Cytomegalovirus retinitis in the absence of AIDS

Gupta, Shivali; Vemulakonda, Gurunadh Atmaram; Suhler, Eric B.; Yeh, Steven; Albini, Thomas A.; Mandelcorn, Efrem D.; Flaxel, Christina J.

doi:10.1016/j.jcjo.2012.12.002

Cited by 24 publications

(13 citation statements)

References 10 publications

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“…7–25 Taken together with our case series, we identified a total of 30 cases (Table 1). The mean age of all 30 patients was 62.6 years (median 65.5 years; range: 22-84 years) with a slight male predominance (63.3%).…”

Section: Discussionmentioning

confidence: 99%

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Viral Retinitis following Intraocular or Periocular Corticosteroid Administration: A Case Series and Comprehensive Review of the Literature

Takakura

Tessler

Goldstein

et al. 2014

Ocular Immunology and Inflammation

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Purpose To describe viral retinitis following intravitreal and periocular corticosteroid administration. Methods Retrospective case series and comprehensive literature review. Results We analyzed 5 unreported and 25 previously published cases of viral retinitis following local corticosteroid administration. Causes of retinitis included 23 CMV (76.7%), 5 HSV (16.7%), and 1 each VZV and unspecified (3.3%). Two of 22 tested patients (9.1%) were HIV positive. Twenty-one of 30 (70.0%) cases followed one or more intravitreal injections of triamcinolone acetonide (TA), 4 (13.3%) after one or more posterior sub-Tenon injections of TA, 3 (10.0%) after placement of a 0.59-mg fluocinolone acetonide implant (Retisert), and 1 (3.3%) each after an anterior subconjunctival injection of TA (together with IVTA), an anterior chamber injection, and an anterior sub-Tenon injection. Mean time from most recent corticosteroid administration to development of retinitis was 4.2 months (median 3.8; range 0.25–13.0). Twelve patients (40.0%) had type II diabetes mellitus. Treatments used included systemic antiviral agents (26/30, 86.7%), intravitreal antiviral injections (20/30, 66.7%), and ganciclovir intravitreal implants (4/30, 13.3%). Conclusions Viral retinitis may develop or reactivate following intraocular or periocular corticosteroid administration. Average time to development of retinitis was 4 months, and CMV was the most frequently observed agent. Diabetes was a frequent co-morbidity and several patients with uveitis who developed retinitis were also receiving systemic immunosuppressive therapy.

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Section: Discussionmentioning

confidence: 99%

“…6 Since that report, 19 studies describing 24 additional patients have appeared in the literature (Table 1). 7–25 The present report presents 5 new cases and includes a comprehensive review of the occurrence and management of viral retinitis following intraocular and periocular corticosteroid administration.…”

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confidence: 99%

Viral Retinitis following Intraocular or Periocular Corticosteroid Administration: A Case Series and Comprehensive Review of the Literature

Takakura

Tessler

Goldstein

et al. 2014

Ocular Immunology and Inflammation

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“…The primary culprit is IVTA, with administered doses ranging from 4 to 20 mg (Saidel et al 2005;Park & Byeon 2008;Sekiryu et al 2008;Vishnevskia-Dai et al 2015). Interestingly, the potential contribution of vascular endothelial growth factor inhibitors to the local immunosuppressive effect of steroids has been suggested (Toyokawa et al 2010;Gupta et al 2013). Yet, it may come with the risk of prolonged local immunosuppression and susceptibility to primary infection or reactivation of endogenous latent viral retinitis (Delyfer et al 2007).…”

Section: Cmvr In Non-hiv-related Systemic Immunosuppressionmentioning

confidence: 99%

“…Classically CMVR has been associated with AIDS, and before the advent of highly active retroviral therapy up to 40% of these patients were affected (Palestine et al 1984). Nevertheless, modern immunosuppressive therapies as well as improved survival rates have in recent years increased the incidence of opportunistic infections in other patient populations, and reports of CMVR in HIV-negative patients have been accumulating (Derzko-Dzulynsky et al 1998;Bertelmann et al 2005;Chawla et al 2005;Delyfer et al 2007;Sloan et al 2008;Jeon et al 2012;Bae et al 2013;Davis et al 2013;Gupta et al 2013;Radwan et al 2013;Samia et al 2014;Jeon & Lee 2015;Vishnevskia-Dai et al 2015;Downes et al 2016;Iu et al 2016;Karkhaneh et al 2016).…”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus retinitis in HIV‐negative patients – associated conditions, clinical presentation, diagnostic methods and treatment strategy

Shapira

Vishnevskia‐Dai

2017

Acta Ophthalmologica

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In recent years, numerous reports have tied cytomegalovirus retinitis (CMVR) with multiple systemic conditions in the absence of human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). These range from reports in apparently healthy individuals, through conditions rendering limited immune dysfunction such as advanced age and diabetes mellitus, and finally severe immune dysfunction such as in haematological and rheumatological conditions. Reports are also emerging, suggesting that induced local ocular immunosuppression is a risk factor for CMVR. We herein present a comprehensive collection of the accumulated findings regarding CMVR in non-HIV patients. We summarize the spectrum of underlying morbidity that has been associated with CMVR, its clinical presentation, diagnostic methods and treatment choice in the attempt to suggest the optimal treatment strategy in this complicated and diverse patient population which is still currently lacking a consensus.

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“…Viral titers correlate with disease activity and may be used to distinguish between active and inactive retinitis [54]. PCR testing has been used to definitively diagnose CMVR in cases of local immunosuppression from steroid injection or implant [55–57]. PCR testing may also be used to identify viral resistance to antiviral medications and may thus help guide therapy [58].…”

Section: Laboratory Testingmentioning

confidence: 99%

Cytomegalovirus Retinitis in the Post-cART Era

Port

Alabi

Koenig

et al. 2018

Curr Ophthalmol Rep

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Purpose of review: To review the epidemiology, diagnosis, and management of cytomegalovirus retinitis (CMVR) in the post-combined antiretroviral era (cART) era. Recent findings: Although cART has dramatically reduced CMVR incidence and morbidity in the HIV population, CMVR continues to cause significant vision loss in both HIV and non-HIV patients, especially amongst patients without immune reconstitution. Advances in imaging including ultra-widefield fundus and autofluorescence imaging, optical coherence tomography, and adaptive optics may reflect CMVR activity; however, the diagnosis remains a clinical one. There have been minimal advances in therapy, with several agents no longer available due to market concerns. Summary: Despite reduced incidence and morbidity in the post-cART HIV population, CMVR continues to cause vision loss amongst HIV and non-HIV patients. Diagnosis remains primarily clinical, and therapy centers upon immune reconstitution along with systemic and/or intravitreal antivirals. Further studies are necessary to determine whether advanced imaging can influence management, and whether novel antiviral agents or adoptive immune transfer have a role in treatment of drug-resistance CMVR.

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Cytomegalovirus retinitis in the absence of AIDS

Cited by 24 publications

References 10 publications

Viral Retinitis following Intraocular or Periocular Corticosteroid Administration: A Case Series and Comprehensive Review of the Literature

Viral Retinitis following Intraocular or Periocular Corticosteroid Administration: A Case Series and Comprehensive Review of the Literature

Cytomegalovirus retinitis in HIV‐negative patients – associated conditions, clinical presentation, diagnostic methods and treatment strategy

Cytomegalovirus Retinitis in the Post-cART Era

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