ArticleTherapeutic advances in ophthalmology
Cytomegalovirus retinitis in diverse immunocompromised populations: clinical presentation, treatment outcomes, and prognostic factors.
Article in Therapeutic advances in ophthalmology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Cytomegalovirus retinitis (CMVR) is a vision-threatening retinal infection that primarily affects severely immunocompromised individuals. Objectives: This study aimed to compare the clinical presentations, long-term visual outcomes, and predictors of visual prognosis in CMVR patients across different immunodeficiency subtypes. Design: Retrospective cohort study. Methods: This study analyzed 117 eyes from 91 patients with CMVR who were treated at a tertiary eye center between 2009 and 2024. Eyes were stratified by the underlying cause of immunosuppression into a human immunodeficiency virus (HIV)-positive group (71 eyes of 58 patients) and an HIV-negative group (46 eyes of 33 patients). The HIV-negative group included patients with hematologic malignancies, drug-induced immunosuppression (e.g., posttransplant or autoimmune therapy), solid organ transplantation, autoimmune disease, congenital immunodeficiency, and poorly controlled diabetes mellitus type 2 (DM2). Patient demographics and comprehensive ophthalmologic examination findings were recorded and compared across these subgroups. Results: The study included 91 patients (117 eyes) with a mean age of 40.1 ± 14.7 years; 62.6% were male. Of these, 58 patients (71 eyes) were HIV-positive (mean age 39.7 ± 10.9 years; 65.5% male) and 33 patients (46 eyes) were HIV-negative. Among HIV-negative patients, 19 eyes were in patients with hematologic malignancies (mean age 35.3 ± 21.1 years; 75% male), 20 eyes were in patients with drug-induced immunosuppression (mean age 38.6 ± 17.9 years; 40% male), and the remainder eyes were associated with solid organ transplant, autoimmune disease, congenital immunodeficiency, or poorly controlled DM (7 eyes). Eyes in HIV-negative patients exhibited more severe vitritis than those in HIV-positive patients (34.8% vs 19.7% with vitritis grade +2; Conclusion: CMV retinitis demonstrates distinct clinical phenotypes in different immunosuppressed populations. HIV-negative patients tend to show more pronounced vitritis and vasculopathic retinal features, whereas HIV-positive patients have worse baseline visual acuity. However, the long-term visual prognosis was not significantly influenced by the underlying cause of immunosuppression.
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