Extralesional microvascular and structural macular abnormalities in cytomegalovirus retinitis.

To evaluate extralesional microvascular and structural changes of the macula using optical coherence tomography angiography (OCTA) and structural OCT in cytomegalovirus retinitis (CMVR). An observational study of CMVR patients were performed. Complete ophthalmic examination, serial color fundus photography, structural OCT and OCTA were performed at baseline and follow-up visits for up to 12 months. The structural OCT was analyzed to evaluate macular areas within, bordering and beyond the CMVR lesions. Extralesional retinal capillary plexus of the macula were evaluated by OCT angiography and compared with the unaffected fellow eyes. Thirteen eyes from 13 patients were enrolled. At baseline, macular areas without CMVR lesions showed decreased vessel density (VD) of both the superficial (P = 0.0002) and deep (P < 0.0001) retinal capillary plexus in eyes with CMVR as compared with the corresponding macular areas of the unaffected fellow eyes. The decrease of VD persisted through the follow-up period for up to 12 months after adjusting for degree of vitreous haze. Structural macular OCT characteristics at the borders and beyond the lesions included intraretinal hyperreflective dots, cystoid macular edema, subretinal fluid and selective ellipsoid zone (EZ) loss. The selective EZ loss found in 6 of 12 eyes showed recovery in 4 eyes after receiving anti-viral treatment. In CMVR eyes, there were microvascular and microstructural abnormalities in the macular area without clinically visible CMVR lesions. Our results provided interesting insights into CMV infection of the retina.

SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN MACULA-INVOLVING CYTOMEGALOVIRUS RETINITIS.

PURPOSE: To evaluate the microstructural features of cytomegalovirus (CMV) retinitis by spectral domain optical coherence tomography (OCT). METHODS: Subjects were patients with macula-involving CMV retinitis with OCT imaging. The leading edge of retinitis in the macula was identified based on fundus imaging, and OCT findings were longitudinally evaluated in three areas: within the area of active retinitis, at the leading edge of retinitis, and just beyond the leading edge of retinitis. RESULTS: Optical coherence tomography imaging of macular CMV retinitis identified vitreous cells in 10 eyes (100%), posterior vitreous detachment in four eyes (40%), broad-based vitreomacular traction in one eye (10%), epiretinal membrane in eight eyes (80%), and lamellar hole-associated epiretinal proliferation associated with an atrophic hole in one eye (10%). Retinal architectural disruption, disruption of inner retinal layers, disruption of the external limiting membrane, and ellipsoid zone abnormalities were noted within the area of retinitis in all eyes and decreased in frequency and severity at and beyond the leading edge of retinitis, although all 10 eyes (100%) exhibited one of these abnormalities, especially outer retinal microabnormalities, beyond the leading edge of retinitis. CONCLUSION: Microstructural abnormalities were frequently noted on OCT of CMV retinitis, including within the retina beyond the leading edge of retinitis identified by corresponding fundus imaging. Outer retinal abnormalities were noted more frequently than inner retinal abnormalities beyond the leading edge of retinitis. These findings provide insight into the effects of CMV retinitis on retinal microstructure and potentially on vision and highlight the potential utility of OCT for monitoring microprogression of macula-involving CMV retinitis.

Epiretinal membrane in a 12-year-old immunocompetent girl with cytomegalovirus infection.

PURPOSE: To report the case of a 12-year-old immunocompetent girl presenting bilateral epiretinal membrane formation in conjunction with systemic human cytomegalovirus (HCMV) infection. METHODS: The patient had a sudden onset of blurred vision and floaters in both eyes. Her medical history was unremarkable, except for allergic asthma that she had had for several years and that she was treating with inhaler corticosteroids prescribed by her pediatrician. The patient underwent a complete ophthalmic examination and serologic blood test. RESULTS: The ocular examination revealed an epiretinal membrane confirmed by optical coherence tomography, which showed a band of high optical reflectivity compatible with a proliferation of abnormal tissue on the surface of the retina. The patient had serologic evidence of exposure to HCMV, which was verified by a strongly positive HCMV IgM antibody test result (320 IU), with detectable IgG antibodies against HCMV, which significantly rose further in consecutive blood samples, due to IgG antibody seroconversion. CONCLUSIONS: Our patient had allergic asthma that she was treating with inhaled corticosteroids. The immunosuppressive properties of corticosteroids could induce endogenous reactivation of latent HCMV.

Ultrasound biomicroscopic study of sclerotomy sites after implantation of sustained release drug devices.

BACKGROUND/AIMS: To evaluate the potential of ultrasound biomicroscopy (UBM) as a tool to study the precise location and changes of sclerotomy sites of the eye with an intraocular drug delivery device. METHODS: Eight eyes of six patients (13 sites) who received ganciclovir implants were examined by UBM. Examinations were performed 1-26 months (mean 12.8 months) postoperatively. Serial transverse and radial sections of the anterior ciliary body around the sclerotomy sites were obtained. RESULTS: The ganciclovir implant contour was successfully viewed using an UBM with high reflectivity. Three implants were deviated anteriorly and they were very close to the ciliary body and the lens (anterior deviation), while four implants were deviated posteriorly and away from the lens (posterior deviation). The other six implants were located at the appropriate position as intended. A solitary homogeneous mass with a medium reflectivity around the suture tab was observed at 12 out of 13 sites in seven eyes. Thick membranes extending from sclerotomy sites to the ora serrata were found at two sites in two eyes. CONCLUSION: UBM is helpful in detecting abnormal manifestations around ganciclovir implants and is a valuable tool to assess the changes of the sclerotomy sites of the sustained released intraocular devices.

Cessation of anti-CMV therapy in patients with CMV retinitis.

AIDS: Highly active antiretroviral therapy (HAART) has had a positive impact on the treatment of CMV retinitis, putting the disease in decline over the past few years. Some reports reveal lesions resembling well-controlled CMV retinitis in patients receiving HAART but who never received specific anti-CMV therapy. Further research is needed to learn more about this issue. Cessation of anti-CMV therapy seems most appropriate in patients with no detectable viral load and increased CD4 cell counts; however, questions remain whether the types of CD4 cells resulting from HAART provide adequate protection against CMV. The response in a patient with CMV retinitis who has never been treated with HAART is also unknown. Until guidelines are developed from results of controlled clinical trials, several recommendations are provided for physicians determining how to treat patients with CMV retinitis.^ieng