| Cytomegalovirus retinitis | |
|---|---|
| Other names | CMV retinitis |
 | |
| Fundus photograph of CMV retinitis | |
| Specialty |
Ophthalmology, infectious diseases 
|
| Symptoms | Blurred vision |
| Causes | Bone marrow transplant, HIV/AIDS |
| Diagnostic method | Ophthalmologic exam, blood test |
| Medication | Antivirals (oral or intraocular injection) |
Cytomegalovirus retinitis, also known as CMV retinitis, is an inflammation of the retina of the eye that can lead to blindness. Caused by human cytomegalovirus, it occurs predominantly in people whose immune system has been compromised, 15-40% of those with AIDS.
Signs and symptoms
The symptoms of cytomegalovirus retinitis have it usually starting in one eye (and also have the possibility of retinal detachment), presenting as:
- Blurred vision
- Blind spots
- Specks in your vision
Cause
Cytomegalovirus (a type of herpes virus) is what causes cytomegalovirus retinitis. Other types of herpes viruses include herpes simplex viruses and Epstein-Barr virus. Once an individual is infected with these viruses they stay in the body for life. What triggers the virus to reactivate are the following (though CMV can also be congenital).
Mechanism
Human cytomegalovirus (HCMV or CMV) is a DNA virus in the family Herpesviridae known for producing large cells with nuclear and cytoplasmic inclusions, CMV infects around 40% of the population worldwide.
Those areas infected by cytomegalovirus have cells evolve to necrosis, though inflammation within the retina is not great. Rhegmatogenous retinal detachments can occur following the development of holes in areas of healed retinitis (retina may be atrophic).Proliferative vitreoretinopathy has been observed in cases of retinal detachment.
Diagnosis
The diagnosis of CMV retinitis can be done via the following:
- Ophthalmic screening frequency is based on CD4 count,(CD4 < 50 cells/mL, 0- 35% possibility of CMV retinitis)
- BUN
- CD8+ T-lymphocyte count
- CMV DNA capture ( polymerase chain reaction (PCR) test)
- DNA PCR ( ocular fluids)
- Viral load
- Complete blood count
Treatment
In terms of the treatment of cytomegalovirus retinitis, oral valganciclovir, intravenous ganciclovir, IV foscarnet, and IV cidofovir are all efficient in the treatment of this condition. Also intravitreal injections, an injection of medicine into the vitreous near the retina, of foscarnet in concomitance with oral valganciclovir can be used for treatment as well.
Often individuals with CMV retinitis will need surgery for either retinal detachment or intravitreal instillation of ganciclovir. Retinal detachment occurs in up to 29% of affected eyes, repair being most effective with endolaser and silicone oil endotamponade. Intravitreal ganciclovir implant has the benefit of less systemic toxicity. An adverse effect of this is retinal detachment (and vitreous hemorrhage), also there is no systemic beneficial effect for cytomegalovirus organ disease.
See also
Further reading
- Ljungman P, Griffiths P, Paya C (April 2002). "Definitions of cytomegalovirus infection and disease in transplant recipients". Clinical Infectious Diseases. 34 (8): 1094–1097. doi:10.1086/339329. ISSN 1058-4838. PMID 11914998.
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Heiden D, Ford N, Wilson D, Rodriguez WR, Margolis T, Janssens B, et al. (December 2007). "Cytomegalovirus retinitis: the neglected disease of the AIDS pandemic". PLOS Medicine. 4 (12): e334. doi:10.1371/journal.pmed.0040334. ISSN 1549-1676. PMC 2100142. PMID 18052600.
- Campbell RJ, Chow B, Victor G, Kravcik S, Hodge WG (September 2001). "Treatment of CMV retinitis with intravitral ganciclovir in the HAART era". The Canadian Journal of Infectious Diseases. 12 (5): 300–304. doi:10.1155/2001/851845. ISSN 1180-2332. PMC 2094829. PMID 18159353.
External links
- "Eye Implant Effective in Treating CMV Retinitis". National Eye Institute. Retrieved 2016-03-17.