Skip to main content
SpringerLink
Log in

CMV Retinitis

  • Chapter
  • First Online:
Uveitis

Abstract

Cytomegalovirus retinitis may lead to significant ocular morbidity in immunocompromised patients that are not readily diagnosed and treated. The advent of HAART has transformed one of the most common intraocular infections within the United States to an entity that may be rarely seen by an ophthalmology resident during a three-year training program. Despite these advances for AIDS patients, CMV retinitis remains a concern for HIV-infected individuals not on treatment or those who have failed anti-HIV treatment as well as those immunocompromised by other means such as chemotherapy, organ transplantation, and bone marrow transplantation. With the advancement in medical therapies prolonging survival and increasing the number of these immunocompromised hosts, physicians should continue to remain vigilant and screen these patients for CMV retinitis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Krech U. Complement-fixing antibodies against cytomegalovirus in different parts of the world. Bull World Health Organ. 1973;49(1):103–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Jackson JB, Erice A, Englund JA, Edson JR, Balfour HH. Prevalence of cytomegalovirus antibody in hemophiliacs and homosexuals infected with human immunodeficiency virus type 1. Transfusion. 1988;28(2):187–9.

    Article  CAS  PubMed  Google Scholar 

  3. Jeon S, Lee WK, Lee Y, Lee DG, Lee JW. Risk factors for cytomegalovirus retinitis in patients with cytomegalovirus viremia after hematopoietic stem cell transplantation. Ophthalmology. 2012;119(9):1892–8.

    Article  PubMed  Google Scholar 

  4. Xhaard A, Robin M, Scieux C, et al. Increased incidence of cytomegalovirus retinitis after allogeneic hematopoietic stem cell transplantation. Transplantation. 2007;83(1):80–3.

    Article  PubMed  Google Scholar 

  5. Hodge WG, Boivin J-F, Shapiro SH, et al. Clinical risk factors for cytomegalovirus retinitis in patients with AIDS. Ophthalmology. 2004;111(7):1326–33.

    Article  PubMed  Google Scholar 

  6. Wiegand TW, Young LHY. Cytomegalovirus retinitis. Int Ophthalmol Clin. 2006;46(2):91–110.

    Article  PubMed  Google Scholar 

  7. Walker S, Iguchi A, Jones NP. Frosted branch angiitis: a review. Eye (Lond). 2004;18(5):527–33.

    Article  CAS  PubMed  Google Scholar 

  8. Mansour AM. Cytomegalovirus optic neuritis. Curr Opin Ophthalmol. 1997;8(3):55–8.

    Article  CAS  PubMed  Google Scholar 

  9. Pathanapitoon K, Ausayakhun S, Kunavisarut P, Pungrasame A, Sirirungsi W. Detection of cytomegalovirus in vitreous, aqueous and conjunctiva by polymerase chain reaction (PCR). J Med Assoc Thai. 2005;88(2):228–32.

    PubMed  Google Scholar 

  10. Henderly DE, Freeman WR, Causey DM, Rao NA. Cytomegalovirus retinitis and response to therapy with ganciclovir. Ophthalmology. 1987;94(4):425–34.

    Article  CAS  PubMed  Google Scholar 

  11. Anand R, Font RL, Fish RH, Nightingale SD. Pathology of cytomegalovirus retinitis treated with sustained release intravitreal ganciclovir. Ophthalmology. 1993;100(7):1032–9.

    Article  CAS  PubMed  Google Scholar 

  12. Jabs DA, Bolton SG, Dunn JP, Palestine AG. Discontinuing anticytomegalovirus therapy in patients with immune reconstitution after combination antiretroviral therapy. Am J Ophthalmol. 1998;126(6):817–22.

    Article  CAS  PubMed  Google Scholar 

  13. Noble S, Faulds D. Ganciclovir. An update of its use in the prevention of cytomegalovirus infection and disease in transplant recipients. Drugs. 1998;56(1):115–46.

    Article  CAS  PubMed  Google Scholar 

  14. McGavin JK, Goa KL. Ganciclovir: an update of its use in the prevention of cytomegalovirus infection and disease in transplant recipients. Drugs. 2001;61(8):1153–83.

    Article  CAS  PubMed  Google Scholar 

  15. Huynh N, Daniels AB, Kohanim S, Young LHY. Medical treatment for cytomegalovirus retinitis. Int Ophthalmol Clin. 2011;51(4):93–103.

    Article  PubMed  Google Scholar 

  16. Martin DF, Sierra-Madero J, Walmsley S, et al. A controlled trial of valganciclovir as induction therapy for cytomegalovirus retinitis. N Engl J Med. 2002;346(15):1119–26.

    Article  CAS  PubMed  Google Scholar 

  17. Ohta H, Matsuda Y, Tokimasa S, et al. Foscarnet therapy for ganciclovir-resistant cytomegalovirus retinitis after stem cell transplantation: effective monitoring of CMV infection by quantitative analysis of CMV mRNA. Bone Marrow Transplant. 2001;27(11):1141–5.

    Article  CAS  PubMed  Google Scholar 

  18. Studies of Ocular Complications of AIDS Research Group. Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis. N Engl J Med. 1992;1992(326):213–20.

    Google Scholar 

  19. Jacobson MA, Wulfsohn M, Feinberg JE, et al. Phase II dose-ranging trial of foscarnet salvage therapy for cytomegalovirus retinitis in AIDS patients intolerant of or resistant to ganciclovir (ACTG protocol 093). AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases. AIDS. 1994;8(4):451–9.

    Article  CAS  PubMed  Google Scholar 

  20. Lalezari JP, Stagg RJ, Kuppermann BD, et al. Intravenous cidofovir for peripheral cytomegalovirus retinitis in patients with AIDS. A randomized, controlled trial. Ann Intern Med. 1997;126(4):257–63.

    Article  CAS  PubMed  Google Scholar 

  21. Polis MA, Spooner KM, Baird BF, et al. Anticytomegaloviral activity and safety of cidofovir in patients with human immunodeficiency virus infection and cytomegalovirus viruria. Antimicrob Agents Chemother. 1995;39(4):882–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Akler ME, Johnson DW, Burman WJ, Johnson SC. Anterior uveitis and hypotony after intravenous cidofovir for the treatment of cytomegalovirus retinitis. Ophthalmology. 1998;105(4):651–7.

    Article  CAS  PubMed  Google Scholar 

  23. Kempen JH, Jabs DA, Dunn JP, West SK, Tonascia J. Retinal detachment risk in cytomegalovirus retinitis related to the acquired immunodeficiency syndrome. Arch Ophthalmol. 2001;119(1):33–40.

    CAS  PubMed  Google Scholar 

  24. Martin DF, Parks DJ, Mellow SD, et al. Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant. A randomized controlled clinical trial. Arch Ophthalmol. 1994;112(12):1531–9.

    Article  CAS  PubMed  Google Scholar 

  25. Diaz-Llopis M, España E, Muñoz G, et al. High dose intravitreal foscarnet in the treatment of cytomegalovirus retinitis in AIDS. Br J Ophthalmol. 1994;78(2):120–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Kirsch LS, Arevalo JF, de la Paz EC, Munguia D, de Clerq E, Freeman WR. Intravitreal cidofovir (HPMPC) treatment of cytomegalovirus retinitis in patients with acquired immune deficiency syndrome. Ophthalmology. 1995;102(4):533–43.

    Article  CAS  PubMed  Google Scholar 

  27. Banker AS, Arevalo JF, Munguia D, et al. Intraocular pressure and aqueous humor dynamics in patients with AIDS treated with intravitreal cidofovir (HPMPC) for cytomegalovirus retinitis. Am J Ophthalmol. 1997;124(2):168–80.

    Article  CAS  PubMed  Google Scholar 

  28. Chavez-de la Paz E, Arevalo JF, Kirsch LS, et al. Anterior nongranulomatous uveitis after intravitreal HPMPC (cidofovir) for the treatment of cytomegalovirus retinitis. Analysis and prevention. Ophthalmology. 1997;104(3):539–44.

    CAS  PubMed  Google Scholar 

  29. De Smet MD, Meenken CJ, van den Horn GJ. Fomivirsen - a phosphorothioate oligonucleotide for the treatment of CMV retinitis. Ocul Immunol Inflamm. 1999;7(3–4):189–98.

    Article  PubMed  Google Scholar 

  30. Amin HI, Ai E, McDonald HR, Johnson RN. Retinal toxic effects associated with intravitreal fomivirsen. Arch Ophthalmol. 2000;118(3):426–7.

    CAS  PubMed  Google Scholar 

  31. Palella FJ, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338(13):853–60.

    Article  PubMed  Google Scholar 

  32. Bloom JN, Palestine AG. The diagnosis of cytomegalovirus retinitis. Ann Intern Med. 1988;109(12):963–9.

    Article  CAS  PubMed  Google Scholar 

  33. Pertel P, Hirschtick R, Phair J, Chmiel J, Poggensee L, Murphy R. Risk of developing cytomegalovirus retinitis in persons infected with the human immunodeficiency virus. J Acquir Immune Defic Syndr. 1992;5(11):1069–74.

    CAS  PubMed  Google Scholar 

  34. Jabs DA, Bartlett JG. AIDS and ophthalmology: a period of transition. Am J Ophthalmol. 1997;124(2):227–33.

    Article  CAS  PubMed  Google Scholar 

  35. Jabs DA, Holbrook JT, Van Natta ML, et al. Risk factors for mortality in patients with AIDS in the era of highly active antiretroviral therapy. Ophthalmology. 2005;112(5):771–9.

    Article  PubMed  Google Scholar 

  36. Holbrook JT, Colvin R, van Natta ML, Thorne JE, Bardsley M, Jabs DA. Evaluation of the United States public health service guidelines for discontinuation of anticytomegalovirus therapy after immune recovery in patients with cytomegalovirus retinitis. Am J Ophthalmol. 2011;152(4):628–37.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Lalezari JP, Drew WL, Glutzer E, et al. (S)-1-[3-hydroxy-2-(phosphonylmethoxy)propyl]cytosine (cidofovir): results of a phase I/II study of a novel antiviral nucleotide analogue. J Infect Dis. 1995;171(4):788–96.

    Article  CAS  PubMed  Google Scholar 

  38. Macdonald JC, Torriani FJ, Morse LS, Karavellas MP, Reed JB, Freeman WR. Lack of reactivation of cytomegalovirus (CMV) retinitis after stopping CMV maintenance therapy in AIDS patients with sustained elevations in CD4 T cells in response to highly active antiretroviral therapy. J Infect Dis. 1998;177(5):1182–7.

    Article  CAS  PubMed  Google Scholar 

  39. Curi AL, Muralha A, Muralha L, Pavesio C. Suspension of anticytomegalovirus maintenance therapy following immune recovery due to highly active antiretroviral therapy. Br J Ophthalmol. 2001;85(4):471–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Whitcup SM, Fortin E, Lindblad AS, et al. Discontinuation of anticytomegalovirus therapy in patients with HIV infection and cytomegalovirus retinitis. JAMA. 1999;282(17):1633–7.

    Article  CAS  PubMed  Google Scholar 

  41. Freeman WR, Henderly DE, Wan WL, et al. Prevalence, pathophysiology, and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis. Am J Ophthalmol. 1987;103(4):527–36.

    Article  CAS  PubMed  Google Scholar 

  42. Freeman WR, Friedberg DN, Berry C, et al. Risk factors for development of rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis. Am J Ophthalmol. 1993;116(6):713–20.

    Article  CAS  PubMed  Google Scholar 

  43. Irvine AR, Lonn L, Schwartz D, Zarbin M, Ballesteros F, Kroll S. Retinal detachment in AIDS: long-term results after repair with silicone oil. Br J Ophthalmol. 1997;81(3):180–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Nasemann JE, Mutsch A, Wiltfang R, Klauss V. Early pars plana vitrectomy without buckling procedure in cytomegalovirus retinitis-induced retinal detachment. Retina. 1995;15(2):111–6.

    Article  CAS  PubMed  Google Scholar 

  45. Karavellas MP, Lowder CY, Macdonald C, Avila CP, Freeman WR. Immune recovery vitritis associated with inactive cytomegalovirus retinitis: a new syndrome. Arch Ophthalmol. 1998;116(2):169–75.

    Article  CAS  PubMed  Google Scholar 

  46. Zegans ME, Walton RC, Holland GN, O’Donnell JJ, Jacobson MA, Margolis TP. Transient vitreous inflammatory reactions associated with combination antiretroviral therapy in patients with AIDS and cytomegalovirus retinitis. Am J Ophthalmol. 1998;125(3):292–300.

    Article  CAS  PubMed  Google Scholar 

  47. Arevalo JF, Mendoza AJ, Ferretti Y. Immune recovery uveitis in AIDS patients with cytomegalovirus retinitis treated with highly active antiretroviral therapy in Venezuela. Retina. 2003;23(4):495–502.

    Article  PubMed  Google Scholar 

  48. Song M-K, Azen SP, Buley A, et al. Effect of anti-cytomegalovirus therapy on the incidence of immune recovery uveitis in AIDS patients with healed cytomegalovirus retinitis. Am J Ophthalmol. 2003;136(4):696–702.

    Article  PubMed  Google Scholar 

  49. Woods ML, MacGinley R, Eisen DP, Allworth AM. HIV combination therapy: partial immune restitution unmasking latent cryptococcal infection. AIDS. 1998;12(12):1491–4.

    Article  CAS  PubMed  Google Scholar 

  50. Karavellas MP, Song M, Macdonald JC, Freeman WR. Long-term posterior and anterior segment complications of immune recovery uveitis associated with cytomegalovirus retinitis. Am J Ophthalmol. 2000;130(1):57–64.

    Article  CAS  PubMed  Google Scholar 

  51. Sanislo SR, Lowder CY, Kaiser PK. Optic nerve head neovascularization in a patient with inactive cytomegalovirus retinitis and immune recovery. Am J Ophthalmol. 1998;126(2):318–20.

    Article  CAS  PubMed  Google Scholar 

  52. Canzano JC, Reed JB, Morse LS. Vitreomacular traction syndrome following highly active antiretroviral therapy in AIDS patients with cytomegalovirus retinitis. Retina. 1998;18(5):443–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA

    Avni Patel & Lucy Young

Authors
  1. Avni Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lucy Young
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lucy Young .

Editor information

Editors and Affiliations

  1. Ocular Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA

    George N. Papaliodis

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Patel, A., Young, L. (2017). CMV Retinitis. In: Papaliodis, G. (eds) Uveitis. Springer, Cham. https://doi.org/10.1007/978-3-319-09126-6_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-09126-6_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09125-9

  • Online ISBN: 978-3-319-09126-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation