CMV Retinitis Treatment & Management

  • Author: Michael Altaweel, MD, FRCS(C); Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jan 28, 2010
 

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)[64]
    • This treatment regimen has altered the long-term management of CMV retinitis.[65, 66] 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, allows individuals to discontinue their CMV therapy if the process has resolved adequately with initial antiviral treatment. As long as the CD4 count remains elevated, little risk exists of disease recurrence.[67]
    • Intravenous or oral therapy can be discontinued, or a scheduled implant replacement can be delayed indefinitely.[68, 69]
    • Careful monitoring of both immune status and ophthalmic findings are necessary to prevent retinal damage from an asymptomatic recurrence.
Next

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.[70]
    • Repair is most successful with vitrectomy, endolaser, scleral buckle, and silicone oil endotamponade.[71]
    • 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.[72, 73]
  • Intravitreal ganciclovir implant[74, 75]
    • 1 µg/h sustained release with life span of 8 months[76] - 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.[77]
    • 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[78]
  • Intravitreal ganciclovir injection[79]
    • Delayed progression of disease
    • Topical anesthesia
    • Short half-life - Injection is required twice per week.
    • Increased risk of endophthalmitis, retinal detachment, and vitreous hemorrhage
Previous
Next

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
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Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Michael Altaweel, MD, FRCS(C)  Associate Professor, Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health

Michael Altaweel, MD, FRCS(C) is a member of the following medical societies: American Academy of Ophthalmology and Association for Research in Vision and Ophthalmology

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.

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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, and South Carolina Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor 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, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

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

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

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, and Pan-American Association of Ophthalmology

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. Oct 1977;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. Nov 1980;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. May 1997;123(5):702-3. [Medline].

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

  5. 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. Jun 1999;83(6):652-5. [Medline].

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

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

  8. 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. Jan 1998;105(1):37-44; discussion 44-5. [Medline].

  9. 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].

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

  11. 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. Jul 1994;101(7):1250-61. [Medline].

  12. 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. Mar 2007;114(3):591-8. [Medline].

  13. 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. Jan 2003;121(1):99-107. [Medline].

  14. 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. Jul 1997;124(1):61-70. [Medline].

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

  16. 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. May 7 1999;13(7):867. [Medline].

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

  18. 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. Apr 2006;113(4):684-94. [Medline].

  19. 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. Mar 1999;179(3):697-700. [Medline].

  20. 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. May 2000;129(5):634-9. [Medline].

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

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

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

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

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

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

  27. 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. Jan 2000;129(1):9-15. [Medline].

  28. 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. Aug 1997;124(2):141-57. [Medline].

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

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

  31. 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].

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

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

  34. 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. Jun 2005;139(6):1028-34. [Medline].

  35. 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].

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

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

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

  39. 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. Nov 1996;49(11):1253-8. [Medline].

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

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

  42. 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. Sep 2000;118(9):1196-204. [Medline].

  43. 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. Nov 1997;35(11):2740-4. [Medline].

  44. 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. Jan 1995;171(1):177-82. [Medline].

  45. 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. Jan 1999;106(1):133-41. [Medline].

  46. 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. Feb 2000;38(2):727-32. [Medline].

  47. 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].

  48. 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. Jul 2008;92(7):928-32. [Medline].

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

  50. 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. Jul 10 1997;337(2):83-90. [Medline].

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

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

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

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

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

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

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

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

  59. 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). Feb 1984;62(1):1-9. [Medline].

  60. 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. Dec 1999;13 ( Pt 6):781-5. [Medline].

  61. 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. Apr 2007;114(4):787-93. [Medline].

  62. 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. Dec 2004;111(12):2224-31. [Medline].

  63. 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. Dec 2004;111(12):2232-9. [Medline].

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

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

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

  67. 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. May 1998;177(5):1182-7. [Medline].

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

  69. 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. Mar 10 2000;14(4):383-6. [Medline].

  70. 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].

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

  72. 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. May 1998;236(5):359-64. [Medline].

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

  74. 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. Mar 1999;127(3):329-39. [Medline].

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

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

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

  78. 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. Mar 1999;127(3):288-93. [Medline].

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

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

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

  82. 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. May 11 1998;158(9):957-69. [Medline].

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

  84. 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. Jul 1997;176(1):50-8. [Medline].

  85. 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. Sep 7 1995;333(10):615-20. [Medline].

  86. 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. Dec 1989;107(12):1759-66. [Medline].

  87. 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. Dec 1993;168(6):1506-9. [Medline].

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

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

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

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

  92. 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. Aug 1999;37(2):167-76. [Medline].

  93. 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. Apr 1997;24(4):620-4. [Medline].

  94. 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. Jun 1995;171(6):1431-7. [Medline].

  95. 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. Jun 6 1996;334(23):1491-7. [Medline].

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

  97. 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].

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

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

  100. 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. Sep 1993;168(3):557-63. [Medline].

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

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

  103. 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. Apr 1 1998;17(4):339-44. [Medline].

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

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

  106. 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. Feb 15 1997;126(4):264-74. [Medline].

  107. 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. Sep 1996;10(10):1113-9. [Medline].

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

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

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

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

  112. 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. Jan 9 1995;155(1):65-74. [Medline].

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

  114. 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. Jan 1996;114(1):23-33. [Medline].

  115. 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. Dec 1997;115(12):1528-36. [Medline].

  116. 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. Apr 16 1998;12(6):613-8. [Medline].

  117. 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. Apr 8 1999;340(14):1063-70. [Medline].

  118. 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. Jan 2008;145(1):5-11. [Medline].

  119. 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. Jan 2008;145(1):12-22. [Medline].

  120. 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. Oct 1998;126(4):543-9. [Medline].

  121. 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. Sep 1998;42(9):2240-4. [Medline].

  122. 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].

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

  124. 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. Mar 1999;28(3):528-33. [Medline].

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

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

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

  128. Lim JI, Enger C, Haller JA, et al. Improved visual results after surgical repair of cytomegalovirus- related retinal detachments. Ophthalmology. Feb 1994;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.
 
 
 
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