Comparison of Clinical Characteristics Among Herpetic Retinitis: Acute Retinal Necrosis and Cytomegalovirus Retinitis.

Abstract

Purpose: To compare the characteristics of patients with herpetic retinitis, specifically acute retinal necrosis (ARN) and cytomegalovirus retinitis (CMVR).

Methods: This retrospective study included patients who visited Nara Medical University Hospital between 2014 and 2024. A total of 38 patients (53 eyes) diagnosed with ARN or CMVR based on the diagnostic criteria were enrolled.

Results: The ARN group (11 patients, 14 eyes) showed more anterior inflammation and peripheral lesions than the CMVR group (27 patients, 39 eyes). Although initial best-corrected visual acuity (BCVA) was similar between groups, the CMVR group demonstrated significantly better BCVA at the final visit (p = 0.004). Among eyes with poor initial BCVA (≥0.3 logMAR), significant post-treatment improvement was observed in the CMVR group but not in the ARN group (p = 0.006, p = 0.30, respectively). Subgroup analysis of CMVR revealed that HIV-positive patients were all male and significantly younger than HIV-negative patients (p = 0.029). HIV-negative patients were further classified based on having either hematologic disease or receiving immunosuppressive therapy. The hematologic disease subgroup had more bilateral involvement (p = 0.0498) and higher cytomegalovirus antigen-positive cell count on the cytomegalovirus antigenemia test (C7HRP, p = 0.049).

Conclusion: Although both ARN and CMVR are caused by herpesviruses, they exhibit distinct clinical features and disease progression. CMVR subtypes can also be differentiated based on patient background and laboratory findings. Appropriate evaluation of the patient's background and clinical presentation is essential for management of herpetic retinitis.