonly in the USA, but it remains an important cause of blindness in HIV-infected patients from developing countries. Immune recovery uveitis has emerged as a major cause of visual disability in the USA. As HIV has become a chronic disease, visual disability due to chronic noninfectious diseases have become increasingly important.
Collapse
Affiliation(s)
- Michael W Stewart
- Department of Ophthalmology, Mayo Clinic School of Medicine, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
| |
Collapse
|
32
|
Miao H, Hou J. [Influent factors for treating procedure of cytomegalovirus retinitis after allogeneic bone marrow hematopoietic stem cell transplantation]. Zhonghua Yan Ke Za Zhi 2017; 53:740-745. [PMID: 29050186 DOI: 10.3760/cma.j.issn.0412-4081.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore clinical and laboratory factors that influencing treating procedure of cytomegalovirus retinitis (CMVR) after allogeneic bone marrow hematopoietic stem cell transplantation (HSCT). Methods: This is a retrospective case series study. A total of 9 CMVR patients (15 eyes) between January 2016 and March 2017 were included in this study. All patients received intravenous or oral ganciclovir, together with intravitreous injection of ganciclovir alone or combined with foscanet sodium. One day before the first injection, aqueous humor samples from the affected eyes were collected, and CMV-DNA and interleukin-8 (IL-8) level were examined. Blood samples were acquired and CMV-DNA was examined too. Best corrected visual acuity, intraocular pressure (Goldmann), slit-lamp and fundus examination, ultra-wide fundus photography were performed before the first injection and every visit since then. Fifty eyes were divided into stop treating group (Group A) and continue-to-treat group (Group B) according to whether local treatment could be seized after loading phase. Image-Pro plus 6.0 was exploited to determine the area of CMVR in the retina, together with number of quadrants involved and whether macular was involved.Then the clinical and laboratory data were compared between two groups. ROC curve was used to calculate the cutoff values for quantitative factors that showed significant differences between two groups. Results: The interval time between HSCT and diagnosis of CMVR, visual acuity and CMV-DNA in the blood at baseline, area of CMVR and number of quadrants involved and whether macular was involved didn't show any difference between two groups. But the intraocular pressure (Z=-2.488, P=0.017), CMV-DNA (Z=-2.239, P=0.013) and IL-8 level (Z=-2.475, P=0.012) in aqueous humor at baseline, proportion of eyes with active inflammation in anterior (P=0.003) and proportion of eyes with ocular hypertension (P=0.021) in group B were significantly higher than those in group A. The cutoff values of intraocular pressure, CMV-DNA and IL-8 level in aqueous humor at baseline were 14.5 mmHg (P=0.013), 2.99×10(5) copy/ml (P=0.025) and 447.8 pg/ml (P=0.013), respectively. Conclusion: Higher intraocular pressure, CMV-DNA and IL-8 in aqueous humor at baseline, especially combined with active inflammation in anterior segment and ocular hypertension suggest longer treating period and more times of intravitreous injections. (Chin J Ophthalmol, 2017, 53: 740-745).
Collapse
Affiliation(s)
- H Miao
- Peking University People's Hospital, Ophthalmology Department, Key Laboratory of Vision Loss and Restoration Ministry of Education, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
| | | |
Collapse
|
33
|
Yeo TH, Yeo TK, Wong EP, Agrawal R, Teoh SC. Immune recovery uveitis in HIV patients with cytomegalovirus retinitis in the era of HAART therapy-a 5-year study from Singapore. J Ophthalmic Inflamm Infect 2016; 6:41. [PMID: 27822743 PMCID: PMC5099291 DOI: 10.1186/s12348-016-0110-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/27/2016] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study is to analyse the clinical features of HIV patients with cytomegalovirus retinitis (CMVR) developing immune recovery uveitis (IRU) while on highly active antiretroviral therapy (HAART) and to identify the risk factors, visual outcomes and complications of IRU. Results Majority (n = 26, 86.7 %) of patients were male, with 76.7 % (n = 23) of patients having bilateral disease. Twenty-seven eyes (50.9 %) had both anterior uveitis and vitritis. The median CD4 at IRU was 210 cells/μL (IQR 140–279), with 86.7 % having CD4 >100 cells/μL. The median duration from initiation of HAART to IRU was significantly different between those <50 years old (median 763 days, IQR 174–1872 days) and those ≥50 years old (median 161 days, IQR 84.5–278 days). Fourteen eyes (26.4 %) had loss of one or more Snellen lines visual acuity at 6 months while the rest maintained or improved vision. Complications developed in 21 eyes, with cataract (66.7 %), glaucoma and ocular hypertension (33.3 %) being the most common. The risk of complications was associated with the absolute difference in CD4 counts at IRU and at HAART commencement (p = 0.041). Age was also negatively associated with the duration from HAART to IRU (p = 0.005, Spearman’s rho coefficient = −0.503). Conclusions It is common to have both anterior uveitis and vitritis in IRU. There was a positive association between the increase in CD4 from HIV to IRU diagnoses and the risk of developing complications. Younger patients appeared to develop IRU later than older patients after HAART, suggesting that long-term follow-ups are essential for these patients.
Collapse
Affiliation(s)
- Tun Hang Yeo
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.
| | - Tun Kuan Yeo
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | - Elizabeth P Wong
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | - Stephen C Teoh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.,Eagle Eye Centre, Singapore, Singapore
| |
Collapse
|
34
|
Abstract
PURPOSE To examine the clinical outcomes achieved by using intravitreal ganciclovir injections combined with systemic anti-viral therapy in treating cytomegalovirus (CMV) retinitis in patients without human immunodeficiency virus (HIV) infection. METHODS Twenty-three eyes of 15 HIV-negative patients diagnosed with CMV retinitis were included in this retrospective study. RESULTS The median follow-up was 68 weeks (range, 12-156), and median number of injections was 10 (range, 2-22). The retinal lesions stopped progressing within 1-2 weeks following treatment. All of the eyes showed either unchanged or ≥2 line improvements of BCVA at last visit. There was no development of CMV retinitis in a fellow eye, or recurrence in a studied eye. Systemic complications such as neutropenia were not detected. CONCLUSIONS Intravitreal ganciclovir injections combined with systemic anti-viral treatment is a good therapeutic option for treating CMV retinitis without HIV infection. Such treatment provided favorable visual outcomes, with minimal ocular and systemic complications.
Collapse
Affiliation(s)
- Sohee Jeon
- a Department of Ophthalmology , Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine , Seoul , South Korea
| | - Won Ki Lee
- a Department of Ophthalmology , Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine , Seoul , South Korea
| |
Collapse
|
35
|
Saldaña Garrido JD, Martínez Rubio M, Carrión Campo R, Moya Moya MA, Rico Sergado L. Leukaemic infiltration and cytomegalovirus retinitis in a patient with acute T-cell lymphoblastic leukaemia in complete remission. ACTA ACUST UNITED AC 2016; 92:145-148. [PMID: 27402450 DOI: 10.1016/j.oftal.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 05/20/2016] [Accepted: 05/23/2016] [Indexed: 11/25/2022]
Abstract
CLINICAL CASE A 43-year-old woman in remission from T- cell acute lymphoblastic leukaemia was referred to our hospital with suspected leukaemic retinitis. The funduscopic examination of her left eye revealed multifocal yellow-white peripheral retinitis and retinal haemorrhage. The patient was treated for cytomegalovirus retinitis after an extended haematological investigation showed no abnormalities. Initial improvement was followed by papillitis in the left eye and motility restriction in the right eye. Magnetic resonance and lumbar puncture confirmed leukaemia relapse. Specific treatment was initiated with complete resolution. DISCUSSION Ocular involvement may precede haematological leukaemia relapse. Physicians should be alerted when ocular symptoms appear in these cases.
Collapse
Affiliation(s)
- J D Saldaña Garrido
- Unidad de Retina, Servicio de Oftalmología, Hospital General Universitario de Alicante, Alicante, España.
| | - M Martínez Rubio
- Unidad de Retina, Servicio de Oftalmología, Hospital General Universitario de Alicante, Alicante, España
| | - R Carrión Campo
- Unidad de Retina, Servicio de Oftalmología, Hospital General Universitario de Alicante, Alicante, España
| | - M A Moya Moya
- Unidad de Retina, Servicio de Oftalmología, Hospital General Universitario de Alicante, Alicante, España
| | - L Rico Sergado
- Unidad de Retina, Servicio de Oftalmología, Hospital General Universitario de Alicante, Alicante, España
| |
Collapse
|
36
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
37
|
Choopong P, Vivittaworn K, Konlakij D, Thoongsuwan S, Pituksung A, Tesavibul N. Treatment outcomes of reduced-dose intravitreal ganciclovir for cytomegalovirus retinitis. BMC Infect Dis 2016; 16:164. [PMID: 27090644 PMCID: PMC4836083 DOI: 10.1186/s12879-016-1490-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/31/2016] [Indexed: 11/25/2022] Open
Abstract
Background Cytomegalovirus retinitis (CMVR) is one of the most common opportunistic infection in immunocompromised individuals. Intravitreal ganciclovir injection has been used successfully but no standard regimen was established. Risks of drug toxicity, endophthalmitis, and injection-related complications increased with number and frequency of injection. The aim of this study is to evaluate the outcomes of reduced-dose intravitreal ganciclovir (2 mg/0.04 mL) for the treatment of CMVR. Methods A prospective observational cohort study involving 67 eyes of 49 patients with CMVR was performed. Induction therapy involved intravenous ganciclovir (10 mg/kg/day) for 2 weeks unless contraindicated or patients refused. Patients were then treated with reduced-dose intravitreal ganciclovir every week for 4 weeks, and then every other week until the lesion healed. The patients’ demographic data were recorded, and vision parameters were examined every visit. Results Twenty eyes (29.9 %) presented with initial visual acuities less than 6/60. The majority of patients were diagnosed with CMVR in zones 1 or 2 (63 eyes, 94 %), and, at least, one quadrant of the retina was involved (56 eyes, 83.6 %). Forty-one eyes (61.2 %) completely resolved after treatment within the 6-month follow-up. There was no significant difference in healing time, whether or not patients received induction treatment with intravenous ganciclovir (111.00 ± 12.96 vs 105.00 ± 28.32 days, p = 0.8). Five eyes (12.2 %) of patients with healed CMVR had visual acuities less than 6/60. Conclusions Reduced-dose intravitreal ganciclovir is a safe and effective treatment option. It provides comparable results to other weekly regimens. Induction with intravenous ganciclovir is not crucial in a resolution of retinitis, although it may be necessary to reduce systemic cytomegalovirus loads and mortality rates. Trial registration The trial was registered with Thai Clinical Trials Registry (TCTR) on 16 March 2016 – TCTR20160316001.
Collapse
Affiliation(s)
- Pitipol Choopong
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
| | - Kamolporn Vivittaworn
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Duanphen Konlakij
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Somanus Thoongsuwan
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Auengporn Pituksung
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Nattaporn Tesavibul
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| |
Collapse
|
38
|
Huang G, Jiang Q, Li M, Lu Y, Wang Z. Retrospective study of cytomegalovirus retinitis complicated with acquired immunodeficiency syndrome. Int J Clin Exp Med 2015; 8:9537-9542. [PMID: 26309620 PMCID: PMC4537961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/03/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE This study was designed to explore the characteristics and therapy of cytomegalovirus retinitis (CR) in patients diagnosed with acquired immunodeficiency syndrome (AIDS). METHODS A total of 67 AIDS patients (78 eyes) with CR findings of were collected from January 2009 to January 2013. The correlation between CR, cellular immunity, risk factor, clinical characteristics, treatment and prognosis of CR was assessed. The incidence of CR in different CD4+T lymphocyte count groups was analyzed. RESULTS Among all participants, 58 were male and 9 females, aged from 18-60 years, (38±9) years on average. CD4+ T lymphocyte count of CR patients ranged from 0-141 cells/µl and < 50 cells/µl in 81.3% of cases. CR was the primary manifestation in 10.2%, retinal lesions in 25.1%, best corrected visual acuity (BCVA) < 0.3 in 54% of AIDS patients. Retinal necrosis was involved near the posterior pole in 62.5% of CR patients. The visual acuity of 60 (47.6%) eyes was improved after treatment and 94.1% cases were cured within 3 months. Anti-CMV treatments including induction and maintenance of ganciclovir or foscarnet were discontinued when CD4+T lymphocyte count was > 150 cells/µl for three consecutive months. Complicated cataract, retinal detachment and immune reconstitution uveitis were observed in 20.5%, 12.1% and 13.1% of cases, respectively. CONCLUSION Decreased CD4+T lymphocyte count is a risk factor for CR. HAART and anti-CMV therapy are efficacious treatment of CR. Conventional eye examinations should be conducted to early diagnose CR or other opportunistic infections in all AIDS patients.
Collapse
Affiliation(s)
- Guobao Huang
- Department of Ophthalmology, Jinan Central Hospital Affiliated to Shandong UniversityJi’nan 250013, P.R. China
| | - Qiang Jiang
- Department of Ophthalmology, Jinan Central Hospital Affiliated to Shandong UniversityJi’nan 250013, P.R. China
| | - Mei Li
- Jiaozhou Central Hospital of QingdaoQingdao 266300, P.R. China
| | - Yong Lu
- Department of Ophthalmology, Jinan Central Hospital Affiliated to Shandong UniversityJi’nan 250013, P.R. China
| | - Zhen Wang
- Department of Ophthalmology, Jinan Central Hospital Affiliated to Shandong UniversityJi’nan 250013, P.R. China
| |
Collapse
|
39
|
Arend LW, Mazzulla DA, Spiegel JA. Atypical Retinal Lesion in a Heart Transplant Patient: Investigation and Management. Ochsner J 2015; 15:473-475. [PMID: 26730237 PMCID: PMC4679314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND A cardiac transplant patient presented to the Ochsner ophthalmology clinic with flashes of light in the left eye and a retinal lesion of unclear etiology. CASE REPORT A 59-year-old male cardiac transplant patient was referred by an outside eye physician. Examination of the anterior chamber of his left eye showed inflammation, and a large hypopigmented lesion was discovered in the nasal retina of the left eye. The patient was admitted to the hospital. Empiric treatment was initiated, and all workup results were negative. During the next several days, the patient's retinal lesion extended. A tap of the eye's vitreous and aqueous fluid yielded no diagnosis. The patient underwent a chorioretinal biopsy through a pars plana vitrectomy. Fluid removed from the vitreous cavity was sent for polymerase chain reaction (PCR) testing, and intravitreal antibiotics were injected. The results of the PCR were negative for all organisms. However, the lesion stabilized, and the patient has remained stable on oral valganciclovir. CONCLUSION Cytomegalovirus PCR testing has 95% sensitivity in untreated patients but only 48% sensitivity in patients treated with systemic ganciclovir, foscarnet, or both. Cytomegalovirus retinitis was determined to be a possible diagnosis; however, the possibility exists that the patient had developed a fungal subretinal abscess.
Collapse
Affiliation(s)
- Laurence W. Arend
- Department of Ophthalmology, Ochsner Clinic Foundation, New Orleans, LA
| | | | | |
Collapse
|
40
|
Abstract
PURPOSE To describe the case of a 74-year-old man who developed cytomegalovirus (CMV) retinitis after multiple ocular surgeries. METHODS Observational case report. RESULTS A 74-year-old man who had a history of multiple ocular surgeries developed unilateral retinitis with whitening of the entire peripheral retina. A presumptive diagnosis of viral retinitis was considered, and polymerase chain reaction of the aqueous fluid was positive for CMV DNA. Laboratory examination revealed that the patient was completely immunocompetent. Moreover, the patient did not have any subtenon or intravitreal injection of triamcinolone acetonide (TA). The patient responded well to intravenous ganciclovir and oral valganciclovir. CONCLUSION CMV retinitis can occur to immunocompetent patients without local immunosuppression with TA injection.
Collapse
Affiliation(s)
- Koji Toriyama
- Department of Ophthalmology, Ehime University School of Medicine, Toon, Japan
| | | | | | | |
Collapse
|
41
|
Tseng A, Foisy M. The role of ganciclovir for the management of cytomegalovirus retinitis in HIV patients: Pharmacological review and update on new developments. Can J Infect Dis 1996; 7:183-94. [PMID: 22514437 DOI: 10.1155/1996/780831] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/1995] [Accepted: 03/13/1996] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To review the pharmacology and pharmacokinetics of intravenous, oral and intraocular ganciclovir, and to discuss the role of these various formulations in the management of cytomegalovirus (CMV) retinitis in AIDS patients. DATA SOURCES A MEDLINE search (1987 through November 1995) of English-language literature using the main medical subject headings 'ganciclovir' and 'cytomegalovirus', and the subheading 'acquired immunodeficiency syndrome'. Relevant articles were also selected from references of identified articles. Abstracts from recent medical conferences of infectious diseases, pharmacology and human immunodeficiency virus were screened for additional data. STUDY SELECTION AND DATA EXTRACTION All articles and abstracts discussing the use of ganciclovir for the management or prophylaxis of CMV retinitis in AIDS patients were considered for inclusion. Pertinent information, as judged by the authors, was selected and synthesized for discussion. DATA SYNTHESIS Ganciclovir has demonstrated virustatic activity against CMV, and is often administered 5 mg/kg intravenously every 12 h as first-line therapy for CMV retinitis. Intravenous maintenance therapy at 5 mg/kg daily is usually effective at delaying retinitis progression for approximately 60 to 70 days. Neutropenia and thrombocytopenia are observed frequently, often necessitating interruption or discontinuation of therapy. Local drug administration may delay disease progression even further, and may be considered for patients who are intolerant to or failing intravenous therapy. However, systemic ganciclovir should be encouraged to reduce the risk of developing contralateral eye or end-organ CMV disease. Oral ganciclovir at 1 g tid is almost as effective as intravenous ganciclovir 5 mg/kg/day in delaying retinitis progression and is associated with fewer line-related complications. Absorption, drug interactions, cost and compliance should also be considered. CONCLUSIONS Until recently, ganciclovir was available only for intravenous use. Recent developments allow for intraocular and oral administration of this agent. A clear understanding of the advantages and disadvantages of these new formulations is required in order to select the most appropriate product for managing CMV retinitis in AIDS patients.
Collapse
|
42
|
Cho WB, Kim HC, Moon JW. Spontaneous resolution of intravitreal steroid-induced bilateral cytomegalovirus retinitis. Korean J Ophthalmol 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Won Bin Cho
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | | | | |
Collapse
|