Cytomegalovirus infection commonly occurs in adults during their fourth decade of life. The retina can be affected when the virus spreads via the bloodstream [1]. People infected with the human immunodeficiency virus (HIV) are at a higher risk of acquiring cytomegalovirus retinitis, as the former organism compromises the endothelial integrity of vasculature, and blood flow, in the retina [2]. Retinitis may involve inflammation as well as bleeding of the retina, often in the ocular fundus. Lesions such as cotton wool spots can be visualized on the retina.

HIV further predisposes individuals to cytomegalovirus retinitis due to its immunosuppressive effects. This results in activation of latent infection after the host immunity decreases [3]. Various conditions, such as diabetes mellitus, malignancy, and organ transplantation, impart the same effect [4] [5]. Although cytomegalovirus retinitis in immunocompetent individuals is rare, cases have been reported. It has also been described in patients with systemic lupus erythematosus and other autoimmune diseases, with concomitant use of immunosuppressive drugs [6].

Cytomegalovirus retinitis can be asymptomatic. In symptomatic infection, patients may experience various visual disturbances, including floaters, photopsia, narrowed visual fields, blurred vision, and scotoma [7]. They do not usually complain of red or painful eyes. Blindness can ensue within months of symptom onset. Furthermore, cytomegalovirus retinitis is often initially unilateral before becoming bilateral.

Notably, immunocompromised children do not seem to have increased susceptibility to this disease [8]. Cytomegalovirus retinitis can also be congenital, occurring in 25% of babies already exhibiting other features of CMV infection, and does not usually worsen after birth.

• Retinal Hemorrhage

  Retinal examination uncovered classical appearance of retinal whitening and retinal hemorrhages with extensive macular involvement. CMV retinitis can occur as a late complication following liver transplantation. [ncbi.nlm.nih.gov]

  White, fluffy retinal necrosis with overlying retinal hemorrhages. [eyerounds.org]

  A, Retinal hemorrhages and areas of opaque retina are present. Note the vascular sheathing in the superotemporal arcade and hard exudates in the macular region. B, Histologically, full-thickness retinal necrosis is present. [aao.org]

• Retinal Pigmentation

  (n 3 eyes) characterized by inner retinal hyperreflectivity, large empty spaces in outer nuclear layer, and bridges of retinal tissue but retinal pigment epithelium and choriocapillaris sparing. [ncbi.nlm.nih.gov]

• Retinal Scar

  Fibrovascular changes occurred in the CMV retinitis scar, were misdiagnosed as CMV retinitis reactivation, and were treated with anti-CMV medication. [ncbi.nlm.nih.gov]

  Two patients were not treated (patients 1 and 8), one of whom (patient 8) had received an autologous transplant and was diagnosed with atrophic retinal scarring compatible with previous CMV active retinitis after spontaneous resolution of the acute retinitis [academic.oup.com]

  In recovered patients, hemorrhage and exudation were disappeared completely and yellow-white retinal scars were formed in 10 eyes. [bmcinfectdis.biomedcentral.com]

• Unilateral Blindness

  However, there is a risk of unilateral blindness in severe cases. [patient.info]

The ophthalmologic examination is the diagnostic procedure employed. This involves dilating the pupils to visualize internal ocular structures through ophthalmoscopy.

CMV infection can be detected through biochemical analysis of blood and urine samples. Furthermore, a biopsy would reveal viral organisms in the tissue, however, this is not a routine procedure.

It is good practice to screen all patients at risk of cytomegalovirus retinitis, including those that lack symptoms, because early stage diagnosis and treatment are uncomplicated, and in addition, a significant proportion of individuals are asymptomatic at the time of diagnosis. Furthermore, intervention prevents blindness, which is a highly debilitating sequela of cytomegalovirus retinitis. Screening via testing visual acuity of patients using a Snellen chart is insufficient, as only a small portion of the retina, the fovea, is assessed in this way. The use of questionnaires specifically tailored to detect or elicit signs and symptoms of cytomegalovirus retinitis can be a more effective screening tool.

HIV patients have a higher risk of cytomegalovirus retinitis, and it is reported that the latter is the most frequently encountered opportunistic viral infection in the above group, especially when CD4 (cluster of differentiation 4) cell count is extremely low, that is, less than 50 per cubic millimeter [9]. Immunocompetent individuals, especially those who have received steroid injections, make up the minority of cytomegalovirus retinitis patients [10] [11].

• Lymphocytic Infiltrate

  Here we present a CVID patient who has developed a clinical polyclonal lymphocytic infiltration phenotype associated with severe and irreversible pancytopenia with unknown etiology. [ncbi.nlm.nih.gov]

  Viral infection also induces CXCL9 and CXCL10, which are known T-cell chemoattractants that precede lymphocyte infiltration. [doi.org]

Treatment was again withheld after diagnosis of retinitis because of immunocompetent status, potential side effects of ganciclovir treatment, and location of retinitis in the retinal periphery of both eyes. [ncbi.nlm.nih.gov]

We believe that systemic treatment with oral valganciclovir should be used routinely as the primary treatment strategy because (1) systemic treatment of CMV retinitis reduces extraocular CMV disease [ 39 ]; (2) systemic treatment reduces mortality [ 40 [doi.org]

CONCLUSION: The overall visual prognosis and the clinical features of CMV retinitis do not differ between HIV and non-HIV patients. The visual prognosis of CMV retinitis still remains quite poor despite advancements in antiviral treatment. [ncbi.nlm.nih.gov]

Treatment and prognosis The treatment for CMV retinitis involves administration of antiviral medications (e.g. valganciclovir, ganciclovir, foscarnet, or cidofovir). [radiopaedia.org]

[…] infection of the eye, a common opportunistic infection in AIDS, a complication of disseminated CMV infection Clinical Retinal inflammation, blindness Management Antivirals–eg, foscarnet, cidofovir, gancyclovir, systemically and as a ganciclovir implant Prognosis [medical-dictionary.thefreedictionary.com]

The occurrence of CMV retinitis signify a very unfavourable prognosis for patients who underwent bone marrow transplantation and these patients died within 12 months since CMV retinitis has been diagnosed. [pesquisa.bvsalud.org]

SUMMARY The incidence and prognosis of CMV retinitis has improved remarkably since the introduction of HAART in 1996. Treatment is tailored to the individual, involving localized and systemic anti-CMV therapy. [retinalphysician.com]

This case provides further evidence implicating CMV infection in the etiology of hypertensive iridocyclitis. [ncbi.nlm.nih.gov]

These include CMV infecting the eye causing retinitis, Pneumonitis of unknown etiology (Probably CMV) and Pseudomonas aeruginosa infection in the UTI. [omicsonline.org]

Division of Laboratory Medicine, University Hospital of Geneva and Medical School, University of Geneva, Geneva hDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland. [ncbi.nlm.nih.gov]

Herein, we describe the pathogenesis of CMVR and compare clinical features, epidemiology, and risk factors in HIV and non-HIV infected individuals with CMVR. [mdpi.com]

However, there is the lack of epidemiological report on the incidence of CMV retinitis in the AIDS patients in China. [bmcinfectdis.biomedcentral.com]

Kestelyn P (1999) The epidemiology of CMV in Africa. Ocul Immunol Inflamm 7: 173–177. View Article Google Scholar 16. [doi.org]

Offers the most comprehensive content available on retina, balancing the latest scientific research and clinical correlations, covering everything you need to know on retinal diagnosis, treatment, development, structure, function, and pathophysiology. [books.google.es]

Prevalence, pathophysiology and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis.Am J Ophthalmol. 1987; 103: 527-536 Holland GN Sakamoto MJ Hardy J et al. [amjmed.com]

bone marrow, lungs, kidneys) References:[1][2][3] Pathophysiology Clinical features CMV infection is usually asymptomatic. Severe manifestations occur in immunocompromised states (e.g., following organ transplantation, AIDS). [amboss.com]

The pathophysiology of pure red cell aplasia: implications for therapy. Blood 1996; 87:4831–4838. 13. Litwin SD, Zanjani ED. Lymphocytes suppressing both immunoglobulin production and erythroid differentiation in hypogammaglobulinaemia. [ekjm.org]

Hence, early intervention may be crucial to prevent its progression to irreversible visual loss. [ncbi.nlm.nih.gov]

Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of [journals.sbmu.ac.ir]

This multicenter, prospective, observational study of patients with AIDS is identifying key combinations of drug treatments to prevent blinding eye disease in AIDS patients.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . [medschool.lsuhsc.edu]

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2. Glasgow BJ, Weisberger AK. A quantitative and cartographic study of retinal microvasculopathy in acquired immunodeficiency syndrome. Am J Ophthalmol. 1994;118(1):46-56.
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