Skip to main content

Advertisement

Log in

Patterns of cytomegalovirus retinitis at a tertiary referral center in Turkey

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To analyze predisposing conditions in Turkish patients with CMV retinitis and to compare HIV-positive and HIV-negative patients.

Methods

We reviewed medical charts and ocular images of 41 patients with CMV retinitis diagnosed between 1996 and 2019.

Results

Eleven patients (27%) had HIV infection and 30 were immunocompromised from diverse causes. Initial visual acuity, type, zone, and extent of CMV retinitis, and response to anti-CMV treatment were not significantly different between the two groups. Vitreous haze and panretinal occlusive vasculopathy were the presenting features only in non-HIV patients, seen in 34% and 16% of eyes, respectively. Although not statistically significant, recurrent CMV retinitis was more common in non-HIV patients (17.4% vs. 4.3%/eye-year) and immune recovery uveitis was more common in HIV patients (43% vs. 26%/eye-year). Visual outcomes were similar. Final visual acuity of 1 logMAR or worse was significantly associated with the recurrence of CMV retinitis (odds ratio 9.67; p = 0.01) and also with the occurrence of immune recovery uveitis (odds ratio 4.31; p = 0.058).

Conclusions

Diverse immunocompromising conditions are more commonly associated with CMV retinitis than HIV infection in Turkish patients. Intraocular inflammation was more commonly associated with active retinitis in non-HIV patients and immune recovery uveitis was more common in HIV patients.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Availability of data and material

Study data can be provided.

References

  1. Lee JH, Agarwal A, Mahendradas P et al (2017) Viral posterior uveitis. Surv Ophthalmol 62:404–445. https://doi.org/10.1016/j.survophthal.2016.12.008

    Article  PubMed  Google Scholar 

  2. Carmichael A (2012) Cytomegalovirus and the eye. Eye 26:237–240. https://doi.org/10.1038/eye.2011.327

    Article  CAS  PubMed  Google Scholar 

  3. Port AD, Orlin A, Kiss S, Patel S, D’Amico DJ, Gupta MP (2017) Cytomegalovirus retinitis: a review. J Ocul Pharmacol Ther 33:224–234. https://doi.org/10.1089/jop.2016.0140

    Article  CAS  PubMed  Google Scholar 

  4. Robinson MR, Ross ML, Whitcup SM (1999) Ocular manifestations of HIV infection. Curr Opin Ophthalmol. https://doi.org/10.1097/00055735-199912000-00011

    Article  PubMed  Google Scholar 

  5. Testi I, Mahajan S, Agrawal R et al (2020) Management of intraocular infections in HIV. Ocul Immunol Inflamm 28:1099–1108. https://doi.org/10.1080/09273948.2020.1727533

    Article  PubMed  Google Scholar 

  6. Shapira Y, Mimouni M, Vishnevskia-Dai V (2018) Cytomegalovirus retinitis in HIV-negative patients—associated conditions, clinical presentation, diagnostic methods and treatment strategy. Acta Ophthalmol 96:e761–e767. https://doi.org/10.1111/aos.13553

    Article  PubMed  Google Scholar 

  7. Holland GN, Tufail A, Jordan M (1996) Cytomegalovirus diseases. In: Pepose JS, Holland GN, Wilhelmus KR (eds) Ocular infection and immunity. Mosby-Year Book, St Louis, pp 1088–1128

    Google Scholar 

  8. Kuo IC, Kempen JH, Dunn JP, Vogelsang G, Jabs DA (2004) Clinical characteristics and outcomes of cytomegalovirus retinitis in persons without human immunodeficiency virus infection. Am J Ophthalmol 138:338–346. https://doi.org/10.1016/j.ajo.2004.04.015

    Article  PubMed  Google Scholar 

  9. Ho M, Invernizzi A, Zagora S et al (2020) Presenting features, treatment and clinical outcomes of cytomegalovirus retinitis: non-HIV patients vs HIV patients. Ocul Immunol Inflamm 28:651–658. https://doi.org/10.1080/09273948.2019.1604003

    Article  PubMed  Google Scholar 

  10. Iu LP, Fan MC, Lau JK, Chan TS, Kwong YL, Wong IY (2016) Long-term follow-up of cytomegalovirus retinitis in non-HIV immunocompromised patients: clinical features and visual prognosis. Am J Ophthalmol 165:145–153. https://doi.org/10.1016/j.ajo.2016.03.015

    Article  PubMed  Google Scholar 

  11. Pathanapitoon K, Tesavibul N, Choopong P et al (2013) Clinical manifestations of cytomegalovirus-associated posterior uveitis and panuveitis in patients without human immunodeficiency virus infection. JAMA Ophthalmol 131:638–645. https://doi.org/10.1001/jamaophthalmol.2013.2860

    Article  CAS  PubMed  Google Scholar 

  12. Schneider EW, Elner SG, van Kuijk FJ et al (2013) Chronic retinal necrosis: cytomegalovirus necrotizing retinitis associated with panretinal vasculopathy in non-HIV patients. Retina 33:1791–1799. https://doi.org/10.1097/IAE.0b013e318285f486

    Article  CAS  PubMed  Google Scholar 

  13. Vishnevskia-Dai V, Shapira Y, Rahav G, Shimoni A, Somech R, Moisseiev J (2015) Cytomegalovirus retinitis in HIV-negative patients: a practical management approach. Ophthalmology 122:866-868.e3. https://doi.org/10.1016/j.ophtha.2014.11.010

    Article  PubMed  Google Scholar 

  14. Davis JL, Haft P, Hartley K (2013) Retinal arteriolar occlusions due to cytomegalovirus retinitis in elderly patients without HIV. J Ophthalmic Inflamm Infect 3:17. https://doi.org/10.1186/1869-5760-3-17

    Article  PubMed  PubMed Central  Google Scholar 

  15. Holladay JT (2004) Visual acuity measurements. J Cataract Refract Surg 30:287–290

    Article  PubMed  Google Scholar 

  16. Jabs DA, Nussenblatt RB, Rosenbaum JT et al (2005) Standardization of uveitis nomenclature for reporting clinical data. results of the first international workshop. Am J Ophthalmol 140:509–516. https://doi.org/10.1016/j.ajo.2005.03.057

    Article  PubMed  Google Scholar 

  17. Holland GN, Vaudaux JD, Jeng SM et al (2008) Characteristics of untreated AIDS-related cytomegalovirus retinitis. I. Findings before the era of highly active antiretroviral therapy (1988 to 1994). Am J Ophthalmol 145:5–11. https://doi.org/10.1016/j.ajo.2007.09.023

    Article  PubMed  Google Scholar 

  18. Urban B, Bakunowicz-Łazarczyk A, Michalczuk M (2014) Immune recovery uveitis: pathogenesis, clinical symptoms, and treatment. Mediators Inflamm 2014:971417. https://doi.org/10.1155/2014/971417

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Tugal-Tutkun I, Kır N, Gül A, Koniçe M, Urgancıoğlu M (2000) Cytomegalovirus retinitis in a patient with Wegener’s granulomatosis. Ophthalmologica 214:149–152

    Article  CAS  PubMed  Google Scholar 

  20. Tugal-Tutkun I, Araz B, Cagatay A (2010) CMV retinitis after intravitreal triamcinolone acetonide injection in a patient with Behçet’s uveitis. Int Ophthalmol 30:591–593

    Article  PubMed  Google Scholar 

  21. Sutcu M, Acar M, Akturk H, Bulut M et al (2016) Cytomegalovirus retinitis in immunosuppressed patients: case studies. Ann Pediatr Child Health 4:1102

    Google Scholar 

  22. Irmak H, Yardım N, Keklik K, Temel F (2019) Türkiye HIV/AIDS Kontrol programı 2019–2024. Arti6 Medya Tanıtım Matbaa, Ankara.

  23. Ausayakhun S, Keenan JD, Ausayakhun S et al (2012) Clinical features of newly diagnosed cytomegalovirus retinitis in northern Thailand. Am J Ophthalmol 153:923-931.e1. https://doi.org/10.1016/j.ajo.2011.10.012

    Article  PubMed  PubMed Central  Google Scholar 

  24. Singh SR, Dogra M, Kaur S et al (2020) Spectrum of newly diagnosed cytomegalovirus retinitis in a developing country in the HAART era. Ocul Immunol Inflamm 28:119–125. https://doi.org/10.1080/09273948.2018.1538460

    Article  PubMed  Google Scholar 

  25. Jabs DA, Ahuja A, Van Natta M, Lyon A, Srivastava S, Gangaputra S (2010) Studies of the ocular complications of AIDS Research Group. Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy: five-year outcomes. Ophthalmology 117:2152-61.e1–2. https://doi.org/10.1016/j.ophtha.2010.03.031

    Article  PubMed  Google Scholar 

  26. Shoeibi N, Abrishami M, Mohammad Esmaeil E, Hosseini SM (2019) Visual prognosis, clinical features, and predisposing factors in non-HIV patients with cytomegalovirus retinitis. Int Ophthalmol 39:1709–1715. https://doi.org/10.1007/s10792-018-0991-2

    Article  PubMed  Google Scholar 

  27. Qian Z, Chen X, Tao Y, Li W, Gu W (2019) Prognostic factors of cytomegalovirus infection associated retinitis in HIV-negative patients: a retrospective cohort study. Ocul Immunol Inflamm. https://doi.org/10.1080/09273948.2019.1659978

    Article  PubMed  Google Scholar 

  28. Jeon S, Lee WK (2015) Cytomegalovirus retinitis in a human immunodeficiency virus-negative cohort: long-term management and complications. Ocul Immunol Inflamm 23:392–399. https://doi.org/10.3109/09273948.2014.985385

    Article  PubMed  Google Scholar 

  29. Agarwal A, Kumari N, Trehan A et al (2014) Outcome of cytomegalovirus retinitis in immunocompromised patients without human immunodeficiency virus treated with intravitreal ganciclovir injection. Graefes Arch Clin Exp Ophthalmol 252:1393–1401. https://doi.org/10.1007/s00417-014-2587-5

    Article  CAS  PubMed  Google Scholar 

  30. Takakura A, Tessler HH, Goldstein DA et al (2014) Viral retinitis following intraocular or periocular corticosteroid administration: a case series and comprehensive review of the literature. Ocul Immunol Inflamm 22:175–182. https://doi.org/10.3109/09273948.2013.866256

    Article  PubMed  PubMed Central  Google Scholar 

  31. Radwan A, Metzinger JL, Hinkle DM, Foster CS (2013) Cytomegalovirus retinitis in immunocompetent patients: case reports and literature review. Ocul Immunol Inflamm 21:324–328. https://doi.org/10.3109/09273948.2013.786095

    Article  PubMed  Google Scholar 

  32. Kim DY, Jo J, Joe SG, Kim JG, Yoon YH, Lee JY (2017) Comparison of visual prognosis and clinical features of cytomegalovirus retinitis in HIV and non-HIV patients. Retina 37:376–381. https://doi.org/10.1097/IAE.0000000000001144

    Article  PubMed  Google Scholar 

Download references

Funding

There was no funding for this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ilknur Tugal-Tutkun.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

Obtained from the Ethics Committee of Istanbul Faculty of Medicine.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sadik, M.T., Aksu Ceylan, N., Cebeci, Z. et al. Patterns of cytomegalovirus retinitis at a tertiary referral center in Turkey. Int Ophthalmol 41, 2981–2992 (2021). https://doi.org/10.1007/s10792-021-01857-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-021-01857-3

Keywords

Navigation