Clinical Features and Outcomes of Cytomegalovirus Retinitis in Immunosuppressed Non-HIV Patients.

Abstract

Purpose: To describe the nature and response of cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-negative patients with hematological malignancies and other immunosuppressive causes.

Methods: This is retrospective case series of CMV retinitis patients with known immunocompromised status and negative HIV results. Patients' data were reviewed for demographics, causes of the immunosuppressed status, concomitant systemic CMV infection, and its management. Ophthalmic findings included visual acuity (VA), anterior and posterior segments findings, CMV retinitis patterns and extensions, medications, number of intravitreal injections, fundus photographs, and CMV retinitis complications.

Results: During a study period of 2 years, 17 eyes of 9 patients were diagnosed with CMV retinitis with detected CMV in blood tests. Indolent granular retinitis pattern was found in 4 eyes (23.5%), and the fulminant necrotizing pattern in another 4 eyes (23.5%). In 1 eye (5.9%), frosted branch angiitis was observed. A mixed pattern between granular and necrotizing retinitis was seen in 4 eye (23.5%). The majority (n 11, 64.7%) of the affected eyes had an extensive retinal involvement (zone 1-3). Only two eyes had no macular involvement (11.8%). A large percentage of the included patients had controlled disease course with stable vision. Out of the studied 17 eyes, deterioration in terms of VA was seen in five eyes. In two patients, the disease course was complicated by vitreous hemorrhage.

Conclusion: In the majority of the patients with HIV-negative tests who received intravitreal and/or systemic anti-CMV medications, the clinical course of CMV retinitis was controlled with final stable vision.