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CMV Retinitis Treatment & Management

  • Author: Michael Altaweel, MD, FRCSC; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Jul 22, 2014
 

Medical Care

An internist or infectious disease specialist coordinates medical care. Ophthalmic assessment is required on a regular basis, with frequency dependent on existence of CMV retinitis and on CD4 count. The immunosuppressed individual requires evaluation for other opportunistic infections and surveillance for side effects of prescribed medications.

Highly active antiretroviral therapy (HAART) [73]

This treatment regimen has altered the long-term management of CMV retinitis.[74, 75] Because the antiviral medications used to treat CMV are virustatic, patients needed to continue their use for the rest of their lives. The advent of HAART, with consequent recovery of immune function (2 consecutive CD4+ T-cell counts of ≥ 100 cells/μL at least 6 mo apart) allows individuals to discontinue their CMV therapy if the retinitis has resolved adequately with antiviral treatment.[9] As long as the CD4 count remains elevated, little risk exists of disease recurrence.[76]

Intravenous or oral therapy can be discontinued, or a scheduled implant replacement can be delayed indefinitely.[77, 78]

Careful monitoring of both immune status and ophthalmic findings are necessary to prevent retinal damage from an asymptomatic recurrence.

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Surgical Care

Individuals with CMV retinitis commonly require surgical intervention, whether for repair of a retinal detachment or for intravitreal instillation of ganciclovir by injection or implantation.

  • Retinal detachment due to CMV retinitis
    • This condition occurs in 5-29% of eyes in various case series. High incidence of bilaterality exists.[79]
    • Repair is most successful with vitrectomy, endolaser, scleral buckle, and silicone oil endotamponade.[80]
    • A total reattachment rate of 76% exists; macular attachment occurs in 90%. Mean postoperative visual acuity is 6/18.
    • Prophylactic laser for the other eye with CMV did not prevent retinal detachment.[81, 82]
  • Intravitreal ganciclovir implant [83, 84]
    • 1 µg/h sustained release with life span of 8 months[85] - Study of immediate versus deferred therapy
      • Deferred - 15 days to progression
      • Immediate - 226 days to progression, only 5 of 14 progressed
      • Retinal detachment rate 11% (13-26% in IV treatment group)
      • Within 6 months, 50% develop CMV retinitis in fellow eye.
    • Pros
      • Less systemic toxicity
      • Better effect versus CMV in implanted eye
      • Can use AZT concomitantly
      • No indwelling catheter
      • Implant is useful if intolerant of systemic ganciclovir or if progression continues despite intravenous treatment.[86]
    • Cons
      • Sixty-seven percent developed CMV in the fellow eye versus 0-15% rate in intravenous treatment group.
      • No systemic effect for CMV organ disease
      • Risk of retinal detachment and vitreous hemorrhage:[87] Retinal detachment may occur despite the implant rather than as a consequence of surgery. The risk of detachment is reduced if immune recovery occurs in the period after the ganciclovir implant.[60]
  • Intravitreal ganciclovir injection [88]
    • Delayed progression of disease
    • Topical anesthesia
    • Short half-life - Injection is required twice per week.
    • Increased risk of endophthalmitis, retinal detachment, and vitreous hemorrhage
    • Can be successful as sole treatment for CMV retinitis associated with immunosuppression without AIDS; in a case series of 13 eyes with active lesions, 5.54 ± 3.36 intravitreal ganciclovir injections were required, allowing resolution in 1.81 ± 1.25 months, with one late recurrence[89]
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Consultations

Infectious disease specialist

  • Evaluation of general medical condition - Assessment for other end-organ sequelae of CMV infection (pneumonitis, gastroenteritis); evaluation for other opportunistic infections
  • Evaluation for criteria sufficient to meet the diagnosis of AIDS
  • Assessment of confirmatory lab tests
  • Institution of systemic therapy (for CMV retinitis and for AIDS)
  • General internist, hematologist, and/or oncologist referral if CMV retinitis is associated with immunosuppression for non–HIV-related reasons
  • Transplantation specialist for transplant-related CMV retinitis
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Contributor Information and Disclosures
Author

Michael Altaweel, MD, FRCSC Professor, Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health

Michael Altaweel, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Society of Retina Specialists

Disclosure: Nothing to disclose.

Coauthor(s)

Peter N Youssef, MD Vitreoretinal Fellow, Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Steve Charles, MD Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, Retina Society, Club Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

V Al Pakalnis, MD, PhD Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, South Carolina Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Matthew D Reed, MD Fellow, Department of Ophthalmology and Visual Sciences, University of Wisconsin Clinical Science Center

Disclosure: Nothing to disclose.

References
  1. Murray HW, Knox DL, Green WR, Susel RM. Cytomegalovirus retinitis in adults. A manifestation of disseminated viral infection. Am J Med. 1977 Oct. 63(4):574-84. [Medline].

  2. Egbert PR, Pollard RB, Gallagher JG, Merigan TC. Cytomegalovirus retinitis in immunosuppressed hosts. II. Ocular manifestations. Ann Intern Med. 1980 Nov. 93(5):664-70. [Medline].

  3. McAuliffe PF, Hall MJ, Castro-Malaspina H, Heinemann MH. Use of the ganciclovir implant for treating cytomegalovirus retinitis secondary to immunosuppression after bone marrow transplantation. Am J Ophthalmol. 1997 May. 123(5):702-3. [Medline].

  4. Hiwarkar P, Gajdosova E, Qasim W, Worth A, Breuer J, Chiesa R, et al. Frequent Occurrence of Cytomegalovirus Retinitis During Immune Reconstitution Warrants Regular Ophthalmic Screening in High-Risk Pediatric Allogeneic Hematopoietic Stem Cell Transplant Recipients. Clin Infect Dis. 2014 May 7. [Medline].

  5. Jeon S, Lee WK, Lee Y, Lee DG, Lee JW. Risk Factors for Cytomegalovirus Retinitis in Patients with Cytomegalovirus Viremia after Hematopoietic Stem Cell Transplantation. Ophthalmology. 2012 May 30. [Medline].

  6. Whitcup SM. Cytomegalovirus Retinitis in the Era of Highly Active Antiretroviral Therapy. JAMA. 2000. 283 No. 5:653-657.

  7. Mitchell SM, Membrey WL, Youle MS, et al. Cytomegalovirus retinitis after the initiation of highly active antiretroviral therapy: a 2 year prospective study. Br J Ophthalmol. 1999 Jun. 83(6):652-5. [Medline].

  8. Zegans M, Marsh B, Walton RC. Cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Int Ophthalmol Clin. 2000 Spring. 40(2):127-35. [Medline].

  9. Holbrook JT, Colvin R, van Natta ML, Thorne JE, Bardsley M, Jabs DA. Evaluation of the United States public health service guidelines for discontinuation of anticytomegalovirus therapy after immune recovery in patients with cytomegalovirus retinitis. Am J Ophthalmol. 2011 Oct. 152(4):628-637.e1. [Medline]. [Full Text].

  10. Baumal CR, Levin AV, Read SE. Cytomegalovirus retinitis in immunosuppressed children. Am J Ophthalmol. 1999 May. 127(5):550-8. [Medline].

  11. Sugar EA, Jabs DA, Ahuja A, Thorne JE, Danis RP, Meinert CL. Incidence of cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Am J Ophthalmol. 2012 Jun. 153(6):1016-1024.e5. [Medline]. [Full Text].

  12. Kempen JH, Sugar EA, Lyon AT, Lewis RA, Jabs DA, Heinemann MH, et al. Risk of Cataract in Persons with Cytomegalovirus Retinitis and the Acquired Immune Deficiency Syndrome. Ophthalmology. 2012 Jul 30. [Medline].

  13. Knox CM, Chandler D, Short GA, Margolis TP. Polymerase chain reaction-based assays of vitreous samples for the diagnosis of viral retinitis. Use in diagnostic dilemmas. Ophthalmology. 1998 Jan. 105(1):37-44; discussion 44-5. [Medline].

  14. Grant AD, Djomand G, De Cock KM. Natural history and spectrum of disease in adults with HIV/AIDS in Africa. AIDS. 1997. 11 Suppl B:S43-54. [Medline].

  15. Kestelyn P. The epidemiology of CMV retinitis in Africa. Ocul Immunol Inflamm. 1999 Dec. 7(3-4):173-7. [Medline].

  16. Heiden D, Saranchuk P. CMV retinitis in China and SE Asia: the way forward. BMC Infect Dis. 2011 Nov 24. 11:327. [Medline]. [Full Text].

  17. Studies of Ocular Complications of AIDS (SOCA) Research Group. Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial. 4. Visual outcomes. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Ophthalmology. 1994 Jul. 101(7):1250-61. [Medline].

  18. Thorne JE, Holbrook JT, Jabs DA, Kempen JH, Nichols C, Meinert CL. Effect of cytomegalovirus retinitis on the risk of visual acuity loss among patients with AIDS. Ophthalmology. 2007 Mar. 114(3):591-8. [Medline].

  19. Holbrook JT, Jabs DA, Weinberg DV. Visual loss in patients with cytomegalovirus retinitis and acquired immunodeficiency syndrome before widespread availability of highly active antiretroviral therapy. Arch Ophthalmol. 2003 Jan. 121(1):99-107. [Medline].

  20. Studies of Ocular Complications of AIDS (SOCA) Research Group. Rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis: the Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial. The Studies of Ocular Complications of AIDS (SOCA) Research Group in Collaboration with the AIDS Clinical Trials G. Am J Ophthalmol. 1997 Jul. 124(1):61-70. [Medline].

  21. Sandy CJ, Bloom PA, Graham EM, et al. Retinal detachment in AIDS-related cytomegalovirus retinitis. Eye. 1995. 9 ( Pt 3):277-81. [Medline].

  22. Boyraz-Ikiz HD, Witmer JP, Frissen PH. Cytomegalovirus (re)activation plays no role in the ocular vitritis observed after initiation of highly active antiretroviral therapy. AIDS. 1999 May 7. 13(7):867. [Medline].

  23. Holland GN. New issues in the management of patients with AIDS-related cytomegalovirus retinitis. Arch Ophthalmol. 2000 May. 118(5):704-6. [Medline].

  24. Kempen JH, Min YI, Freeman WR, Holland GN, Friedberg DN, Dieterich DT, et al. Risk of immune recovery uveitis in patients with AIDS and cytomegalovirus retinitis. Ophthalmology. 2006 Apr. 113(4):684-94. [Medline].

  25. Karavellas MP, Plummer DJ, Macdonald JC, et al. Incidence of immune recovery vitritis in cytomegalovirus retinitis patients following institution of successful highly active antiretroviral therapy. J Infect Dis. 1999 Mar. 179(3):697-700. [Medline].

  26. Nguyen QD, Kempen JH, Bolton SG, et al. Immune recovery uveitis in patients with AIDS and cytomegalovirus retinitis after highly active antiretroviral therapy. Am J Ophthalmol. 2000 May. 129(5):634-9. [Medline].

  27. Ruiz-Cruz M, Barrera CA, Ablanedo-Terrazas Y, Reyes-Terán G. Proposed Clinical Case Definition for Cytomegalovirus-Immune Recovery Retinitis. Clin Infect Dis. 2014 Apr 24. [Medline].

  28. Jabs DA, Ahuja A, Van Natta M, Lyon A, Srivastava S, Gangaputra S. Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy: five-year outcomes. Ophthalmology. 2010 Nov. 117(11):2152-61.e1-2. [Medline].

  29. Bowen EF, Griffiths PD, Davey CC, et al. Lessons from the natural history of cytomegalovirus. AIDS. 1996 Nov. 10 Suppl 1:S37-41. [Medline].

  30. Bowen EF, Wilson P, Atkins M, et al. Natural history of untreated cytomegalovirus retinitis. Lancet. 1995 Dec 23-30. 346(8991-8992):1671-3. [Medline].

  31. Bloom PA, Sandy CJ, Migdal CS, et al. Visual prognosis of AIDS patients with cytomegalovirus retinitis. Eye. 1995. 9 ( Pt 6):697-702. [Medline].

  32. McCutchan JA. Clinical impact of cytomegalovirus infections of the nervous system in patients with AIDS. Clin Infect Dis. 1995 Oct. 21 Suppl 2:S196-201. [Medline].

  33. McCutchan JA. Cytomegalovirus infections of the nervous system in patients with AIDS. Clin Infect Dis. 1995 Apr. 20(4):747-54. [Medline].

  34. Brody JM, Butrus SI, Laby DM, et al. Anterior segment findings in AIDS patients with cytomegalovirus retinitis. Graefes Arch Clin Exp Ophthalmol. 1995 Jun. 233(6):374-6. [Medline].

  35. Biswas J, Madhavan HN, George AE, et al. Ocular lesions associated with HIV infection in India: a series of 100 consecutive patients evaluated at a referral center. Am J Ophthalmol. 2000 Jan. 129(1):9-15. [Medline].

  36. Studies of Ocular Complications of AIDS (SOCA) Research Group. Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial: 5. Clinical features of cytomegalovirus retinitis at diagnosis. Studies of ocular complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Am J Ophthalmol. 1997 Aug. 124(2):141-57. [Medline].

  37. Biswas J, Raizada S, Gopal L, et al. Bilateral frosted branch angiitis and cytomegalovirus retinitis in acquired immunodeficiency syndrome. Indian J Ophthalmol. 1999 Sep. 47(3):195-7. [Medline].

  38. Mansour AM, Li HK. Frosted retinal periphlebitis in the acquired immunodeficiency syndrome. Ophthalmologica. 1993. 207(4):182-6. [Medline].

  39. Saran BR, Pomilla PV. Retinal vascular nonperfusion and retinal neovascularization as a consequence of cytomegalovirus retinitis and cryptococcal choroiditis. Retina. 1996. 16(6):510-2. [Medline].

  40. Mansor AM, Li HK. Cytomegalovirus optic neuritis: characteristics, therapy and survival. Ophthalmologica. 1995. 209(5):260-6. [Medline].

  41. Kempen JH, Jabs DA, Wilson LA. Risk of vision loss in patients with cytomegalovirus retinitis and the acquired immunodeficiency syndrome. Arch Ophthalmol. 2003 Apr. 121(4):466-76. [Medline].

  42. Kempen JH, Jabs DA, Wilson LA. Incidence of cytomegalovirus (CMV) retinitis in second eyes of patients with the acquired immune deficiency syndrome and unilateral CMV retinitis. Am J Ophthalmol. 2005 Jun. 139(6):1028-34. [Medline].

  43. Pertel P, Hirschtick R, Phair J, et al. Risk of developing cytomegalovirus retinitis in persons infected with the human immunodeficiency virus. J Acquir Immune Defic Syndr. 1992. 5(11):1069-74. [Medline].

  44. Nasir MA, Jaffe GJ. Cytomegalovirus retinitis associated with Hodgkin''s disease. Retina. 1996. 16(4):324-7. [Medline].

  45. Elkins BS, Holland GN, Opremcak EM, et al. Ocular toxoplasmosis misdiagnosed as cytomegalovirus retinopathy in immunocompromised patients. Ophthalmology. 1994 Mar. 101(3):499-507. [Medline].

  46. Davis JL. Differential diagnosis of CMV retinitis. Ocul Immunol Inflamm. 1999 Dec. 7(3-4):159-66. [Medline].

  47. Phillips AN, Lazzarin A, Gonzales-Lahoz J, et al. Factors associated with the CD4+ lymphocyte count at diagnosis of acquired immunodeficiency syndrome. The AIDS IN EUROPE Study Group. J Clin Epidemiol. 1996 Nov. 49(11):1253-8. [Medline].

  48. Baldassano V, Dunn JP, Feinberg J, Jabs DA. Cytomegalovirus retinitis and low CD4+ T-lymphocyte counts. N Engl J Med. 1995 Sep 7. 333(10):670. [Medline].

  49. Sandy CJ, Ferris JD, Bloom PA, et al. Screening for cytomegalovirus retinitis in HIV-positive and AIDS patients. QJM. 1995 Dec. 88(12):899-903. [Medline].

  50. Holbrook JT, Davis MD, Hubbard LD, et al. Risk factors for advancement of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome. Studies of Ocular Complications of AIDS Research Group. Arch Ophthalmol. 2000 Sep. 118(9):1196-204. [Medline].

  51. Chernoff DN, Miner RC, Hoo BS, et al. Quantification of cytomegalovirus DNA in peripheral blood leukocytes by a branched-DNA signal amplification assay. J Clin Microbiol. 1997 Nov. 35(11):2740-4. [Medline].

  52. Rasmussen L, Morris S, Zipeto D, et al. Quantitation of human cytomegalovirus DNA from peripheral blood cells of human immunodeficiency virus-infected patients could predict cytomegalovirus retinitis. J Infect Dis. 1995 Jan. 171(1):177-82. [Medline].

  53. Tufail A, Moe AA, Miller MJ, et al. Quantitative cytomegalovirus DNA level in the blood and its relationship to cytomegalovirus retinitis in patients with acquired immune deficiency syndrome. Ophthalmology. 1999 Jan. 106(1):133-41. [Medline].

  54. Wattanamano P, Clayton JL, Kopicko JJ, et al. Comparison of three assays for cytomegalovirus detection in AIDS patients at risk for retinitis. J Clin Microbiol. 2000 Feb. 38(2):727-32. [Medline].

  55. Liu JH, Hsu WM, Wong WW, et al. Using conjunctival swab with polymerase chain reaction to aid diagnosis of cytomegalovirus retinitis in AIDS patients. Ophthalmologica. 2000. 214(2):126-30. [Medline].

  56. Sugita S, Shimizu N, Watanabe K, Mizukami M, Morio T, Sugamoto Y, et al. Use of multiplex PCR and real-time PCR to detect human herpes virus genome in ocular fluids of patients with uveitis. Br J Ophthalmol. 2008 Jul. 92(7):928-32. [Medline].

  57. Fuchs AV, Wolf E, Scheider A, Jager H, Kampik A. [Cytomegalovirus (CMV) retinitis in AIDS. Gancilovir implantation in comparison with systemic therapy]. Ophthalmologe. 1999 Jan. 96(1):11-5. [Medline].

  58. Musch DC, Martin DF, Gordon JF, et al. Treatment of cytomegalovirus retinitis with a sustained-release ganciclovir implant. The Ganciclovir Implant Study Group. N Engl J Med. 1997 Jul 10. 337(2):83-90. [Medline].

  59. Guembel HO, Krieglsteiner S, Rosenkranz C, et al. Complications after implantation of intraocular devices in patients with cytomegalovirus retinitis. Graefes Arch Clin Exp Ophthalmol. 1999 Oct. 237(10):824-9. [Medline].

  60. Oktavec KC, Nolan K, Brown DM, Dunn JP, Livingston AG, Thorne JE. Clinical outcomes in patients with cytomegalovirus retinitis treated with ganciclovir implant. Am J Ophthalmol. 2012 Apr. 153(4):728-33, 733.e1-2. [Medline].

  61. Boyer DS, Posalski J. Potential complication associated with removal of ganciclovir implants. Am J Ophthalmol. 1999 Mar. 127(3):349-50. [Medline].

  62. Freeman WR, Friedberg DN, Berry C, et al. Risk factors for development of rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis. Am J Ophthalmol. 1993 Dec 15. 116(6):713-20. [Medline].

  63. Baumal CR, Reichel E. Management of cytomegalovirus-related rhegmatogenous retinal detachments. Ophthalmic Surg Lasers. 1998 Nov. 29(11):916-25. [Medline].

  64. Davis JL, Serfass MS, Lai MY, et al. Silicone oil in repair of retinal detachments caused by necrotizing retinitis in HIV infection. Arch Ophthalmol. 1995 Nov. 113(11):1401-9. [Medline].

  65. Freeman WR. Retinal detachment in cytomegalovirus retinitis: should our approach be changed?. Retina. 1999. 19(4):271-3. [Medline].

  66. Ross WH, Bryan JS, Barloon AS. Management of retinal detachments secondary to cytomegalovirus retinitis. Can J Ophthalmol. 1994 Jun. 29(3):129-33. [Medline].

  67. Erice A, Jordan MC, Chace BA, et al. Ganciclovir treatment of cytomegalovirus disease in transplant recipients and other immunocompromised hosts. JAMA. 1987 Jun 12. 257(22):3082-7. [Medline].

  68. Jensen OA, Gerstoft J, Thomsen HK, Marner K. Cytomegalovirus retinitis in the acquired immunodeficiency syndrome (AIDS). Light-microscopical, ultrastructural and immunohistochemical examination of a case. Acta Ophthalmol (Copenh). 1984 Feb. 62(1):1-9. [Medline].

  69. Pecorella I, Ciardi A, Credendino A, et al. Ocular, cerebral and systemic interrelationships of cytomegalovirus infection in a post-mortem study of AIDS patients. Eye. 1999 Dec. 13 ( Pt 6):781-5. [Medline].

  70. Jabs DA, Van Natta ML, Holbrook JT, Kempen JH, Meinert CL, Davis MD. Longitudinal study of the ocular complications of AIDS: 2. Ocular examination results at enrollment. Ophthalmology. 2007 Apr. 114(4):787-93. [Medline].

  71. Jabs DA, Van Natta ML, Thorne JE, et al. Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy: 1. Retinitis progression. Ophthalmology. 2004 Dec. 111(12):2224-31. [Medline].

  72. Jabs DA, Van Natta ML, Thorne JE, et al. Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy: 2. Second eye involvement and retinal detachment. Ophthalmology. 2004 Dec. 111(12):2232-9. [Medline].

  73. D'Aquila R, Walker B. Exploring the benefits and limits of highly active antiretroviral therapy. JAMA. 1999 Nov 3. 282(17):1668-9. [Medline].

  74. Doan S, Cochereau I, Guvenisik N, et al. Cytomegalovirus retinitis in HIV-infected patients with and without highly active antiretroviral therapy. Am J Ophthalmol. 1999 Aug. 128(2):250-1. [Medline].

  75. Kedhar SR, Jabs DA. Cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Herpes. 2007 Dec. 14(3):66-71. [Medline].

  76. Macdonald JC, Torriani FJ, Morse LS, et al. Lack of reactivation of cytomegalovirus (CMV) retinitis after stopping CMV maintenance therapy in AIDS patients with sustained elevations in CD4 T cells in response to highly active antiretroviral therapy. J Infect Dis. 1998 May. 177(5):1182-7. [Medline].

  77. Margolis TP. Discontinuation of anticytomegalovirus therapy in patients with HIV infection and cytomegalovirus retinitis. Surv Ophthalmol. 2000 Mar-Apr. 44(5):455. [Medline].

  78. Soriano V, Dona C, Rodriguez-Rosado R, et al. Discontinuation of secondary prophylaxis for opportunistic infections in HIV-infected patients receiving highly active antiretroviral therapy. AIDS. 2000 Mar 10. 14(4):383-6. [Medline].

  79. Nasemann JE, Mutsch A, Wiltfang R, Klauss V. Early pars plana vitrectomy without buckling procedure in cytomegalovirus retinitis-induced retinal detachment. Retina. 1995. 15(2):111-6. [Medline].

  80. Azen SP, Scott IU, Flynn HW Jr, et al. Silicone oil in the repair of complex retinal detachments. A prospective observational multicenter study. Ophthalmology. 1998 Sep. 105(9):1587-97. [Medline].

  81. Althaus C, Loeffler KU, Schimkat M, et al. Prophylactic argon laser coagulation for rhegmatogenous retinal detachment in AIDS patients with cytomegalovirus retinitis. Graefes Arch Clin Exp Ophthalmol. 1998 May. 236(5):359-64. [Medline].

  82. Meffert SA, Ai E. Laser photocoagulation prophylaxis for CMV retinal detachments. Ophthalmology. 1998 Aug. 105(8):1353-5. [Medline].

  83. Martin DF, Dunn JP, Davis JL, et al. Use of the ganciclovir implant for the treatment of cytomegalovirus retinitis in the era of potent antiretroviral therapy: recommendations of the International AIDS Society-USA panel. Am J Ophthalmol. 1999 Mar. 127(3):329-39. [Medline].

  84. Sanborn GE, Anand R, Torti RE, et al. Sustained-release ganciclovir therapy for treatment of cytomegalovirus retinitis. Use of an intravitreal device. Arch Ophthalmol. 1992 Feb. 110(2):188-95. [Medline].

  85. Martin DF, Ferris FL, Parks DJ, et al. Ganciclovir implant exchange. Timing, surgical procedure, and complications. Arch Ophthalmol. 1997 Nov. 115(11):1389-94. [Medline].

  86. Roth DB, Feuer WJ, Blenke AJ, Davis JL. Treatment of recurrent cytomegalovirus retinitis with the ganciclovir implant. Am J Ophthalmol. 1999 Mar. 127(3):276-82. [Medline].

  87. Lim JI, Wolitz RA, Dowling AH, et al. Visual and anatomic outcomes associated with posterior segment complications after ganciclovir implant procedures in patients with AIDS and cytomegalovirus retinitis. Am J Ophthalmol. 1999 Mar. 127(3):288-93. [Medline].

  88. Desatnik HR, Foster RE, Lowder CY. Treatment of clinically resistant cytomegalovirus retinitis with combined intravitreal injections of ganciclovir and foscarnet. Am J Ophthalmol. 1996 Jul. 122(1):121-3. [Medline].

  89. Agarwal A, Kumari N, Trehan A, Khadwal A, Dogra MR, Gupta V, et al. Outcome of cytomegalovirus retinitis in immunocompromised patients without Human Immunodeficiency Virus treated with intravitreal ganciclovir injection. Graefes Arch Clin Exp Ophthalmol. 2014 Feb 21. [Medline].

  90. Akerele T, Lightman S. Current and novel agents for the treatment of cytomegalovirus retinitis. Drugs R D. 1999 Nov. 2(5):289-97. [Medline].

  91. Holland GN. Treatment options for cytomegalovirus retinitis: a time for reassessment. Arch Ophthalmol. 1999 Nov. 117(11):1549-50. [Medline].

  92. Whitley RJ, Jacobson MA, Friedberg DN, et al. Guidelines for the treatment of cytomegalovirus diseases in patients with AIDS in the era of potent antiretroviral therapy: recommendations of an international panel. International AIDS Society-USA. Arch Intern Med. 1998 May 11. 158(9):957-69. [Medline].

  93. Marwick C. First "antisense" drug will treat CMV retinitis. JAMA. 1998 Sep 9. 280(10):871. [Medline].

  94. Studies of Ocular Complications of AIDS (SOCA) Research Group. Cytomegalovirus (CMV) culture results, drug resistance, and clinical outcome in patients with AIDS and CMV retinitis treated with foscarnet or ganciclovir. Studies of Ocular Complications of AIDS (SOCA) in collaboration with the AIDS Clinical Trial Gr. J Infect Dis. 1997 Jul. 176(1):50-8. [Medline].

  95. Drew WL, Ives D, Lalezari JP, et al. Oral ganciclovir as maintenance treatment for cytomegalovirus retinitis in patients with AIDS. Syntex Cooperative Oral Ganciclovir Study Group. N Engl J Med. 1995 Sep 7. 333(10):615-20. [Medline].

  96. Holland GN, Buhles WC Jr, Mastre B, Kaplan HJ. A controlled retrospective study of ganciclovir treatment for cytomegalovirus retinopathy. Use of a standardized system for the assessment of disease outcome. UCLA CMV Retinopathy. Study Group. Arch Ophthalmol. 1989 Dec. 107(12):1759-66. [Medline].

  97. Kuppermann BD, Quiceno JI, Flores-Aguilar M, et al. Intravitreal ganciclovir concentration after intravenous administration in AIDS patients with cytomegalovirus retinitis: implications for therapy. J Infect Dis. 1993 Dec. 168(6):1506-9. [Medline].

  98. Goldberg DE, Wang H, Azen SP. Long term visual outcome of patients with cytomegalovirus retinitis treated with highly active antiretroviral therapy. Br J Ophthalmol. 2003 Jul. 87(7):853-5. [Medline].

  99. Whitcup SM. Cytomegalovirus retinitis in the era of highly active antiretroviral therapy. JAMA. 2000 Feb 2. 283(5):653-7. [Medline].

  100. Whitcup, SM, Fortin, E, Linblad, AS. Discontinuation of Anticytomegalovirus Therapy in Patients With HIV Infection and Cytomegalovirus Retinits. JAMA. 1999. 282:1633-1637.

  101. Martin DF, Sierra-Madero J, Walmsley S. A controlled trial of valganciclovir as induction therapy for cytomegalovirus retinitis. N Engl J Med. 2002 Apr 11. 346(15):1119-26. [Medline].

  102. Brown F, Banken L, Saywell K, Arum I. Pharmacokinetics of valganciclovir and ganciclovir following multiple oral dosages of valganciclovir in HIV- and CMV-seropositive volunteers. Clin Pharmacokinet. 1999 Aug. 37(2):167-76. [Medline].

  103. Stalder N, Sudre P, Olmari M, et al. Cytomegalovirus retinitis: decreased risk of bilaterality with increased use of systemic treatment. Swiss HIV Cohort Study Group. Clin Infect Dis. 1997 Apr. 24(4):620-4. [Medline].

  104. Spector SA, Busch DF, Follansbee S, et al. Pharmacokinetic, safety, and antiviral profiles of oral ganciclovir in persons infected with human immunodeficiency virus: a phase I/II study. AIDS Clinical Trials Group, and Cytomegalovirus Cooperative Study Group. J Infect Dis. 1995 Jun. 171(6):1431-7. [Medline].

  105. Spector SA, McKinley GF, Lalezari JP, et al. Oral ganciclovir for the prevention of cytomegalovirus disease in persons with AIDS. Roche Cooperative Oral Ganciclovir Study Group. N Engl J Med. 1996 Jun 6. 334(23):1491-7. [Medline].

  106. Squires KE. Oral ganciclovir for cytomegalovirus retinitis in patients with AIDS: results of two randomized studies. AIDS. 1996 Dec. 10 Suppl 4:S13-8. [Medline].

  107. Cvetkovic RS, Wellington K. Valganciclovir: a review of its use in the management of CMV infection and disease in immunocompromised patients. Drugs. 2005. 65(6):859-78. [Medline].

  108. Danner SA, Matheron S. Cytomegalovirus retinitis in AIDS patients: a comparative study of intravenous and oral ganciclovir as maintenance therapy. AIDS. 1996 Dec. 10 Suppl 4:S7-11. [Medline].

  109. Gilbert C, Handfield J, Toma E, et al. Emergence and prevalence of cytomegalovirus UL97 mutations associated with ganciclovir resistance in AIDS patients. AIDS. 1998 Jan 22. 12(2):125-9. [Medline].

  110. Spector SA, Weingeist T, Pollard RB, et al. A randomized, controlled study of intravenous ganciclovir therapy for cytomegalovirus peripheral retinitis in patients with AIDS. AIDS Clinical Trials Group and Cytomegalovirus Cooperative Study Group. J Infect Dis. 1993 Sep. 168(3):557-63. [Medline].

  111. Lietman PS. Clinical pharmacology: foscarnet. Am J Med. 1992 Feb 14. 92(2A):8S-11S. [Medline].

  112. Lalezari JP. Cidofovir: a new therapy for cytomegalovirus retinitis. J Acquir Immune Defic Syndr Hum Retrovirol. 1997. 14 Suppl 1:S22-6. [Medline].

  113. Lalezari JP, Holland GN, Kramer F, et al. Randomized, controlled study of the safety and efficacy of intravenous cidofovir for the treatment of relapsing cytomegalovirus retinitis in patients with AIDS. J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Apr 1. 17(4):339-44. [Medline].

  114. Plosker GL, Noble S. Cidofovir: a review of its use in cytomegalovirus retinitis in patients with AIDS. Drugs. 1999 Aug. 58(2):325-45. [Medline].

  115. Rahhal FM, Arevalo JF, Munguia D, et al. Intravitreal cidofovir for the maintenance treatment of cytomegalovirus retinitis. Ophthalmology. 1996 Jul. 103(7):1078-83. [Medline].

  116. Studies of Ocular Complications of AIDS (SOCA) Research Group. Parenteral cidofovir for cytomegalovirus retinitis in patients with AIDS: the HPMPC peripheral cytomegalovirus retinitis trial. A randomized, controlled trial. Studies of Ocular complications of AIDS Research Group in Collaboration with the AIDS Clini. Ann Intern Med. 1997 Feb 15. 126(4):264-74. [Medline].

  117. Drusano GL, Aweeka F, Gambertoglio J, et al. Relationship between foscarnet exposure, baseline cytomegalovirus (CMV) blood culture and the time to progression of CMV retinitis in HIV- positive patients. AIDS. 1996 Sep. 10(10):1113-9. [Medline].

  118. Harb GE, Bacchetti P, Jacobson MA. Survival of patients with AIDS and cytomegalovirus disease treated with ganciclovir or foscarnet. AIDS. 1991 Aug. 5(8):959-65. [Medline].

  119. Jabs DA. Controversies in the treatment of cytomegalovirus retinitis: foscarnet versus ganciclovir. Infect Agents Dis. 1995 Sep. 4(3):131-42. [Medline].

  120. Ambati J, Wynne KB, Angerame MC, Robinson MR. Anterior uveitis associated with intravenous cidofovir use in patients with cytomegalovirus retinitis. Br J Ophthalmol. 1999 Oct. 83(10):1153-8. [Medline].

  121. Cochereau I, Doan S, Diraison MC, et al. Uveitis in patients treated with intravenous cidofovir. Ocul Immunol Inflamm. 1999 Dec. 7(3-4):223-9. [Medline].

  122. Studies of Ocular Complications of AIDS (SOCA) Research Group. Morbidity and toxic effects associated with ganciclovir or foscarnet therapy in a randomized cytomegalovirus retinitis trial. Studies of ocular complications of AIDS Research Group, in collaboration with the AIDS Clinical Trials Group. Arch Intern Med. 1995 Jan 9. 155(1):65-74. [Medline].

  123. Tseng AL, Mortimer CB, Salit IE. Iritis associated with intravenous cidofovir. Ann Pharmacother. 1999 Feb. 33(2):167-71. [Medline].

  124. Studies of Ocular Complications of AIDS (SOCA) Research Group. Combination foscarnet and ganciclovir therapy vs monotherapy for the treatment of relapsed cytomegalovirus retinitis in patients with AIDS. The Cytomegalovirus Retreatment Trial. The Studies of Ocular Complications of AIDS Research Group in Collaborat. Arch Ophthalmol. 1996 Jan. 114(1):23-33. [Medline].

  125. Studies of Ocular Complications of AIDS (SOCA) Research Group. MSL-109 adjuvant therapy for cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome: the Monoclonal Antibody Cytomegalovirus Retinitis Trial. The Studies of Ocular Complications of AIDS Research Group. AIDS Clinical Trials Group. Arch Ophthalmol. 1997 Dec. 115(12):1528-36. [Medline].

  126. Walsh JC, Jones CD, Barnes EA, et al. Increasing survival in AIDS patients with cytomegalovirus retinitis treated with combination antiretroviral therapy including HIV protease inhibitors. AIDS. 1998 Apr 16. 12(6):613-8. [Medline].

  127. Martin DF, Kuppermann BD, Wolitz RA, et al. Oral ganciclovir for patients with cytomegalovirus retinitis treated with a ganciclovir implant. Roche Ganciclovir Study Group. N Engl J Med. 1999 Apr 8. 340(14):1063-70. [Medline].

  128. Holland GN, Vaudaux JD, Jeng SM, Yu F, Goldenberg DT, Folz IC, et al. Characteristics of untreated AIDS-related cytomegalovirus retinitis. I. Findings before the era of highly active antiretroviral therapy (1988 to 1994). Am J Ophthalmol. 2008 Jan. 145(1):5-11. [Medline].

  129. Holland GN, Vaudaux JD, Shiramizu KM, Yu F, Goldenberg DT, Gupta A, et al. Characteristics of untreated AIDS-related cytomegalovirus retinitis. II. Findings in the era of highly active antiretroviral therapy (1997 to 2000). Am J Ophthalmol. 2008 Jan. 145(1):12-22. [Medline].

  130. Jabs DA, Enger C, Dunn JP, et al. Cytomegalovirus retinitis and viral resistance: 3. Culture results. CMV Retinitis and Viral Resistance Study Group. Am J Ophthalmol. 1998 Oct. 126(4):543-9. [Medline].

  131. Jabs DA, Enger C, Forman M, et al. Incidence of foscarnet resistance and cidofovir resistance in patients treated for cytomegalovirus retinitis. The Cytomegalovirus Retinitis and Viral Resistance Study Group. Antimicrob Agents Chemother. 1998 Sep. 42(9):2240-4. [Medline].

  132. Hardy WD. Combined ganciclovir and recombinant human granulocyte-macrophage colony-stimulating factor in the treatment of cytomegalovirus retinitis in AIDS patients. J Acquir Immune Defic Syndr. 1991. 4 Suppl 1:S22-8. [Medline].

  133. Hardy WD. Management strategies for patients with cytomegalovirus retinitis. J Acquir Immune Defic Syndr Hum Retrovirol. 1997. 14 Suppl 1:S7-12. [Medline].

  134. Jacobson MA, Wilson S, Stanley H, et al. Phase I study of combination therapy with intravenous cidofovir and oral ganciclovir for cytomegalovirus retinitis in patients with AIDS. Clin Infect Dis. 1999 Mar. 28(3):528-33. [Medline].

  135. Jabs DA. Design of clinical trials for drug combinations: cytomegalovirus retinitis--foscarnet and ganciclovir. The CMV retinitis retreatment trial. Antiviral Res. 1996 Jan. 29(1):69-71. [Medline].

  136. Davis JL, Hummer J, Feuer WJ. Laser photocoagulation for retinal detachments and retinal tears in cytomegalovirus retinitis. Ophthalmology. 1997 Dec. 104(12):2053-60; discussion 2060-1. [Medline].

  137. Gross JG, Bozzette SA, Mathews WC, et al. Longitudinal study of cytomegalovirus retinitis in acquired immune deficiency syndrome. Ophthalmology. 1990 May. 97(5):681-6. [Medline].

  138. Lim JI, Enger C, Haller JA, et al. Improved visual results after surgical repair of cytomegalovirus- related retinal detachments. Ophthalmology. 1994 Feb. 101(2):264-9. [Medline].

 
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White granular retinitis with intraretinal hemorrhage.
Early necrosis at periphery.
Attenuation of vessels in area affected by retinitis.
Retinitis typically starts in the midperiphery and can progress in a "brush fire" pattern.
Progression of retinitis toward the optic nerve.
Frosted branch angiitis.
Inactive cytomegalovirus retinitis.
Cytomegalovirus papillitis.
Intranuclear inclusions (arrows) found in cytomegalovirus retinitis. Referred to as owl's eye because of the dark intranuclear inclusion surrounded by a clear halo.
Retinal detachment due to peripheral tear in area of necrosis.
CMV retinitis with new lesion nasally and older lesion temporally that is starting to pigment.
 
 
 
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