Cytomegalovirus retinitis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]
Cytomegalovirus retinitis, also known as CMV retinitis, is an inflammation of the eye's retina that can lead to blindness. Cytomegalovirus (CMV)) is a DNA virus in the family Herpesviridae known for producing large cells with nuclear and cytoplasmic inclusions. Such inclusions are called an "owl's eye" effect.
While CMV is found in almost everyone, and is usually fought off by the immune system, for people who are immunocompromised, by diseases, transplants, or chemotherapy the virus is not adequately destroyed and can cause damage to the eye and the rest of the body. HIV positive persons are most at risk, especially when the CD4 cell count decreases. CMV is a common virus that infects those who are HIV positive.
It affects the eye in about 30% of the cases by causing damage to the retina. Symptoms can include blurred vision, eye pain, photophobia, redness, and blindness. It may affect just one eye at first, but then may spread to the other. Because the virus is so threatening to vision, it is usually treated by a vitreo-retinal surgeon, by antivirals such as ganciclovir or foscarnet, which can be taken orally, intravenously, injected directly into the eye (intravitreal injection), or through an intravitreal implant.
The systemic use of corticosteroids has recently been implicated as elevating the risk of CMV in AIDS patients.[1]
The first report of CMV retinitis in a patient with dermatomyositis was recently published.[2]
Medical Treatment
Preferred regimen: Foscarnet 1.2-2.4 mg/0.1 mL intravitreal injection 1-3 times per week AND Ganciclovir 5 mg/kg IV q12 for 2 weeks followed by 5 mg/kg q24h for 5-7 weeks followed by Valganciclovir 900 mg PO qd for chronic maintenance
References
- ↑ Hodge WG, Boivin JF, Shapiro SH, Shah KC, Dionne MA. "Iatrogenic risk factors for cytomegalovirus retinitis." Can J Ophthalmol. 2005 Dec;40(6):701-10. PMID 16518896.
- ↑ Kim HR, Kim SD, Kim SH, Yoon CH, Lee SH, Park SH, Kim HY. "Cytomegalovirus retinitis in a patient with dermatomyositis." Clin Rheumatol. 2006 Mar 15; [Epub ahead of print]. PMID 16552465.
Active Cytomegalovirus retinitis is treated by a uveitis and ocular immunology specialist
See also
- List of eye diseases and disorders
- List of systemic diseases with ocular manifestations
- Progressive outer retinal necrosis