Cytomegalovirus retinitis explained

Cytomegalovirus retinitis
Synonyms:CMV retinitis
Symptoms:Blurred vision
Causes:Bone marrow transplant, HIV/AIDS
Diagnosis: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.[1] Caused by human cytomegalovirus, it occurs predominantly in people whose immune system has been compromised, 15-40% of those with AIDS.[2]

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:[1]

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.[3] What triggers the virus to reactivate are the following (though CMV can also be congenital).[4]

Mechanism

Human cytomegalovirus (HCMV or CMV) is a DNA virus in the family Herpesviridae known for producing large cells with nuclear and cytoplasmic inclusions,[5] CMV infects around 40% of the population worldwide.[6]

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).[7] [8] Proliferative vitreoretinopathy has been observed in cases of retinal detachment.[9]

Diagnosis

The diagnosis of CMV retinitis can be done via the following:[4] [10]

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.[11] [12] [13]

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.[4]

See also

Further reading

External links

Notes and References

  1. Encyclopedia: Cytomegalovirus retinitis . MedlinePlus Medical Encyclopedia . U.S. National Library of Medicine . 2016-03-14.
  2. Book: Principles and Practice of Vitreoretinal Surgery. Narendran V, Kothari A . 2014-05-30. JP Medical Ltd. 571. 978-9-351-52097-9 . en.
  3. Web site: CMV Overview Cytomegalovirus and Congenital CMV Infection . U.S. Centers for Disease Control and Prevention . 2016-03-16.
  4. . Web site: Archived copy . 8 September 2023 . 7 March 2023 . https://archive.today/20230307081606/https://emedicine.medscape.com/article/1227228-clinical . bot: unknown .
  5. Book: Ray K, Bala M . Human Cytomegalovirus Infection . Sexually Transmitted Infections . 2nd . Kumar B, Gupta S . February 2014 . Elsevier Health Sciences. 399. 978-8-131-22978-1 . en.
  6. Book: Offermanns S, Rosenthal W . Encyclopedia of Molecular Pharmacology . limited . 2nd . 437–438 . Springer . 2008 . 978-3-540-38916-3 .
  7. Web site: Wu L, Pakalnis VA . 8 October 2019 . Law SK, Charles S, Dahl AA . Rhegmatogenous Retinal Detachment Clinical Presentation: History, Physical, Causes. Medscape . 2016-03-16.
  8. Cheeran MC, Lokensgard JR, Schleiss MR . Neuropathogenesis of congenital cytomegalovirus infection: disease mechanisms and prospects for intervention . Clinical Microbiology Reviews . 0893-8512 . 22 . 1 . 99–126, Table of Contents . January 2009 . 19136436 . 2620634 . 10.1128/CMR.00023-08 .
  9. Sadaka A, Giuliari GP . Proliferative vitreoretinopathy: current and emerging treatments . Clinical Ophthalmology . 1177-5467 . 6 . 1325–1333 . January 2012 . 22942638 . 3429288 . 10.2147/OPTH.S27896 . free .
  10. Book: Diagnosis & Treatment of Uveitis. Foster CS, Vitale AT . 2013-03-30. JP Medical Ltd. 449. 978-9-350-25572-8 . en.
  11. Web site: Cytomegalovirus Disease Adult and Adolescent OI Prevention and Treatment Guidelines . AIDSinfo . U.S. National Institutes of Health . 2016-03-16. 2016-03-23. https://web.archive.org/web/20160323165559/https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/337/cmv. dead.
  12. Web site: Tidy C . 12 March 2014 . Huinsn H . Inflammatory Retinal Diseases. . en-GB. 2016-03-16 . Patient . Egton Medical Information Systems Limited . Leeds, UK .
  13. Encyclopedia: Intravitreal injection. MedlinePlus Medical Encyclopedia. U.S. National Library of Medicine . 2016-03-16.

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