Clinical features of cytomegalovirus retinitis, A retrospective analysis of 90 patients

Clinical features of cytomegalovirus retinitis, A retrospective analysis of 90 patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Clinical features of cytomegalovirus retinitis, A retrospective analysis of 90 patients Yan Zhang, lei Yu, Na Li, Ge Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4715667/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background To analyze the clinical features of patients with cytomegalovirus retinitis and provide evidence for a better understanding of the disease. Methods A retrospective analysis was conducted on the clinical manifestations of 90 patients with cytomegalovirus retinitis. The analysis included general data, visual acuity, intraocular pressure, anterior segment examination, vitreous body examination, and color fundus photography. Results The patients' ages ranged from 1 to 64 years, with 59 males and 31 females. Among the 90 patients, 18 had acquired immune deficiency syndrome (AIDS) as a secondary condition, 70 had various types of hematological diseases following bone marrow transplantation, 1 had a history of thymus extraction, and 1 had congenital autoimmune hemolytic anemia. Of the affected eyes, 35 cases were monocular and 55 were binocular. Anterior chamber inflammation was observed in 67 eyes out of 145 affected eyes, while 40 eyes showed significant vitreous inflammation. Some cases exhibited typical "cheese and ketchup" changes during fundus examination, with various fundus manifestations observed. Based on the extent and location of the lesions, they were classified into diffuse, hemilateral, and focal types. Conclusion Cytomegalovirus retinitis is more prevalent among immunodeficient individuals rather than those with normal immune systems. Regular eye examinations are recommended for patients of AIDS diagnosis and bone marrow transplantation. Understanding the clinical characteristics of the disease can aid in early diagnosis and treatment. Health sciences/Diseases Health sciences/Risk factors cytomegalovirus retinitis acquired immune deficiency syndrome allogeneic hematopoietic stem-cell transplantation Figures Figure 1 Figure 2 Figure 3 Introduction Cytomegalovirus (CMV) is a double-stranded DNA virus belonging to the beta genus of the Herpesviridae family, with a protein shell and a lipoprotein envelope. CMV commonly infects healthy individuals, but most cases result in either latent infections or mild symptoms[ 1 ]. Data indicates that CMV infection rates range from 30–70% in developed countries and from 90–100% in developing countries.[ 1 – 2 ] The clinical manifestations of CMV infection are complex, and the consequences can be severe in immunodeficient patients. The most common CMV infections manifest as interstitial pneumonia, enteritis, and esophagitis, which are well-recognized and can be identified early [ 3 – 6 ]. However, for less common infection sites, clinical understanding and experience are lacking. In particular, the early symptoms of ocular CMV infection are often mild and challenging to detect. Cytomegalovirus retinitis (CMVR) is characterized by chronic progressive necrotizing retinitis. Without treatment or timely intervention, the disease progresses rapidly and can lead to severe visual impairment[ 7 – 9 ]. This study summarized and analyzed the characteristics of 90 patients with CMVR to enhance understanding of the disease's atypical clinical manifestations. Timely treatment of CMVR can stabilize vision, prevent disease progression, and improve patients' quality of life. Material and methods General Data A retrospective analysis was conducted on 90 patients with cytomegalovirus retinitis from March 2016 to April 2023 at Eye Hospital, China Academy of Chinese Medical Sciences, comprising 59 males and 31 females. The age of the patients ranged from 1 to 64 years, with the duration of the disease varying from 3 days to 4 years. This research protocols received ethical approval from the Eye Hospital, China Academy of Chinese Medical Sciences Ethics Committee. The committee decided to waive the need for written informed consent from the participants studied in this analysis as the data were analyzed retrospectively and anonymously. Inclusion Criteria The diagnostic criteria for including standard CMVR were as follows:①Fundus examination revealing white sheathing of retinal veins, retinal hemorrhage, irregular patchy retinal edema, and necrosis.②Positive testing of CMV nucleic acid in the intraocular fluid. Examination Items Clinical symptoms, visual acuity, intraocular pressure, Anterior chamber inflammation, and anterior vitreous body observed through slit-lamp microscopy, retina observed via mydriatic and indirect ophthalmoscopy, fundus photography, fundus fluorescence angiography (in some patients), and other patient information were collected for statistical analysis. Results General Data Among the 90 patients with CMV retinitis, 59 were male, representing 65.6% (59/90) of the total. There were 31 female patients, accounting for 34.4% (31/90). The age of the patients ranged from 1 to 64 years, and the duration of the disease varied from 3 days to 4 years. There were 35 cases of monocular disease (38.9%) and 55 cases of binocular disease (61.1%). Additionally, there were 18 cases secondary to acquired immune deficiency syndrome (AIDS), making up 20% (18/90) of the total. Furthermore, 70 cases were secondary to bone marrow transplantation, representing 77.8% (70/90). As our hospital's Hematology Department is a national key department, we have a large number of patients, especially post-bone marrow transplant. There was 1 case following thymus extraction, accounting for 1.1% (1/90), and 1 case of autoimmune hemolytic anemia, also representing 1.1% (1/90). Eye condition Complaints and Intraocular Pressure Among the 90 patients, there were 8 cases of sudden vision loss, 48 cases of blurred vision, 21 cases of dark shadows floating or occluding the eyes, and 7 cases of dark spots before the eyes. Additionally, there were 6 cases without any discomfort. The intraocular pressure (IOP) of 145 eyes in these 90 patients was measured using a non-contact tonometer, with values ranging from a minimum of 6 mmHg to a maximum of 45 mmHg. For patients with an IOP greater than 21 mmHg, the IOP was monitored at each follow-up visit, and it could be controlled within the normal range by using IOP-lowering drops and locally controlling inflammation. Anterior chamber Condition Among the 145 eyes of the 90 patients, 67 eyes exhibited keratic precipitates (KP). Of these, 43 eyes mainly showed granulomatous KP (Fig. 1 A), while 22 eyes displayed nongranulomatous KP (Fig. 1 B), and 2 eyes had pigmented KP. The remaining 78 eyes did not show KP. KP was often accompanied by plankton in the anterior chamber. Posterior iris adhesions were observed in only 3 out of the 145 eyes of the 90 patients, with 2 eyes belonging to AIDS patients and 1 eye to a bone marrow transplant patient. Vitreous Condition In 40 out of 145 eyes of the 90 patients, vitreous inflammatory cells were visible, accounting for 27.6% (40/145). Vitreous hemorrhage was observed in 3 eyes, while no obvious abnormalities were found in the vitreous body of the remaining 102 eyes. Fundus Condition The fundus manifestations mainly included typical necrotizing retinitis, with the white sheath of retinal veins commonly visible (Fig. 2A). Yellow and white retinal lesions along the retinal vasculature, with granular active edges, often accompanied by retinal hemorrhage, were also observed (Fig. 2B). The presence of vascular sheath, exudation, and retinal hemorrhage simultaneously resulted in a fundus appearance resembling cheese and tomato paste. The retinal blood vessels exhibited frosty dendritic changes. Additionally, white or yellowish-white patchy or clustered exudative lesions of the medial retina were noted, which may fuse with or without retinal hemorrhage. Old CMVR could be identified by observing retinal fiber scarring and subretinal crystal formation (Fig. 2C). Among the 145 eyes of the 90 patients with CMVR, retinal detachment occurred in 9 eyes. Optic disc were involved in 76 out of the 145 eyes, with 56 eyes showing papilloedema with an unclear boundary and 20 eyes displaying disc hemorrhage. According to the scope and location of the lesions involved in relevant literature[ 10 – 11 ], CMVR could be divided into diffuse, hemilateral, and focal types. In 90 cases with 145 eyes, 64 eyes were classified as diffuse type(Fig. 3A). The fundus exhibited involvement of the entire retina, with lesions extending to blood vessels in all four quadrants of the posterior pole and the optic disc. The hemilateral type accounted for 33 eyes (Fig. 3B): The lesions involved half of the retina with clear boundaries. The focal type accounted for 48 eyes (Fig. 3C): Retinal lesions were confined to only one quadrant. Fundus fluorescence angiography revealed that retinal veins, along with the white sheath of blood vessels, exhibited fluorescent staining of the vessel walls, with nearby areas showing punctate hyperfluorescence. In contrast, areas corresponding to retinal hemorrhage and granular necrosis displayed low fluorescence, which decreased as the angiography time extended (Fig. 2D). Visual acuity Visual acuity ranged from non-light perception (NLP) to 0.3 in 70 eyes. Most of these patients exhibited involvement in the posterior pole of the retina, with the majority of fundus changes being diffuse. There were 24 eyes with visual acuity greater than 0.3 and less than or equal to 0.5, and most of them showed local retinal involvement. In 38 eyes, visual acuity exceeding 0.5 involved the peripheral retina. The best visual acuity recorded was 1.0 in 8 eyes, and the macular region was not involved. All 13 eyes that did not pass the vision test belonged to infants. In terms of visual acuity, those involving the macula, leading to macular hemorrhage and edema, generally had poor visual acuity, while those affecting the peripheral retina had good visual acuity. Discussion and conclusion Cytomegalovirus belongs to the human species-specific herpesvirus type 5, falling under the ß subfamily and possessing a double-stranded DNA structure. People are generally susceptible to cytomegalovirus, but most of them are recessive carriers or exhibit no obvious symptoms[ 1 – 3 ]. CMV is widely prevalent in China, with the positive rate of anti-CMV IgG in adult serum exceeding 90% in clinical tests, often without clinical symptoms. Following CMV infection, the virus often remains in the early stage of the replication cycle, leading to latent infection. Cytomegalovirus primarily resides in human salivary glands, mammary glands, kidneys, and other organs, with the ability to hide in host epithelial cells, endothelial cells, peripheral mononuclear cells, and other cell types[ 12 ]. Currently, the number of AIDS patients in China is increasing, and cytomegalovirus retinitis is a common eye complication among AIDS patients, accounting for 1/4 to 1/3 of AIDS-related eye manifestations and being a primary cause of vision loss. Cytomegalovirus retinitis often serves as the initial symptom in most AIDS patients. Moreover, with advancements in technology, allogeneic hematopoietic stem cell transplantation (allo-HSCT) has become an effective treatment method for malignant blood diseases. Infections are the most common complications associated with allo-HSCT, with various infections observed throughout the transplantation process. Due to pretreatment, the use of immunosuppressants, and immune function deficiencies in patients undergoing hematopoietic stem cell transplantation, various infections may arise. Activated cytomegalovirus, which typically lies dormant in all organs, can lead to diseases affecting multiple organs[ 13 – 15 ]. According to the data from this study, among the 90 patients with CMV retinitis, 18 cases were secondary to AIDS, 70 cases were secondary to bone marrow transplantation, 1 case was secondary to thymus extraction, and 1 case was secondary to autoimmune hemolytic anemia. This finding aligns with previous reports indicating that CMV retinitis frequently occurs in immunosuppressed patients. The reason for the high incidence of CMVR after bone marrow transplantation in our hospital is that our hematology department is a national key discipline, with a majority of patients undergoing bone marrow transplantation, which leads to a high proportion of post-bone marrow transplantation patients among the 90 cases we have, resulting in the high incidence rate. Cytomegalovirus infection is a major complication and a leading cause of death following allogeneic hematopoietic stem cell transplantation. Although reports on this disease are not uncommon both domestically and internationally, many doctors are still unfamiliar with it, leading to misdiagnosis. Therefore, it is necessary for us to enhance doctors' understanding of this disease. [ 16 – 17 ]. Our data revealed that 70 out of 90 patients developed secondary CMV retinitis after bone marrow transplantation, with clinical manifestations similar to those seen in AIDS-related CMV retinitis. This highlights the importance of vigilance for CMV retinitis in patients experiencing visual impairment or shadows before their eyes post-bone marrow transplantation, emphasizing the need for regular screening by experienced ophthalmologists to prevent delayed treatment. In summary, CMVR exhibits the following characteristics: ①It predominantly affects individuals with compromised immune function, particularly AIDS patients and those who have undergone hematopoietic stem cell transplantation, potentially leading to blindness if not promptly treated[ 18 – 20 ]. ②Clinical manifestations include bilateral or unilateral onset, with early symptoms possibly being mild, such as central and peripheral dark spots or no symptoms at all. Granulomatous KP or nongranulomatous KP may be observed. In some cases, the anterior chamber may not be involved, while others may present with vitreous floaters or even vitreous hemorrhage. Typical fundus changes can resemble cheese and tomato sauce, involving either the entire retina or a portion of it. The white sheathing of retinal blood vessels is common, resembling frost branches. Pigment scars of varying sizes begin to form after approximately 4 to 6 weeks, potentially leading to retinal detachment due to scarring[ 21 – 24 ]. In conclusion, immunocompromised patients should promptly seek evaluation at an ophthalmology department upon experiencing eye discomfort symptoms. Even asymptomatic individuals post-bone marrow transplantation or with AIDS should undergo regular eye examinations to facilitate early detection and treatment of the disease. Declarations Ethics approval and consent to participate: This research protocols received ethical approval from the Eye Hospital, China Academy of Chinese Medical Sciences Ethics Committee. The committee decided to waive the need for written informed consent from the participants studied in this analysis as the data were analyzed retrospectively and anonymously. Consent for publication: Not Applicable. Availability of data and materials ：The datasets generated and/or analyzed during the current study are not all publicly available in order to protect patient anonymity, but are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This study was supported by High-level Traditional Chinese Medicine Hospital Projects at the Eye Hospital of China Academy of Chinese Medical Sciences. (GSP5-02). Authors’ contributions: Y.Z and L.Y were the major contributor in writing the manuscript. G.Z designed the research. Y.Z, L.Y and N. L collected the patient data. All authors read and approved the final manuscript. Acknowledgements: We thank Dr. Yong Tao for helpful discussions and technical assistance. Author details: 1. Eye Hospital, China Academy of Chinese Medical Sciences, Beijing 100040, China;2. 2. Korla Hospital ,Xinjiang Production and Construction Corps Second Division, Xinjiang 841000 ,China;3. Yanqi Hospital ,Xinjiang Production and Construction Corps Second Division, Xinjiang 841100 ,China References Mocarski ES, Shenk T, Pass RF. Cytomegaloviruses. Lippincott Williams & Wilkins, Philadelphia, PA, USA, 2007: 2701-2772. Gumbo H, Chasekwa B, Church JA, et al. Congenital and postnatal CMV and EBV acquisition in HIV-infected Zimbabwean infants. PLoS One. 2014; 9(12): 14870. Holland GN. Survival of patients with the acquired immunodeficiency syndrome after development of CMV retinopathy. Ophthalmology. 1990; 97: 204-210. Monique Munro, Tejabhiram Yadavalli, Cheryl Fonteh, et al. Cytomegalovirus Retinitis in HIV and Non-HIV Individuals. Microorganisms. 2020 Jan; 8(1): 55. Joo Young Kim, Seo-Yeon Hong, Woo Kyung Park, et al. Prognostic factors of cytomegalovirus retinitis after hematopoietic stem cell transplantation. PLoS One. 2020; 15(9): e0238257. Yuehong Zhang, Yuqin Liang, Xu Zhang, et al. Pre-Transplant Platelet Refractoriness and Alternative Donors Are Associated With Cytomegalovirus Retinitis in Hematopoietic Stem Cell Transplantation for Severe Aplastic Anemia. Front Cell Infect Microbiol. 2022; 12: 870296. Yalin Zhou, Fei Hong, Xiaojuan Wang, et al. Abnormal levels of aqueous humor trace elements in patients with cytomegalovirus retinitis. Eye (Lond). 2019 Oct; 33(10): 1606–1612. Holland GN, Shuler JD. Progression rates of cytomegalovirus retinopathy in ganciclovir-treated and untreated patients. Arch Ophthalmol. 1992; 110: 1435-1442. Freeman WR. Prevalence, pathophysiology, and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis. Am J Ophthalmol. 1987; 103: 527-531. Yang Tang, Jianjun Sun, Taiwen He, et al. Clinical Features of Cytomegalovirus Retinitis in HIV Infected Patients. Front Cell Infect Microbiol. 2020; 10: 136. Qing Zhao, Ning-ning Li, You-xin Chen, et al. Clinical features of Cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome and efficacy of the current therapy. Front Cell Infect Microbiol. 2023; 13: 1107237. Schnitzler MA, Woodward RS, Brennan DC, et al. The effects of cytomegalovirus serology on graft and recipient survival in cadaveric renal transplantation: implications for organ allocation. Am J Kidney Dis. 1997; 29(3): 428-434. Ye Junjie, Li Haiyan, Sun Ding, et al. Clinical analysis of acquired immune deficiency syndrome complicated with cytomegalovirus retinitis. Chinese Journal of Ophthalmology. 2005; 41(9): 803-806. Ausayakhun S, Watananikorn S, Ittipunkul N, et al. Epidemiology of the ocular complications of HIV infection in Chiang Mai. J Med Assoc Thai. 2003; 86(5): 399-406. 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; 129(1): 9-15. Lu Jin, Huang Xiaojun, Lu Daopei. Cytomegalovirus retinitis after allogeneic bone marrow transplantation: a case report and literature review. Chinese Journal of Hematology. 2003; 24(6): 312-315. Mori T, Okamoto S, Matsuoka S, et al. Risk-adapted pre-emptive therapy for cytomegalovirus disease in patients undergoing allogeneic bone marrow transplantation. Bone Marrow Transplant. 2000; 25: 765-769. The Standardization of Uveitis Nomenclature (SUN) Working Group. Classification criteria for cytomegalovirus retinitis. Am J Ophthalmol. 2021 Aug; 228: 245–254. Mrinali P. Gupta, Lisa R. Koenig, Ekaterina Doubrovina, et al. Ocular outcomes after treatment of cytomegalovirus (CMV) retinitis using adoptive immunotherapy with CMV-specific cytotoxic T-lymphocytes. Ophthalmol Retina. 2021 Sep; 5(9): 838–849. Kui-Fang Du, Xiao-Jie Huang, Chao Chen, et al. Clinical characteristics in the misdiagnosis of cytomegalovirus retinitis: A retrospective analysis of eight patients. Indian J Ophthalmol. 2022 Oct; 70(10): 3596–3602. Anastasia Tasiopoulou, Cristhian A. Urzua, Susan Lightman. Successful treatment of cytomegalovirus retinitis with oral/intravitreal antivirals in HIV-negative patients with lymphoma. Eye (Lond). 2023 Jun; 37(9): 1895–1903. Sana Khochtali, Ahmed Mahjoub, Tarek Dridi, et al. Cytomegalovirus retinitis following corticosteroid overdose for Vogt-Koyanagi-Harada disease. Indian J Ophthalmol. 2020 Sep; 68(9): 2012–2014. Filipa Silva, Klaus Nunes Ficher, Laila Viana, et al. Presumed cytomegalovirus retinitis late after kidney transplant. J Bras Nefrol. 2022 Jul-Sep; 44(3): 457–461. Xiao-Qing He, Yin-Qiu Huang, Yan-Ming Zeng, et al. Timing of antiretroviral therapy for HIV-infected patients with cytomegalovirus retinitis: study protocol of a multi-center prospective randomized controlled trial. Trials. 2021; 22: 218. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4715667","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":329940951,"identity":"b8d0e275-940f-4bb6-bd60-c865d9409c59","order_by":0,"name":"Yan Zhang","email":"","orcid":"","institution":"China Academy of Chinese Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Zhang","suffix":""},{"id":329940952,"identity":"04da7f02-5239-4951-b33f-c99009eca9cb","order_by":1,"name":"lei Yu","email":"","orcid":"","institution":"China Academy of Chinese Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"lei","middleName":"","lastName":"Yu","suffix":""},{"id":329940953,"identity":"d4d22237-4b22-44c8-84ea-8950041c22a3","order_by":2,"name":"Na Li","email":"","orcid":"","institution":"China Academy of Chinese Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Na","middleName":"","lastName":"Li","suffix":""},{"id":329940954,"identity":"e802b2e7-78ee-45ed-8057-a39dded16b8f","order_by":3,"name":"Ge Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIie3RsQrCMBCA4ZPCuQS7RtSKb1AoiKOPkiB0Exw7OHQQO1hxdfAhsqlbpJAp7h31DSwubhpwVNq6OeSb85PcBcCy/hD2MynZAz23uSkuLJpXJy2KXBZpK2inMvAvWlUnHiXBaYseF9vxsH1dODUe1on9jJAhFxTCiMcIbrJi5UlXsoyMwmDfiVXOD12g+izKE2DS3KJ6x91pmXON4NNpVcLjjOCzIfIJzvjSqZHQCZjxcSDy0OS1EqLALBnNkrVDmVakcpZ+srnf3l+ZNopHNPfcZF2efCC/Hbcsy7K+egFbm04vDLog0wAAAABJRU5ErkJggg==","orcid":"","institution":"Korla Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ge","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-07-10 05:20:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4715667/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4715667/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62064801,"identity":"f0c11154-9bfd-473e-96ee-9940f13b017f","added_by":"auto","created_at":"2024-08-09 00:35:45","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":314042,"visible":true,"origin":"","legend":"\u003cp\u003eA shows retrocorneal granulomatous KP, which is round in shape, while B displays retrocorneal nongranulomatous KP mainly distributed in the lower cornea.\u003c/p\u003e","description":"","filename":"fig.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4715667/v1/6a2d796f018075e823da0a35.jpg"},{"id":62064799,"identity":"45be9799-f57f-40f1-8a6f-0207a6a21131","added_by":"auto","created_at":"2024-08-09 00:35:45","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":966240,"visible":true,"origin":"","legend":"\u003cp\u003eA: Diffuse retinal exudation along the direction of blood vessel shape, with blood vessels exhibiting frost branch-like changes. Retinal bleeding, yellow exudation, and retinal depigmentation can be observed, along with the coexistence of old and fresh lesions.\u003c/p\u003e\n\u003cp\u003eB: Localized yellow and white exudation, white sheath of blood vessels, granular necrotic lesions, and small flaky bleeding are visible.\u003c/p\u003e\n\u003cp\u003eC: Represents late CMVR, characterized by proliferative film formation, peripheral retinal depigmentation, and scar-like changes.\u003c/p\u003e\n\u003cp\u003eD: The fundus fluorescence angiography\u003c/p\u003e","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4715667/v1/c3e158770f34d3afd5aece35.jpg"},{"id":62065345,"identity":"9a1618f5-56da-4e62-8e3e-96ba7077b43b","added_by":"auto","created_at":"2024-08-09 00:43:45","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":440652,"visible":true,"origin":"","legend":"\u003cp\u003eA: Diffuse type: The fundus examination revealed involvement of the entire retina, with lesions extending to the blood vessels in the four quadrants of the posterior pole, the optic disc, and the white sheath of retinal blood vessels. Retinal exudation, bleeding, and papilledema were observed in all quadrants.\u003c/p\u003e\n\u003cp\u003eB:Hemilateral type:Hemiretinal involvement: the lesion affects half of the retina, resembling the appearance of \"cheese ketchup\" on one half of the retina, while the other half remains unaffected with a clear boundary.\u003c/p\u003e\n\u003cp\u003eC: Focal type, where only one quadrant of the retina is affected by the lesion.\u003c/p\u003e","description":"","filename":"fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4715667/v1/49b4538faceddc21c1fc5391.jpg"},{"id":62065963,"identity":"6a933c71-8443-40f1-a89e-66bea82add94","added_by":"auto","created_at":"2024-08-09 00:59:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1945900,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4715667/v1/39c0f999-df54-4b9e-8f83-5359f6b0295f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical features of cytomegalovirus retinitis, A retrospective analysis of 90 patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCytomegalovirus (CMV) is a double-stranded DNA virus belonging to the beta genus of the Herpesviridae family, with a protein shell and a lipoprotein envelope. CMV commonly infects healthy individuals, but most cases result in either latent infections or mild symptoms[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Data indicates that CMV infection rates range from 30\u0026ndash;70% in developed countries and from 90\u0026ndash;100% in developing countries.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe clinical manifestations of CMV infection are complex, and the consequences can be severe in immunodeficient patients. The most common CMV infections manifest as interstitial pneumonia, enteritis, and esophagitis, which are well-recognized and can be identified early [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, for less common infection sites, clinical understanding and experience are lacking. In particular, the early symptoms of ocular CMV infection are often mild and challenging to detect.\u003c/p\u003e \u003cp\u003eCytomegalovirus retinitis (CMVR) is characterized by chronic progressive necrotizing retinitis. Without treatment or timely intervention, the disease progresses rapidly and can lead to severe visual impairment[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This study summarized and analyzed the characteristics of 90 patients with CMVR to enhance understanding of the disease's atypical clinical manifestations. Timely treatment of CMVR can stabilize vision, prevent disease progression, and improve patients' quality of life.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eGeneral Data\u003c/p\u003e \u003cp\u003eA retrospective analysis was conducted on 90 patients with cytomegalovirus retinitis from March 2016 to April 2023 at Eye Hospital, China Academy of Chinese Medical Sciences, comprising 59 males and 31 females. The age of the patients ranged from 1 to 64 years, with the duration of the disease varying from 3 days to 4 years. This research protocols received ethical approval from the Eye Hospital, China Academy of Chinese Medical Sciences Ethics Committee. The committee decided to waive the need for written informed consent from the participants studied in this analysis as the data were analyzed retrospectively and anonymously.\u003c/p\u003e \u003cp\u003eInclusion Criteria\u003c/p\u003e \u003cp\u003eThe diagnostic criteria for including standard CMVR were as follows:①Fundus examination revealing white sheathing of retinal veins, retinal hemorrhage, irregular patchy retinal edema, and necrosis.②Positive testing of CMV nucleic acid in the intraocular fluid.\u003c/p\u003e \u003cp\u003eExamination Items\u003c/p\u003e \u003cp\u003eClinical symptoms, visual acuity, intraocular pressure, Anterior chamber inflammation, and anterior vitreous body observed through slit-lamp microscopy, retina observed via mydriatic and indirect ophthalmoscopy, fundus photography, fundus fluorescence angiography (in some patients), and other patient information were collected for statistical analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eGeneral Data\u003c/p\u003e\n\u003cp\u003eAmong the 90 patients with CMV retinitis, 59 were male, representing 65.6% (59/90) of the total. There were 31 female patients, accounting for 34.4% (31/90). The age of the patients ranged from 1 to 64 years, and the duration of the disease varied from 3 days to 4 years. There were 35 cases of monocular disease (38.9%) and 55 cases of binocular disease (61.1%). Additionally, there were 18 cases secondary to acquired immune deficiency syndrome (AIDS), making up 20% (18/90) of the total. Furthermore, 70 cases were secondary to bone marrow transplantation, representing 77.8% (70/90). As our hospital\u0026apos;s Hematology Department is a national key department, we have a large number of patients, especially post-bone marrow transplant. There was 1 case following thymus extraction, accounting for 1.1% (1/90), and 1 case of autoimmune hemolytic anemia, also representing 1.1% (1/90).\u003c/p\u003e\n\u003cp\u003eEye condition\u003c/p\u003e\n\u003cp\u003eComplaints and Intraocular Pressure\u003c/p\u003e\n\u003cp\u003eAmong the 90 patients, there were 8 cases of sudden vision loss, 48 cases of blurred vision, 21 cases of dark shadows floating or occluding the eyes, and 7 cases of dark spots before the eyes. Additionally, there were 6 cases without any discomfort. The intraocular pressure (IOP) of 145 eyes in these 90 patients was measured using a non-contact tonometer, with values ranging from a minimum of 6 mmHg to a maximum of 45 mmHg. For patients with an IOP greater than 21 mmHg, the IOP was monitored at each follow-up visit, and it could be controlled within the normal range by using IOP-lowering drops and locally controlling inflammation.\u003c/p\u003e\n\u003cp\u003eAnterior chamber Condition\u003c/p\u003e\n\u003cp\u003eAmong the 145 eyes of the 90 patients, 67 eyes exhibited keratic precipitates (KP). Of these, 43 eyes mainly showed granulomatous KP (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eA), while 22 eyes displayed nongranulomatous KP (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eB), and 2 eyes had pigmented KP. The remaining 78 eyes did not show KP. KP was often accompanied by plankton in the anterior chamber. Posterior iris adhesions were observed in only 3 out of the 145 eyes of the 90 patients, with 2 eyes belonging to AIDS patients and 1 eye to a bone marrow transplant patient.\u003c/p\u003e\n\u003cp\u003eVitreous Condition\u003c/p\u003e\n\u003cp\u003eIn 40 out of 145 eyes of the 90 patients, vitreous inflammatory cells were visible, accounting for 27.6% (40/145). Vitreous hemorrhage was observed in 3 eyes, while no obvious abnormalities were found in the vitreous body of the remaining 102 eyes.\u003c/p\u003e\n\u003cp\u003eFundus Condition\u003c/p\u003e\n\u003cp\u003eThe fundus manifestations mainly included typical necrotizing retinitis, with the white sheath of retinal veins commonly visible (Fig. 2A). Yellow and white retinal lesions along the retinal vasculature, with granular active edges, often accompanied by retinal hemorrhage, were also observed (Fig. 2B). The presence of vascular sheath, exudation, and retinal hemorrhage simultaneously resulted in a fundus appearance resembling cheese and tomato paste. The retinal blood vessels exhibited frosty dendritic changes. Additionally, white or yellowish-white patchy or clustered exudative lesions of the medial retina were noted, which may fuse with or without retinal hemorrhage. Old CMVR could be identified by observing retinal fiber scarring and subretinal crystal formation (Fig. 2C). Among the 145 eyes of the 90 patients with CMVR, retinal detachment occurred in 9 eyes. Optic disc were involved in 76 out of the 145 eyes, with 56 eyes showing papilloedema with an unclear boundary and 20 eyes displaying disc hemorrhage.\u003c/p\u003e\n\u003cp\u003eAccording to the scope and location of the lesions involved in relevant literature[\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e], CMVR could be divided into diffuse, hemilateral, and focal types. In 90 cases with 145 eyes, 64 eyes were classified as diffuse type(Fig. 3A). The fundus exhibited involvement of the entire retina, with lesions extending to blood vessels in all four quadrants of the posterior pole and the optic disc. The hemilateral type accounted for 33 eyes (Fig. 3B): The lesions involved half of the retina with clear boundaries. The focal type accounted for 48 eyes (Fig. 3C): Retinal lesions were confined to only one quadrant. Fundus fluorescence angiography revealed that retinal veins, along with the white sheath of blood vessels, exhibited fluorescent staining of the vessel walls, with nearby areas showing punctate hyperfluorescence. In contrast, areas corresponding to retinal hemorrhage and granular necrosis displayed low fluorescence, which decreased as the angiography time extended (Fig. 2D).\u003c/p\u003e\n\u003cp\u003eVisual acuity\u003c/p\u003e\n\u003cp\u003eVisual acuity ranged from non-light perception (NLP) to 0.3 in 70 eyes. Most of these patients exhibited involvement in the posterior pole of the retina, with the majority of fundus changes being diffuse. There were 24 eyes with visual acuity greater than 0.3 and less than or equal to 0.5, and most of them showed local retinal involvement. In 38 eyes, visual acuity exceeding 0.5 involved the peripheral retina. The best visual acuity recorded was 1.0 in 8 eyes, and the macular region was not involved. All 13 eyes that did not pass the vision test belonged to infants. In terms of visual acuity, those involving the macula, leading to macular hemorrhage and edema, generally had poor visual acuity, while those affecting the peripheral retina had good visual acuity.\u003c/p\u003e"},{"header":"Discussion and conclusion","content":"\u003cp\u003eCytomegalovirus belongs to the human species-specific herpesvirus type 5, falling under the \u0026szlig; subfamily and possessing a double-stranded DNA structure. People are generally susceptible to cytomegalovirus, but most of them are recessive carriers or exhibit no obvious symptoms[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. CMV is widely prevalent in China, with the positive rate of anti-CMV IgG in adult serum exceeding 90% in clinical tests, often without clinical symptoms. Following CMV infection, the virus often remains in the early stage of the replication cycle, leading to latent infection. Cytomegalovirus primarily resides in human salivary glands, mammary glands, kidneys, and other organs, with the ability to hide in host epithelial cells, endothelial cells, peripheral mononuclear cells, and other cell types[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently, the number of AIDS patients in China is increasing, and cytomegalovirus retinitis is a common eye complication among AIDS patients, accounting for 1/4 to 1/3 of AIDS-related eye manifestations and being a primary cause of vision loss. Cytomegalovirus retinitis often serves as the initial symptom in most AIDS patients. Moreover, with advancements in technology, allogeneic hematopoietic stem cell transplantation (allo-HSCT) has become an effective treatment method for malignant blood diseases. Infections are the most common complications associated with allo-HSCT, with various infections observed throughout the transplantation process. Due to pretreatment, the use of immunosuppressants, and immune function deficiencies in patients undergoing hematopoietic stem cell transplantation, various infections may arise. Activated cytomegalovirus, which typically lies dormant in all organs, can lead to diseases affecting multiple organs[\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the data from this study, among the 90 patients with CMV retinitis, 18 cases were secondary to AIDS, 70 cases were secondary to bone marrow transplantation, 1 case was secondary to thymus extraction, and 1 case was secondary to autoimmune hemolytic anemia. This finding aligns with previous reports indicating that CMV retinitis frequently occurs in immunosuppressed patients. The reason for the high incidence of CMVR after bone marrow transplantation in our hospital is that our hematology department is a national key discipline, with a majority of patients undergoing bone marrow transplantation, which leads to a high proportion of post-bone marrow transplantation patients among the 90 cases we have, resulting in the high incidence rate.\u003c/p\u003e \u003cp\u003eCytomegalovirus infection is a major complication and a leading cause of death following allogeneic hematopoietic stem cell transplantation. Although reports on this disease are not uncommon both domestically and internationally, many doctors are still unfamiliar with it, leading to misdiagnosis. Therefore, it is necessary for us to enhance doctors' understanding of this disease. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Our data revealed that 70 out of 90 patients developed secondary CMV retinitis after bone marrow transplantation, with clinical manifestations similar to those seen in AIDS-related CMV retinitis. This highlights the importance of vigilance for CMV retinitis in patients experiencing visual impairment or shadows before their eyes post-bone marrow transplantation, emphasizing the need for regular screening by experienced ophthalmologists to prevent delayed treatment.\u003c/p\u003e \u003cp\u003eIn summary, CMVR exhibits the following characteristics:\u003c/p\u003e \u003cp\u003e①It predominantly affects individuals with compromised immune function, particularly AIDS patients and those who have undergone hematopoietic stem cell transplantation, potentially leading to blindness if not promptly treated[\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e②Clinical manifestations include bilateral or unilateral onset, with early symptoms possibly being mild, such as central and peripheral dark spots or no symptoms at all. Granulomatous KP or nongranulomatous KP may be observed. In some cases, the anterior chamber may not be involved, while others may present with vitreous floaters or even vitreous hemorrhage. Typical fundus changes can resemble cheese and tomato sauce, involving either the entire retina or a portion of it. The white sheathing of retinal blood vessels is common, resembling frost branches. Pigment scars of varying sizes begin to form after approximately 4 to 6 weeks, potentially leading to retinal detachment due to scarring[\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn conclusion, immunocompromised patients should promptly seek evaluation at an ophthalmology department upon experiencing eye discomfort symptoms. Even asymptomatic individuals post-bone marrow transplantation or with AIDS should undergo regular eye examinations to facilitate early detection and treatment of the disease.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: This research protocols received ethical approval from the Eye Hospital, China Academy of Chinese Medical Sciences Ethics Committee. The committee decided to waive the need for written informed consent from the participants studied in this analysis as the data were analyzed retrospectively and anonymously.\u0026nbsp;\u003c/p\u003e\n\u003cp skip=\"true\"\u003eConsent for publication: Not Applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u0026nbsp;：The datasets generated and/or analyzed during the current study are not all publicly available in order to protect patient anonymity, but are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding: This study was supported by High-level Traditional Chinese Medicine Hospital Projects at the Eye Hospital of China Academy of Chinese Medical Sciences. (GSP5-02).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions: Y.Z and L.Y were the major contributor in writing the manuscript. G.Z designed the research. Y.Z, L.Y and N. L collected the patient data. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgements:\u0026nbsp;We thank Dr. Yong Tao for helpful discussions and technical assistance.\u003c/p\u003e\n\u003cp\u003eAuthor details: 1. Eye Hospital, China Academy of Chinese Medical Sciences, Beijing 100040, China;2. 2. Korla Hospital ,Xinjiang Production and Construction Corps Second Division, Xinjiang 841000 ,China;3. Yanqi Hospital ,Xinjiang Production and Construction Corps Second Division, Xinjiang 841100 ,China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMocarski ES, Shenk T, Pass RF. Cytomegaloviruses. Lippincott Williams \u0026amp; Wilkins, Philadelphia, PA, USA, 2007: 2701-2772.\u003c/li\u003e\n \u003cli\u003eGumbo H, Chasekwa B, Church JA, et al. Congenital and postnatal CMV and EBV acquisition in HIV-infected Zimbabwean infants. PLoS One. 2014; 9(12): 14870.\u003c/li\u003e\n \u003cli\u003eHolland GN. Survival of patients with the acquired immunodeficiency syndrome after development of CMV retinopathy. Ophthalmology. 1990; 97: 204-210.\u003c/li\u003e\n \u003cli\u003eMonique Munro, Tejabhiram Yadavalli, Cheryl Fonteh, et al. Cytomegalovirus Retinitis in HIV and Non-HIV Individuals. Microorganisms. 2020 Jan; 8(1): 55.\u003c/li\u003e\n \u003cli\u003eJoo Young Kim, Seo-Yeon Hong, Woo Kyung Park, et al. Prognostic factors of cytomegalovirus retinitis after hematopoietic stem cell transplantation. PLoS One. 2020; 15(9): e0238257.\u003c/li\u003e\n \u003cli\u003eYuehong Zhang, Yuqin Liang, Xu Zhang, et al. Pre-Transplant Platelet Refractoriness and Alternative Donors Are Associated With Cytomegalovirus Retinitis in Hematopoietic Stem Cell Transplantation for Severe Aplastic Anemia. Front Cell Infect Microbiol. 2022; 12: 870296.\u003c/li\u003e\n \u003cli\u003eYalin Zhou, Fei Hong, Xiaojuan Wang, et al. Abnormal levels of aqueous humor trace elements in patients with cytomegalovirus retinitis. Eye (Lond). 2019 Oct; 33(10): 1606\u0026ndash;1612.\u003c/li\u003e\n \u003cli\u003eHolland GN, Shuler JD. Progression rates of cytomegalovirus retinopathy in ganciclovir-treated and untreated patients. Arch Ophthalmol. 1992; 110: 1435-1442.\u003c/li\u003e\n \u003cli\u003eFreeman WR. Prevalence, pathophysiology, and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis. Am J Ophthalmol. 1987; 103: 527-531.\u003c/li\u003e\n \u003cli\u003eYang Tang, Jianjun Sun, Taiwen He, et al. Clinical Features of Cytomegalovirus Retinitis in HIV Infected Patients. Front Cell Infect Microbiol. 2020; 10: 136.\u003c/li\u003e\n \u003cli\u003eQing Zhao, Ning-ning Li, You-xin Chen, et al. Clinical features of Cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome and efficacy of the current therapy. Front Cell Infect Microbiol. 2023; 13: 1107237.\u003c/li\u003e\n \u003cli\u003eSchnitzler MA, Woodward RS, Brennan DC, et al. The effects of cytomegalovirus serology on graft and recipient survival in cadaveric renal transplantation: implications for organ allocation. Am J Kidney Dis. 1997; 29(3): 428-434.\u003c/li\u003e\n \u003cli\u003eYe Junjie, Li Haiyan, Sun Ding, et al. Clinical analysis of acquired immune deficiency syndrome complicated with cytomegalovirus retinitis. Chinese Journal of Ophthalmology. 2005; 41(9): 803-806.\u003c/li\u003e\n \u003cli\u003eAusayakhun S, Watananikorn S, Ittipunkul N, et al. Epidemiology of the ocular complications of HIV infection in Chiang Mai. J Med Assoc Thai. 2003; 86(5): 399-406.\u003c/li\u003e\n \u003cli\u003eBiswas 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; 129(1): 9-15.\u003c/li\u003e\n \u003cli\u003eLu Jin, Huang Xiaojun, Lu Daopei. Cytomegalovirus retinitis after allogeneic bone marrow transplantation: a case report and literature review. Chinese Journal of Hematology. 2003; 24(6): 312-315.\u003c/li\u003e\n \u003cli\u003eMori T, Okamoto S, Matsuoka S, et al. Risk-adapted pre-emptive therapy for cytomegalovirus disease in patients undergoing allogeneic bone marrow transplantation. Bone Marrow Transplant. 2000; 25: 765-769.\u003c/li\u003e\n \u003cli\u003eThe Standardization of Uveitis Nomenclature (SUN) Working Group. Classification criteria for cytomegalovirus retinitis. Am J Ophthalmol. 2021 Aug; 228: 245\u0026ndash;254.\u003c/li\u003e\n \u003cli\u003eMrinali P. Gupta, Lisa R. Koenig, Ekaterina Doubrovina, et al. Ocular outcomes after treatment of cytomegalovirus (CMV) retinitis using adoptive immunotherapy with CMV-specific cytotoxic T-lymphocytes. Ophthalmol Retina. 2021 Sep; 5(9): 838\u0026ndash;849.\u003c/li\u003e\n \u003cli\u003eKui-Fang Du, Xiao-Jie Huang, Chao Chen, et al. Clinical characteristics in the misdiagnosis of cytomegalovirus retinitis: A retrospective analysis of eight patients. Indian J Ophthalmol. 2022 Oct; 70(10): 3596\u0026ndash;3602.\u003c/li\u003e\n \u003cli\u003eAnastasia Tasiopoulou, Cristhian A. Urzua, Susan Lightman. Successful treatment of cytomegalovirus retinitis with oral/intravitreal antivirals in HIV-negative patients with lymphoma. Eye (Lond). 2023 Jun; 37(9): 1895\u0026ndash;1903.\u003c/li\u003e\n \u003cli\u003eSana Khochtali, Ahmed Mahjoub, Tarek Dridi, et al. Cytomegalovirus retinitis following corticosteroid overdose for Vogt-Koyanagi-Harada disease. Indian J Ophthalmol. 2020 Sep; 68(9): 2012\u0026ndash;2014.\u003c/li\u003e\n \u003cli\u003eFilipa Silva, Klaus Nunes Ficher, Laila Viana, et al. Presumed cytomegalovirus retinitis late after kidney transplant. J Bras Nefrol. 2022 Jul-Sep; 44(3): 457\u0026ndash;461.\u003c/li\u003e\n \u003cli\u003eXiao-Qing He, Yin-Qiu Huang, Yan-Ming Zeng, et al. Timing of antiretroviral therapy for HIV-infected patients with cytomegalovirus retinitis: study protocol of a multi-center prospective randomized controlled trial. Trials. 2021; 22: 218.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cytomegalovirus retinitis, acquired immune deficiency syndrome, allogeneic hematopoietic stem-cell transplantation","lastPublishedDoi":"10.21203/rs.3.rs-4715667/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4715667/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo analyze the clinical features of patients with cytomegalovirus retinitis and provide evidence for a better understanding of the disease.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA retrospective analysis was conducted on the clinical manifestations of 90 patients with cytomegalovirus retinitis. The analysis included general data, visual acuity, intraocular pressure, anterior segment examination, vitreous body examination, and color fundus photography.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe patients' ages ranged from 1 to 64 years, with 59 males and 31 females. Among the 90 patients, 18 had acquired immune deficiency syndrome (AIDS) as a secondary condition, 70 had various types of hematological diseases following bone marrow transplantation, 1 had a history of thymus extraction, and 1 had congenital autoimmune hemolytic anemia. Of the affected eyes, 35 cases were monocular and 55 were binocular. Anterior chamber inflammation was observed in 67 eyes out of 145 affected eyes, while 40 eyes showed significant vitreous inflammation. Some cases exhibited typical \"cheese and ketchup\" changes during fundus examination, with various fundus manifestations observed. Based on the extent and location of the lesions, they were classified into diffuse, hemilateral, and focal types.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eCytomegalovirus retinitis is more prevalent among immunodeficient individuals rather than those with normal immune systems. Regular eye examinations are recommended for patients of AIDS diagnosis and bone marrow transplantation. Understanding the clinical characteristics of the disease can aid in early diagnosis and treatment.\u003c/p\u003e","manuscriptTitle":"Clinical features of cytomegalovirus retinitis, A retrospective analysis of 90 patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-09 00:35:40","doi":"10.21203/rs.3.rs-4715667/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b660ac91-a547-4023-8fa1-1ef2e4e80e1e","owner":[],"postedDate":"August 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":34922877,"name":"Health sciences/Diseases"},{"id":34922878,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2024-10-25T14:08:37+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-09 00:35:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4715667","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4715667","identity":"rs-4715667","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}