Cytomegalovirus retinitis

Cytomegalovirus retinitis
Synonyms	CMV retinitis
Pronounce
Field
Symptoms	Blurred vision<ref name=nih/>
Complications
Onset
Duration
Types
Causes	Bone marrow transplant, HIV/AIDS<ref name=nih/>
Risks
Diagnosis	Ophthalmologic exam, blood test<ref name=nih/>
Differential diagnosis
Prevention
Treatment
Medication	Antivirals (oral or intraocular injection)<ref name=pat/>
Prognosis
Frequency
Deaths

Cytomegalovirus retinitis, also known as CMV retinitis, is an inflammation of the retina of the eye that can lead to blindness.<ref name="nih">

Cytomegalovirus retinitis : MedlinePlus Medical Encyclopedia(link). www.nlm.nih.gov.

Accessed 2016-03-14.

</ref> Caused by human cytomegalovirus, it occurs predominantly in people whose immune system has been compromised, 15-40% of those with AIDS.<ref>Narendran,

 Principles and Practice of Vitreoretinal Surgery. online version, 
  
 JP Medical Ltd, 
  
  
  
 ISBN 9789351520979,</ref> There are different types of retinitis, such as retinitis pigmentosa (causes tunnel vision).Template:Medical citation needed

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:<ref name=nih/>

• Blurred vision
• Blind spots
• Specks in your vision

Cause

Leukemia

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.<ref>

CMV | Overview | Cytomegalovirus and Congenital CMV Infection | CDC(link). www.cdc.gov.

Accessed 2016-03-16.

</ref> What triggers the virus to reactivate are the following (though CMV can also be congenital).<ref name="emed">

CMV Retinitis Clinical Presentation: History, Physical, Causes(link). emedicine.medscape.com.

Accessed 2016-03-16.

</ref>

• Leukemia
• AIDS
• Immunosuppressive chemotherapy

Mechanism

Human cytomegalovirus (HCMV or CMV) is a DNA virus in the family Herpesviridae known for producing large cells with nuclear and cytoplasmic inclusions,<ref>Bhushan,

 Sexually Transmitted Infections. online version, 
  
 Elsevier Health Sciences, 
  
  
  
 ISBN 9788131229781,</ref> CMV infects around 40% of the population worldwide.<ref>, 
  
 Encyclopedia of Molecular Pharmacology, 
 2nd edition, 
 Springer, 
 2008, 
  
  
 ISBN 978-3-540-38916-3, 
  
  
  
 Pages: 437–438,</ref>

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).<ref>

Rhegmatogenous Retinal Detachment Clinical Presentation: History, Physical, Causes(link). emedicine.medscape.com.

Accessed 2016-03-16.

</ref><ref>Cheeran, Maxim C.-J.,

 Neuropathogenesis of Congenital Cytomegalovirus Infection: Disease Mechanisms and Prospects for Intervention, 
 Clinical Microbiology Reviews, 
 
 Vol. 22(Issue: 1),
 pp. 99–126,
 DOI: 10.1128/CMR.00023-08,
 PMID: 19136436,
 PMC: 2620634,</ref> Proliferative vitreoretinopathy has been observed in cases of retinal detachment.<ref>Sadaka, Ama, 
 Proliferative vitreoretinopathy: current and emerging treatments, 
 Clinical Ophthalmology, 
 
 Vol. 6,
 pp. 1325–1333,
 DOI: 10.2147/OPTH.S27896,
 PMID: 22942638,
 PMC: 3429288,</ref>

Diagnosis

PCR result, Gel electrophoresis

The diagnosis of CMV retinitis can be done via the following:<ref name=emed/><ref>C. Stephen,

 Diagnosis & Treatment of Uveitis. online version, 
  
 JP Medical Ltd, 
  
  
  
 ISBN 9789350255728,</ref>

• Ophthalmic screening frequency is based on CD4 count,(CD4 < 50 cells/mL, 0- 35% possibility of CMV retinitis)
• BUN
• CD8+ T-lymphocyte count
• CMV DNA capture ( polymerase chain reaction (PCR) test)
• DNA PCR ( ocular fluids)
• Viral load
• Complete blood count

Treatment

Ganciclovir

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.<ref>

Cytomegalovirus Disease | Adult and Adolescent OI Prevention and Treatment Guidelines | AIDSinfo(link). AIDSinfo.

Accessed 2016-03-16.

</ref><ref name="pat">

Inflammatory Retinal Diseases. Medical information | Patient(link). Patient.

Accessed 2016-03-16.

</ref><ref>

Intravitreal injection: MedlinePlus Medical Encyclopedia(link). www.nlm.nih.gov.

Accessed 2016-03-16.

</ref>

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.<ref name=emed/>

See also

• List of eye diseases and disorders
• List of systemic diseases with ocular manifestations
• Progressive outer retinal necrosis